Oesophagus: Boerhaave perforation: practice question

A ENT 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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ENT · Oesophagus: Boerhaave perforation

Sample item

After a bout of forceful vomiting, a man has severe chest pain, subcutaneous emphysema in the neck and fever. A chest radiograph shows pneumomediastinum and a left pleural effusion. Which investigation best confirms the suspected diagnosis?

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

The answer and the reasoning

A. Contrast swallow with a water-soluble agent or CT with oral contrast

Spontaneous oesophageal rupture (Boerhaave syndrome) occurs in the lower left posterolateral oesophagus after a sudden rise in intraluminal pressure. A water-soluble contrast study or CT with oral contrast shows the leak. Treatment is urgent surgical repair or stenting with drainage and antibiotics, and mediastinitis is the main danger.

Option by option

  • A. Contrast swallow with a water-soluble agent or CT with oral contrast (correct)

    Correct. Contrast leak confirms rupture, and water-soluble contrast is safer in the mediastinum.

  • B. Oesophageal manometry

    Manometry is a motility test and may be harmful.

  • C. Barium swallow only, with no alternative

    Barium in the mediastinum or pleura causes inflammation and obscures later imaging.

  • D. Bronchoscopy

    Bronchoscopy does not evaluate the oesophageal wall.

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.

More ENT questions

Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Contrast swallow with a water-soluble agent or CT with oral contrast. Spontaneous oesophageal rupture (Boerhaave syndrome) occurs in the lower left posterolateral oesophagus after a sudden rise in intraluminal pressure.

Why is "Oesophageal manometry" not the answer?

Manometry is a motility test and may be harmful.

Why is "Barium swallow only, with no alternative" not the answer?

Barium in the mediastinum or pleura causes inflammation and obscures later imaging.

Why is "Bronchoscopy" not the answer?

Bronchoscopy does not evaluate the oesophageal wall.

What concept does this question test?

It tests Oesophagus: Boerhaave perforation in ENT. A water-soluble contrast study or CT with oral contrast shows the leak. Treatment is urgent surgical repair or stenting with drainage and antibiotics, and mediastinitis is the main danger.

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 Oesophagus: Boerhaave perforation?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT 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.