Q:

A 48 year old woman is admitted to the emergency department with a productive cough and months which affects her daily food intake. CXR: air-fluid level behind a normal sized heart. What is the single most likely diagnosis?

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A 48 year old woman is admitted to the emergency department with a productive cough and

moderate fever. She often has central chest pain and she regurgitates undigested food most of

the time but doesn’t suffer from acid reflux. These symptoms have been present for the last 3.5

months which affects her daily food intake. CXR: air-fluid level behind a normal sized heart.

What is the single most likely diagnosis?


  1. Pharyngeal pouch
  2. Hiatus hernia
  3. Bulbar palsy
  4. Achalasia
  5. TB

All Answers

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1. The key is B. Hiatus hernia. This is wrong key. Correct key is D. Achalasia. [Usually in hiatus hernia there is acid reflux].

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