Archive Of Standardized Exam Questions: Esophageal Perforation


This page is dedicated to organizing various examples of standardized exam questions whose answer is esophageal perforation. While this may seem a odd practice, it is useful to see multiple examples of how esophageal perforation will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.


Question # 1

The 45-year-old man is being evaluated for a four month history of burning chest pain after every meal. He explains that he’s tried several over-the-counter antacids only with minimal relief. He undergoes an upper G.I. endoscopy which shows mucosal irregularity and ulceration at the squamocolumnar junction above the lower esophageal sphincter. A few hours after the procedure the patient develops worsening substernal and left sided chest pain that radiates to the back and also complaints of shortness of breath. His temperature is 98.6°F, blood pressure is 110/70 mmHg, pulse is one 15 beats for minutes, his restorations are 34/min. A chest x-ray demonstrates the presence of a small left-sided pleural effusion that was absent on chest radiographs that were ordered two weeks ago. And EKG shows sinus tachycardia but is otherwise noncontributory. What is the likely diagnosis in this patient?

Explanation: recent upper GI instrumentation + substernal chest pain radiating to back + new pleural effusion = esophageal perforation

Question # 2

A 25 year old man spends the night drinking heavily as he usually does. Early in  the morning he is quite intoxicated and starts vomiting repeatedly. Eventually he has a particularly violent episode of emesis and he feels a very severe, wrenching epigastric and low sternal pain that begins suddenly. When he arrives to the hospital one hour later he still has the pain, he is diaphoretic, has fever and leukocytosis and looks quite ill.

Explanation: violent episode of vomiting + sudden onset of epigastric/low sternal pain = esophageal perforation (Boerhave’s syndrome)

Question # 3

A 60 year old man has an upper G.I. endoscopy done to evaluate the progression of a gastric ulcer. five hours after the procedure, he returns complaining of severe and constant retrosternal chest pain that began shortly after he went home. He looks very ill, and is diaphoretic.  He has a temperature of 103°F and respiratory rate of 29/min

Explanation: upper endoscopy + sudden onset of retrosternal chest pain = esophageal perforation (due to instrumentation)

Question # 4

A 24 year old male is seen in the emergency room. He spent the last night heavily drinking and returned to his room where he began vomiting forcefully. He felt a sudden onset of epigastric pain that persisted during his most severe retching episode. His temperature is 102.5°F, heart rate is 105 bpm, blood pressure is 95/55 mm Hg, and respirations are 24/min. A cardiac examination reveals the presence of a crunching sound that can be heard with each heartbeat Labs reveal an elevated white count. What is the likely diagnosis this patient? 

Explanation: violent episode of vomiting + sudden onset of epigastric/low sternal pain = esophageal perforation (Boerhave’s syndrome)


Page Updated:02.22.2017