ABSITE - ESOPHAGUS – QUESTIONS WITH
CORRECT ANSWERS 2025
A 75-year-
old male presents to the clinic with a feeling of fullness in his throat and trouble swallowing. He comp
lains of a worsening cough and more recently, bad breath to the point he avoids going out in public.
What is the most appropriate first diagnostic test?
A. Plain chest x-ray
B. Barium esophagram
C. Upper endoscopy
D. Manometry
E. CT of the chest - CORRECT ANSWER -Barium esophagram
Correct.
This patient presents with classic symptoms of Zenker's diverticulum, which is most commonly found i
n elderly patients and is believed to be the result of loss of tissue elasticity and muscle tone associate
d with aging. It is found herniating into Killian's triangle, located at the junction of the hypopharynx an
d the esophagus. The most appropriate first diagnostic test would be a barium esophagram, especially
lateral views since it is usually found posteriorly alongside the esophagus. Upper endoscopy and man
ometry are not necessary in diagnosing Zenker's.
A 50-year-
old male presents to the ER with chest pain 6 hours after undergoing pneumatic dilation for achalasia.
A water-soluble contrast UGI demonstrates a small well-
contained perforation. The distal esophagus appears patent. The patient is hemodynamically stable. W
hat is the next best step in management?
A. Observe and attempt PO trial.
B. Admit, keep NPO and start broad-spectrum antibiotics.
C. Placement of a CT-guided mediastinal drain
D. Immediate operative debridement
E. Discharge patient with close follow-up. - CORRECT ANSWER -Admit, keep NPO and start broad-
spectrum antibiotics.
Correct.
Most iatrogenic esophageal perforations secondary to pneumatic dilation are small and well-
contained. The patient should be initially considered for non-
operative management with antibiotics and close monitoring based on the aforementioned UGI findin
,gs Vif Vthe Vdistal Vobstruction Vhas Vbeen Vresolved Vand Vthe Vpatient Vremains Vhemodynamically Vstable.
VDevelo Vpment Vof Vconcerning Vsigns Vmay Vultimately Vwarrant Vintervention Vsuch Vas VCT-
guided Vdrainage Vor Voperative Vmanagement. VAttempting VPO Vtrial Vor Vdischarge Vwould Vbe
Vinappropriate Va Vnd Vpremature Vat Vthis Vtime.
A V35-year-
old Vmale Vpresents Vto Vthe VER Vcomplaining Vof Vchest Vpain. VHe Vwent Vout Vto Vdinner V2 Vnights Vago Vand
Vrapidly V developed Vabdominal Vcramps, Vemesis Vand Vdiarrhea; Vhowever, Vhe Vdid Vnot Vnotice Vblood Vin
Vhis Vvomit Vor Vstools. VThis Vmorning Vhe Vwoke Vup Vwith Vacute Vonset Vof V10/10 Vchest Vpain Vand
Vdescribed Vfeeling Vlighthead V ed Vand Vdizzy. VHe V denies V any V recent V alcohol Vuse. V Current V vital Vsigns
V are: VHR V 120 V bpm, V BP V 100/68 V mmHg
, V R V 24/min V and V T V101.6°F. VWhich Vtest V is V most V likely V to V identify V the V diagnosis?
A. EKG
B. Flat V plate V and V upright V of V the V abdomen
C. Esophagram
D. Stool V pathogens
E. Urea Vbreath Vtest V- V CORRECT VANSWER V-
Esophagram VCorrect.
The Vcorrect Vdiagnosis Vis Vspontaneous Vesophageal Vperforation, Vor VBoerhaave Vsyndrome. VThe Vstem
Videnti Vfies Va Vrecent Vepisode Vof Vfood Vpoisoning Vwith Vsignificant Vemesis. VAlthough Vthis Vpatient
Vdoesn't Vdrink, Valc Voholism Vand Vbinge Vdrinking Vwith Vemesis Vis Vanother Vred Vflag Vfor Vesophageal
Vspontaneous Vperforation. VC Vontrast V esophagram V is V the V test V most V likely V to V identify V the
V diagnosis. V CT V scan, V although V not V listed, V is V als Vo V helpful. V EKG V would V be V helpful V to V identify V a
V cardiac Vetiology V such V as V MI, V but V in V our V patient V would V likel Vy Vjust Vshow Vsinus Vtachycardia.
