Professional and Linguistic Assessments Board (PLAB) Practice Exam

Which clinical feature distinguishes achalasia from other esophageal disorders?

1. Acid reflux

2. Dysphagia for solids and liquids

3. Chest pain

4. Regurgitation

The correct answer is: Dysphagia for solids and liquids

Dysphagia for solids and liquids is a key clinical feature that distinguishes achalasia from other esophageal disorders. In achalasia, the esophagus fails to properly relax at the lower esophageal sphincter, leading to a buildup of food and difficulty in swallowing both solid foods and liquids. This progressive difficulty is notably different from other conditions where patients may experience dysphagia primarily for solids or have intermittent swallowing issues. In contrast, acid reflux is commonly associated with gastroesophageal reflux disease (GERD) rather than achalasia, where the lack of normal peristalsis contributes to the sensation of food getting stuck. Chest pain can occur in various esophageal disorders, including esophageal spasms and reflux diseases, but it is not specific to achalasia. Regurgitation is also seen in other conditions, like GERD and esophageal motility disorders, but the unique combination of dysphagia for both solids and liquids coupled with the typical progression of symptoms is what makes dysphagia a hallmark sign of achalasia.