Oesophagus: practice question

A General Surgery 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.

Try it

General Surgery · Oesophagus

Sample item

A man develops severe retrosternal chest pain and subcutaneous emphysema in the neck after forceful vomiting following binge drinking. Which investigation is most appropriate?

AWater-soluble contrast oesophagogram or CT with oral contrastBBarium swallow with thick bariumCExercise stress testDUpper GI endoscopy with air insufflation as first test

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

The answer and the reasoning

A. Water-soluble contrast oesophagogram or CT with oral contrast

Boerhaave syndrome is spontaneous full-thickness rupture of the distal oesophagus after a sudden rise in intraluminal pressure. Mackler triad is vomiting, chest pain and subcutaneous emphysema. Water-soluble contrast study or CT confirms the leak, and treatment is early surgical repair or drainage with antibiotics.

Option by option

A. Water-soluble contrast oesophagogram or CT with oral contrast (correct)
Correct. Water-soluble contrast shows the leak without the harm of barium in the mediastinum.
B. Barium swallow with thick barium
Barium in the mediastinum causes intense inflammation, so it is avoided first.
C. Exercise stress test
Pain is due to rupture, not ischaemia, so a stress test is not indicated.
D. Upper GI endoscopy with air insufflation as first test
Insufflation can extend the tear and worsen contamination.

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 Surgery question

What is the answer to this General Surgery question?

The best answer is A, Water-soluble contrast oesophagogram or CT with oral contrast. Boerhaave syndrome is spontaneous full-thickness rupture of the distal oesophagus after a sudden rise in intraluminal pressure.

Why is "Barium swallow with thick barium" not the answer?

Barium in the mediastinum causes intense inflammation, so it is avoided first.

Why is "Exercise stress test" not the answer?

Pain is due to rupture, not ischaemia, so a stress test is not indicated.

Why is "Upper GI endoscopy with air insufflation as first test" not the answer?

Insufflation can extend the tear and worsen contamination.

What concept does this question test?

It tests Oesophagus in General Surgery. Mackler triad is vomiting, chest pain and subcutaneous emphysema. Water-soluble contrast study or CT confirms the leak, and treatment is early surgical repair or drainage with antibiotics.

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 Oesophagus?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.