VAbdominal Vseries Vwould Vhelp Vdiagnose Vbowel Vobstruction Vor Vpneumoper Vitoneum Vfrom Va Vhollow
Vviscus Vperforation. VStool Vpathogen Vmay Vbe Vpositive Vgiven Vrecent Vgastroenteritis; Vhowever, Vthis Vis
Vnot Vthe Vcause V of Vdelayed Vsepsis. VUrea Vbreath Vtest Vis Vused Vto V diagnose V H. Vpylori Vrelated V to
Vpeptic Vulcer Vdisease.
A V45-year-
old Vmale Vpresents Vto Vthe VER Vcomplaining Vof Vnausea Vand Vvomiting. VHe Vsmells Vof Valcohol Vand Vnotes
Va Vcha V nge V in V emesis V from V bilious V to V bloody V acutely V this V evening. V Upon V further V questioning,
V he V admits V to V bing Ve Vdrinking Voften Vto Vthe Vpoint Vof Vvomiting. VHis Vcurrent Vvitals Vare: VHR V110
Vbpm, VBP V120/74 VmmHg, VR V22/ V min Vand VT V99.3°F. VWhat Vis Vthe Vlikely Vcause Vof Vhis Vsymptoms?
A. Peptic Vulcer Vdisease
B. Esophageal Vvarices
C. Esophageal Vperforation
D. Esophageal Vcancer
, E. Mallory-Weiss syndrome
V V- CORRECT
V ANSWER
V V-Mallory-Weiss
syndrome VCorrect.
V
The V patient V has VMallory-
Weiss Vsyndrome. VFrom Vhis Vhistory, Vhe Vappears Vto Vbe Van Valcoholic Von Va Vrecent Vbinge. VAlthough Vthe
Vdiffer Vential Vfor Vupper VGI Vbleeding Vand Vemesis Vis Vbroad, Vbilious Vemesis Vwhich Vacutely Vchanges Vto
Vbloody Vemes V is Vis Vhighly Vsuggestive Vof Va VMallory-
Weiss Vtear, Vwhich Voccurs Vat Vthe Vjunction Vof Vthe Vesophagus Vand Vgastric Vcardia. VCancer Vis Vlikely Vto
Vhave Va Vmore Vindolent Vobstructive Vpresentation. VPerforation Voften Vpresents Vwith Vtachycardia,
Vleukocytosis Vand Vf Vever.
A V42-year-
old Votherwise Vhealthy Vfemale Vwas Vnoted Vto Vhave Vpersistent VUGI Vbleeding Vfollowing Van Vepisode Vof
Vsever V e Vvomiting. VEndoscopic Vevaluation Vnotes Va Vmucosal Vtear Vin Vthe Vgastric Vcardia. VMultiple
Vendoscopic Vatte Vmpts Vfail Vto Vcontrol Vthe Vbleeding. VThe Vpatient Vis Vnow Vhemodynamically Vunstable.
VWhat Vis Vthe Vnext Vstep V in Vmanagement?
A. Octreotide
B. Continuous Vproton Vpump Vinhibitor
C. Repeat Vattempt Vat Vendoscopic Velectrocoagulation
D. Angiographic Vembolization
E. Oversewing Vlaceration Vthrough Van Vanterior Vgastrostomy V- VCORRECT
VANSWER V- VOversewing Vlaceration Vthrough Van Vanterior Vgastrostomy
Correct.
Mallory-
Weiss Vtears V are Voften Vcaused Vby V forceful Vretching Vor Vcoughing. VSimilar Vto V other Vsources Vof VUGI
V bleeding
, V initial Vtreatment Vtypically Vconsists Vof V non-
operative Vmedical Vmanagement Vand Vendoscopic Vmaneuvers. VHowever, Vin Vcases Vof Vpersistent
Vbleeding Va Vnd Vconcurrent Vhemodynamic Vinstability, Voperative Vintervention Vis Vwarranted. VThe
Vmucosal Vtear Vis Vtypica Vlly Vlocated Vin Vthe Vgastric Vcardia Vand Vcan Vbe Vaccessed Vthrough Van Vanterior
Vgastrostomy. VContinued Vmedic Val Vtherapy Vwould Vnot Vbe Vappropriate Vat Vthis Vtime. VAngiographic
Vembolization Vcan Vbe Vutilized Vin Vcases Vw Vhen Vpatients Vare Vnot Vsuitable Vor Vunwilling Vto Vundergo
Vsurgery.
A V 1-year-
old Vchild Vpresents Vto Vthe Vemergency Vroom Vafter Vhaving Vswallowed Va Vpenny. VAt Vwhich Vlevel Vof Vthe
Vesoph Vagus Vis Vthe Vcoin Vmost Vlikely Vto Vbecome Vlodged?
