ROSH Gastrointestinal Practice Exam

At which location is an obstruction most likely to occur in a 3-year-old boy who swallowed a quarter?

1. Aortic arch

2. Cricopharyngeus muscle

3. Gastroesophageal junction

4. Tracheal bifurcation

The correct answer is: Cricopharyngeus muscle

In the context of a 3-year-old boy who has swallowed a quarter, the location where an obstruction is most likely to occur is at the cricopharyngeus muscle. This muscle is part of the upper esophageal sphincter and is known for being a common site where foreign bodies can become lodged, especially in children. The cricopharyngeus muscle constricts as a normal part of swallowing, which can make it difficult for larger objects, like a quarter, to pass through. Since young children often have a smaller esophageal lumen and variances in their swallowing mechanics, a swallowed object may easily become impacted at this anatomical narrowing. While other options like the aortic arch, gastroesophageal junction, and tracheal bifurcation may also present potential sites for obstruction in theory, they are less common for the specific case of a quarter in a young child. The aortic arch is typically not an obstruction site in this scenario, as it relates more to vascular structures. The gastroesophageal junction could be considered for food bolus obstruction, but it's less frequent for objects like coins. The tracheal bifurcation is more relevant to airway obstruction than to an esophageal obstruction. Understanding these anatomical and physiological