ABSITE Esophagus Questions with Correct Answers 2025 | American Board of Surgery In-Training Exam Prep

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 if the distal obstruction has been resolved and the patient remains hemodynamically stable. Develo
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pment of concerning signs may ultimately warrant intervention such as CT-
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guided drainage or operative management. Attempting PO trial or discharge would be inappropriate a
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nd premature at this time.
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A 35-year-
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old male presents to the ER complaining of chest pain. He went out to dinner 2 nights ago and rapidly
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Tdeveloped abdominal cramps, emesis and diarrhea; however, he did not notice blood in his vomit or
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Tstools. This morning he woke up with acute onset of 10/10 chest pain and described feeling lighthead
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Ted and dizzy. He denies any recent alcohol use. Current vital signs are: HR 120 bpm, BP 100/68
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TmmHg
, R 24/min and T 101.6°F. Which test is most likely to identify the diagnosis?
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A. EKG

B. Flat plate and upright of the abdomen
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C. Esophagram

D. Stool pathogens T




E. Urea breath test - CORRECT ANSWER -Esophagram
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Correct.
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The correct diagnosis is spontaneous esophageal perforation, or Boerhaave syndrome. The stem identi
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fies a recent episode of food poisoning with significant emesis. Although this patient doesn't drink, alc
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oholism and binge drinking with emesis is another red flag for esophageal spontaneous perforation. C
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ontrast esophagram is the test most likely to identify the diagnosis. CT scan, although not listed,
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is als o helpful. EKG would be helpful to identify a cardiac etiology such as MI, but in our patient
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would likel y just show sinus tachycardia. Abdominal series would help diagnose bowel obstruction or
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pneumoper itoneum from a hollow viscus perforation. Stool pathogen may be positive given recent
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gastroenteritis; however, this is not the cause of delayed sepsis. Urea breath test is used to diagnose
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H. pylori related to peptic ulcer disease.
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A 45-year-
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old male presents to the ER complaining of nausea and vomiting. He smells of alcohol and notes a cha
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Tnge in emesis from bilious to bloody acutely this evening. Upon further questioning, he admits to
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bing e drinking often to the point of vomiting. His current vitals are: HR 110 bpm, BP 120/74 mmHg, R
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22/ min and T 99.3°F. What is the likely cause of his symptoms?
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A. Peptic ulcer disease T T




B. Esophageal varices T




C. Esophageal perforation T




D. Esophageal cancer T

, E. Mallory-Weiss syndrome - CORRECT ANSWER -Mallory-Weiss syndrome T T T T T T




Correct.
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The patient has Mallory-
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Weiss syndrome. From his history, he appears to be an alcoholic on a recent binge. Although the differ
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ential for upper GI bleeding and emesis is broad, bilious emesis which acutely changes to bloody emes
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T is is highly suggestive of a Mallory-
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Weiss tear, which occurs at the junction of the esophagus and gastric cardia. Cancer is likely to have a
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more indolent obstructive presentation. Perforation often presents with tachycardia, leukocytosis and
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f ever.
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A 42-year-
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old otherwise healthy female was noted to have persistent UGI bleeding following an episode of sever
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Te vomiting. Endoscopic evaluation notes a mucosal tear in the gastric cardia. Multiple endoscopic
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atte mpts fail to control the bleeding. The patient is now hemodynamically unstable. What is the next
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step in management?
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A. Octreotide

B. Continuous proton pump inhibitor T T T




C. Repeat attempt at endoscopic electrocoagulation
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D. Angiographic embolization T




E. Oversewing laceration through an anterior gastrostomy - CORRECT ANSWER -
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Oversewing laceration through an anterior gastrostomy
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Correct.

Mallory-
Weiss tears are often caused by forceful retching or coughing. Similar to other sources of UGI bleeding
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, initial treatment typically consists of non-
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operative medical management and endoscopic maneuvers. However, in cases of persistent bleeding a
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Tnd concurrent hemodynamic instability, operative intervention is warranted. The mucosal tear is typica
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Tlly located in the gastric cardia and can be accessed through an anterior gastrostomy. Continued medic
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Tal therapy would not be appropriate at this time. Angiographic embolization can be utilized in cases w
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Then patients are not suitable or unwilling to undergo surgery.
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A 1-year-
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old child presents to the emergency room after having swallowed a penny. At which level of the esoph
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agus is the coin most likely to become lodged?
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A. Cervical esophagus T




B. Mid esophagus T