Systemic pathology: oesophageal rupture: practice question

A Pathology 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.

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Pathology · Systemic pathology: oesophageal rupture

Sample item

A 40-year-old man has severe retrosternal pain and subcutaneous emphysema in the neck after forceful vomiting following binge drinking. A chest radiograph shows a left pleural effusion. What is the lesion?

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

The answer and the reasoning

B. Full-thickness tear of the distal oesophagus

Boerhaave syndrome is a full-thickness rupture of the distal oesophagus, usually on the left posterolateral wall, caused by a sudden rise in intraoesophageal pressure during vomiting. Mediastinitis and pleural effusion follow. In Mallory-Weiss syndrome the tear involves only mucosa and submucosa and presents with haematemesis.

Option by option

  • A. Perforated duodenal ulcer

    A perforated ulcer causes free air under the diaphragm and does not produce cervical subcutaneous emphysema in this setting.

  • B. Full-thickness tear of the distal oesophagus (correct)

    Correct. Forceful vomiting can rupture all layers of the distal oesophageal wall.

  • C. Dissection of the descending thoracic aorta

    Aortic dissection causes tearing pain with pulse deficits and widened mediastinum, not emphysema after vomiting.

  • D. Superficial mucosal laceration at the gastro-oesophageal junction

    A mucosal tear at the junction is Mallory-Weiss syndrome and presents with haematemesis, not emphysema.

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.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Full-thickness tear of the distal oesophagus. Boerhaave syndrome is a full-thickness rupture of the distal oesophagus, usually on the left posterolateral wall, caused by a sudden rise in intraoesophageal pressure during vomiting.

Why is "Perforated duodenal ulcer" not the answer?

A perforated ulcer causes free air under the diaphragm and does not produce cervical subcutaneous emphysema in this setting.

Why is "Dissection of the descending thoracic aorta" not the answer?

Aortic dissection causes tearing pain with pulse deficits and widened mediastinum, not emphysema after vomiting.

Why is "Superficial mucosal laceration at the gastro-oesophageal junction" not the answer?

A mucosal tear at the junction is Mallory-Weiss syndrome and presents with haematemesis, not emphysema.

What concept does this question test?

It tests Systemic pathology: oesophageal rupture in Pathology. Mediastinitis and pleural effusion follow. In Mallory-Weiss syndrome the tear involves only mucosa and submucosa and presents with haematemesis.

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 Systemic pathology: oesophageal rupture?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.