Gastroenterology: Boerhaave syndrome: practice question

A General Medicine 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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General Medicine · Gastroenterology: Boerhaave syndrome

Sample item

After a night of heavy drinking and violent vomiting, a man develops severe chest pain, subcutaneous emphysema in the neck and a left pleural effusion. What is the most likely diagnosis?

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

The answer and the reasoning

B. Boerhaave syndrome

Boerhaave syndrome is spontaneous full-thickness rupture of the lower oesophagus after forceful vomiting. Vomiting, chest pain and subcutaneous emphysema are the Mackler triad, and the effusion has a low pH with high amylase. Management is urgent surgery or repair with antibiotics.

Option by option

  • A. Achalasia cardia

    Achalasia causes dysphagia and regurgitation, not acute rupture.

  • B. Boerhaave syndrome (correct)

    Correct. Full-thickness rupture explains mediastinal air, subcutaneous emphysema and effusion.

  • C. Acute myocardial infarction

    MI would not explain subcutaneous emphysema and a post-emetic onset.

  • D. Mallory-Weiss tear

    A Mallory-Weiss tear is a mucosal laceration presenting with haematemesis, not mediastinal air.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Boerhaave syndrome. Boerhaave syndrome is spontaneous full-thickness rupture of the lower oesophagus after forceful vomiting.

Why is "Achalasia cardia" not the answer?

Achalasia causes dysphagia and regurgitation, not acute rupture.

Why is "Acute myocardial infarction" not the answer?

MI would not explain subcutaneous emphysema and a post-emetic onset.

Why is "Mallory-Weiss tear" not the answer?

A Mallory-Weiss tear is a mucosal laceration presenting with haematemesis, not mediastinal air.

What concept does this question test?

It tests Gastroenterology: Boerhaave syndrome in General Medicine. Vomiting, chest pain and subcutaneous emphysema are the Mackler triad, and the effusion has a low pH with high amylase. Management is urgent surgery or repair with antibiotics.

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 Gastroenterology: Boerhaave syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.