Gastroenterology and hepatology: Zenker diverticulum: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology and hepatology: Zenker diverticulum

Sample item

A 70-year-old man has dysphagia, regurgitation of undigested food hours after eating, halitosis and a gurgling sound in the neck. A barium swallow shows a posterior outpouching at the level of the cricoid cartilage. Which abnormality underlies this condition?

ALoss of myenteric neurons in the oesophageal bodyBHerniation of the gastric fundus through the hiatusCIncomplete relaxation of the cricopharyngeusDFailed relaxation of the lower oesophageal sphincter

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Incomplete relaxation of the cricopharyngeus

Zenker diverticulum is a pulsion pouch through Killian triangle above the cricopharyngeus. Poor coordination or incomplete relaxation of the cricopharyngeus raises hypopharyngeal pressure during swallowing. Treatment is by cricopharyngeal myotomy with diverticulotomy or diverticulectomy.

Option by option

A. Loss of myenteric neurons in the oesophageal body
Loss of myenteric neurons in the oesophageal body causes achalasia, not an upper pouch.
B. Herniation of the gastric fundus through the hiatus
Fundal herniation describes a hiatus hernia, which does not cause a neck pouch.
C. Incomplete relaxation of the cricopharyngeus (correct)
Correct. Poor relaxation of the cricopharyngeus pushes mucosa out through Killian triangle.
D. Failed relaxation of the lower oesophageal sphincter
Failure of the lower sphincter to relax describes achalasia, with a bird-beak lower oesophagus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Incomplete relaxation of the cricopharyngeus. Zenker diverticulum is a pulsion pouch through Killian triangle above the cricopharyngeus.

Why is "Loss of myenteric neurons in the oesophageal body" not the answer?

Loss of myenteric neurons in the oesophageal body causes achalasia, not an upper pouch.

Why is "Herniation of the gastric fundus through the hiatus" not the answer?

Fundal herniation describes a hiatus hernia, which does not cause a neck pouch.

Why is "Failed relaxation of the lower oesophageal sphincter" not the answer?

Failure of the lower sphincter to relax describes achalasia, with a bird-beak lower oesophagus.

What concept does this question test?

It tests Gastroenterology and hepatology: Zenker diverticulum in General Medicine. Poor coordination or incomplete relaxation of the cricopharyngeus raises hypopharyngeal pressure during swallowing. Treatment is by cricopharyngeal myotomy with diverticulotomy or diverticulectomy.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology and hepatology: Zenker diverticulum?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.