A. Cervical V esophagus
B. Mid V esophagus
CORRECT ANSWERS 2025
A 75-year-
old male presents to the clinic with a feeling of fullness in his throat and trouble swallowing. He comp
lains of a worsening cough and more recently, bad breath to the point he avoids going out in public.
What is the most appropriate first diagnostic test?
A. Plain chest x-ray
B. Barium esophagram
C. Upper endoscopy
D. Manometry
E. CT of the chest - CORRECT ANSWER -Barium esophagram
Correct.
This patient presents with classic symptoms of Zenker's diverticulum, which is most commonly found i
n elderly patients and is believed to be the result of loss of tissue elasticity and muscle tone associate
d with aging. It is found herniating into Killian's triangle, located at the junction of the hypopharynx an
d the esophagus. The most appropriate first diagnostic test would be a barium esophagram, especially
lateral views since it is usually found posteriorly alongside the esophagus. Upper endoscopy and man
ometry are not necessary in diagnosing Zenker's.
A 50-year-
old male presents to the ER with chest pain 6 hours after undergoing pneumatic dilation for achalasia.
A water-soluble contrast UGI demonstrates a small well-
contained perforation. The distal esophagus appears patent. The patient is hemodynamically stable. W
hat is the next best step in management?
A. Observe and attempt PO trial.
B. Admit, keep NPO and start broad-spectrum antibiotics.
C. Placement of a CT-guided mediastinal drain
D. Immediate operative debridement
E. Discharge patient with close follow-up. - CORRECT ANSWER -Admit, keep NPO and start broad-
spectrum antibiotics.
Correct.
Most iatrogenic esophageal perforations secondary to pneumatic dilation are small and well-
contained. The patient should be initially considered for non-
operative management with antibiotics and close monitoring based on the aforementioned UGI findin
,gs Vif Vthe Vdistal Vobstruction Vhas Vbeen Vresolved Vand Vthe Vpatient Vremains Vhemodynamically Vstable.
VDevelo Vpment Vof Vconcerning Vsigns Vmay Vultimately Vwarrant Vintervention Vsuch Vas VCT-
guided Vdrainage Vor Voperative Vmanagement. VAttempting VPO Vtrial Vor Vdischarge Vwould Vbe
Vinappropriate Va Vnd Vpremature Vat Vthis Vtime.
A V35-year-
old Vmale Vpresents Vto Vthe VER Vcomplaining Vof Vchest Vpain. VHe Vwent Vout Vto Vdinner V2 Vnights Vago Vand
Vrapidly V developed Vabdominal Vcramps, Vemesis Vand Vdiarrhea; Vhowever, Vhe Vdid Vnot Vnotice Vblood Vin
Vhis Vvomit Vor Vstools. VThis Vmorning Vhe Vwoke Vup Vwith Vacute Vonset Vof V10/10 Vchest Vpain Vand
Vdescribed Vfeeling Vlighthead V ed Vand Vdizzy. VHe V denies V any V recent V alcohol Vuse. V Current V vital Vsigns
V are: VHR V 120 V bpm, V BP V 100/68 V mmHg
, V R V 24/min V and V T V101.6°F. VWhich Vtest V is V most V likely V to V identify V the V diagnosis?
A. EKG
B. Flat V plate V and V upright V of V the V abdomen
C. Esophagram
D. Stool V pathogens
E. Urea Vbreath Vtest V- V CORRECT VANSWER V-
Esophagram VCorrect.
The Vcorrect Vdiagnosis Vis Vspontaneous Vesophageal Vperforation, Vor VBoerhaave Vsyndrome. VThe Vstem
Videnti Vfies Va Vrecent Vepisode Vof Vfood Vpoisoning Vwith Vsignificant Vemesis. VAlthough Vthis Vpatient
Vdoesn't Vdrink, Valc Voholism Vand Vbinge Vdrinking Vwith Vemesis Vis Vanother Vred Vflag Vfor Vesophageal
Vspontaneous Vperforation. VC Vontrast V esophagram V is V the V test V most V likely V to V identify V the
V diagnosis. V CT V scan, V although V not V listed, V is V als Vo V helpful. V EKG V would V be V helpful V to V identify V a
V cardiac Vetiology V such V as V MI, V but V in V our V patient V would V likel Vy Vjust Vshow Vsinus Vtachycardia.
