Eating and sleep disorders: complication of forceful vomiting: practice question

A Psychiatry 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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Psychiatry · Eating and sleep disorders: complication of forceful vomiting

Sample item

A 22-year-old woman with recurrent binge eating and self-induced vomiting has one episode of violent retching and then develops severe retrosternal pain, fever and crepitus in the neck. Which diagnosis must be excluded urgently?

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

The answer and the reasoning

B. Full-thickness oesophageal perforation

Forceful emesis against a closed glottis can cause a full-thickness tear of the lower oesophagus (Boerhaave syndrome). Pain, fever and subcutaneous emphysema signal mediastinal contamination and need urgent imaging and surgery. A partial mucosal tear (Mallory-Weiss) presents with haematemesis and no emphysema.

Option by option

  • A. Primary spontaneous pneumothorax

    A pneumothorax is not triggered by retching and would not cause fever with this sequence.

  • B. Full-thickness oesophageal perforation (correct)

    Correct. Transmural rupture after retching causes chest pain, fever and cervical subcutaneous emphysema.

  • C. Acute inferior wall myocardial infarction

    Myocardial infarction does not explain neck crepitus or the onset immediately after retching.

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

    A Mallory-Weiss tear is limited to the mucosa and presents with bleeding, not crepitus or mediastinitis.

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 Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Full-thickness oesophageal perforation. Forceful emesis against a closed glottis can cause a full-thickness tear of the lower oesophagus (Boerhaave syndrome).

Why is "Primary spontaneous pneumothorax" not the answer?

A pneumothorax is not triggered by retching and would not cause fever with this sequence.

Why is "Acute inferior wall myocardial infarction" not the answer?

Myocardial infarction does not explain neck crepitus or the onset immediately after retching.

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

A Mallory-Weiss tear is limited to the mucosa and presents with bleeding, not crepitus or mediastinitis.

What concept does this question test?

It tests Eating and sleep disorders: complication of forceful vomiting in Psychiatry. Pain, fever and subcutaneous emphysema signal mediastinal contamination and need urgent imaging and surgery. A partial mucosal tear (Mallory-Weiss) presents with haematemesis and no emphysema.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Eating and sleep disorders: complication of forceful vomiting?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry 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.