Rosh Internal Medicine Boost Practice Exam

What kind of stricture is likely in a patient who received radiation therapy for a neck neoplasm?

1. Distal esophageal stricture

2. Proximal esophageal stricture

3. Cervical esophageal stricture

4. Gastric outlet obstruction

The correct answer is: Proximal esophageal stricture

In patients who have undergone radiation therapy for treatments such as neck neoplasms, the likelihood of developing strictures in the cervical esophagus is significantly increased. Radiation can cause inflammation and fibrosis of the tissues in the irradiated area, leading to a narrowing of the esophagus. When considering where these strictures typically occur after radiation treatment, the cervical esophagus is the most affected segment because it is located directly in the path where radiation is delivered to treat the neck regions. The proximal esophagus is less likely to be impacted because it can be somewhat shielded by surrounding structures and tissues. While distal esophageal strictures can occur due to various reasons, including reflux or other types of injuries that are not specifically linked to radiation in the neck region, the focus here is on the strictures that arise from the direct consequences of radiation therapy in the neck area. Gastric outlet obstruction is unrelated to radiation treatment of neck neoplasms, as it pertains to issues in the stomach rather than the esophagus. Thus, a cervical esophageal stricture is the most likely outcome in this context.