VAbdominal Vseries Vwould Vhelp Vdiagnose Vbowel Vobstruction Vor Vpneumoper Vitoneum Vfrom Va Vhollow
Vviscus Vperforation. VStool Vpathogen Vmay Vbe Vpositive Vgiven Vrecent Vgastroenteritis; Vhowever, Vthis Vis
Vnot Vthe Vcause V of Vdelayed Vsepsis. VUrea Vbreath Vtest Vis Vused Vto V diagnose V H. Vpylori Vrelated V to
Vpeptic Vulcer Vdisease.
A V45-year-
old Vmale Vpresents Vto Vthe VER Vcomplaining Vof Vnausea Vand Vvomiting. VHe Vsmells Vof Valcohol Vand Vnotes
Va Vcha V nge V in V emesis V from V bilious V to V bloody V acutely V this V evening. V Upon V further V questioning,
V he V admits V to V bing Ve Vdrinking Voften Vto Vthe Vpoint Vof Vvomiting. VHis Vcurrent Vvitals Vare: VHR V110
Vbpm, VBP V120/74 VmmHg, VR V22/ V min Vand VT V99.3°F. VWhat Vis Vthe Vlikely Vcause Vof Vhis Vsymptoms?
A. Peptic Vulcer Vdisease
B. Esophageal Vvarices
C. Esophageal Vperforation
D. Esophageal Vcancer
, E. Mallory-Weiss syndrome
V V- CORRECT
V ANSWER
V V-Mallory-Weiss
syndrome VCorrect.
V
The V patient V has VMallory-
Weiss Vsyndrome. VFrom Vhis Vhistory, Vhe Vappears Vto Vbe Van Valcoholic Von Va Vrecent Vbinge. VAlthough Vthe
Vdiffer Vential Vfor Vupper VGI Vbleeding Vand Vemesis Vis Vbroad, Vbilious Vemesis Vwhich Vacutely Vchanges Vto
Vbloody Vemes V is Vis Vhighly Vsuggestive Vof Va VMallory-
Weiss Vtear, Vwhich Voccurs Vat Vthe Vjunction Vof Vthe Vesophagus Vand Vgastric Vcardia. VCancer Vis Vlikely Vto
Vhave Va Vmore Vindolent Vobstructive Vpresentation. VPerforation Voften Vpresents Vwith Vtachycardia,
Vleukocytosis Vand Vf Vever.
A V42-year-
old Votherwise Vhealthy Vfemale Vwas Vnoted Vto Vhave Vpersistent VUGI Vbleeding Vfollowing Van Vepisode Vof
Vsever V e Vvomiting. VEndoscopic Vevaluation Vnotes Va Vmucosal Vtear Vin Vthe Vgastric Vcardia. VMultiple
Vendoscopic Vatte Vmpts Vfail Vto Vcontrol Vthe Vbleeding. VThe Vpatient Vis Vnow Vhemodynamically Vunstable.
VWhat Vis Vthe Vnext Vstep V in Vmanagement?
A. Octreotide
B. Continuous Vproton Vpump Vinhibitor
C. Repeat Vattempt Vat Vendoscopic Velectrocoagulation
D. Angiographic Vembolization
E. Oversewing Vlaceration Vthrough Van Vanterior Vgastrostomy V- VCORRECT
VANSWER V- VOversewing Vlaceration Vthrough Van Vanterior Vgastrostomy
Correct.
Mallory-
Weiss Vtears V are Voften Vcaused Vby V forceful Vretching Vor Vcoughing. VSimilar Vto V other Vsources Vof VUGI
V bleeding
, V initial Vtreatment Vtypically Vconsists Vof V non-
operative Vmedical Vmanagement Vand Vendoscopic Vmaneuvers. VHowever, Vin Vcases Vof Vpersistent
Vbleeding Va Vnd Vconcurrent Vhemodynamic Vinstability, Voperative Vintervention Vis Vwarranted. VThe
Vmucosal Vtear Vis Vtypica Vlly Vlocated Vin Vthe Vgastric Vcardia Vand Vcan Vbe Vaccessed Vthrough Van Vanterior
Vgastrostomy. VContinued Vmedic Val Vtherapy Vwould Vnot Vbe Vappropriate Vat Vthis Vtime. VAngiographic
Vembolization Vcan Vbe Vutilized Vin Vcases Vw Vhen Vpatients Vare Vnot Vsuitable Vor Vunwilling Vto Vundergo
Vsurgery.
A V 1-year-
old Vchild Vpresents Vto Vthe Vemergency Vroom Vafter Vhaving Vswallowed Va Vpenny. VAt Vwhich Vlevel Vof Vthe
Vesoph Vagus Vis Vthe Vcoin Vmost Vlikely Vto Vbecome Vlodged?
A. Cervical V esophagus
B. Mid V esophagus
