ABSITE - ESOPHAGUS – QUESTIONS WITH
CORRECT ANSWERS 2026 guide
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 pment of concerning signs may ultimately
warrant intervention such as CT-
guided drainage or operative management. Attempting PO trial or discharge
would be inappropriate a nd premature at this time.
A 35-year-
old male presents to the ER complaining of chest pain. He went out to dinner 2
nights ago and rapidly developed abdominal cramps, emesis and diarrhea;
however, he did not notice blood in his vomit or stools. This morning he woke up
with acute onset of 10/10 chest pain and described feeling lighthead ed and
dizzy. He denies any recent alcohol use. Current vital signs are: HR 120 bpm, BP
100/68 mmHg
, R 24/min and T 101.6°F. Which test is most likely to identify the diagnosis?
A. EKG
B. Flat plate and upright of the abdomen
C. Esophagram
D. Stool pathogens
E. Urea breath test - CORRECT ANSWER -
Esophagram Correct.
The correct diagnosis is spontaneous esophageal perforation, or Boerhaave
syndrome. The stem identi fies a recent episode of food poisoning with significant
emesis. Although this patient doesn't drink, alc oholism and binge drinking with
emesis is another red flag for esophageal spontaneous perforation. C ontrast
esophagram is the test most likely to identify the diagnosis. CT scan, although
not listed, is als o helpful. EKG would be helpful to identify a cardiac etiology
such as MI, but in our patient would likel y just show sinus tachycardia.
Abdominal series would help diagnose bowel obstruction or pneumoper itoneum
from a hollow viscus perforation. Stool pathogen may be positive given recent
gastroenteritis; however, this is not the cause of delayed sepsis. Urea breath test
is used to diagnose H. pylori related to peptic ulcer disease.
A 45-year-
, old male presents to the ER complaining of nausea and vomiting. He smells of
L. L. L. L. L. L. L. L. L. L. L. L. L. L.
alcohol and notes a cha nge in emesis from bilious to bloody acutely this
L. L. L. L. L . L. L. L. L. L. L. L. L. L.
evening. Upon further questioning, he admits to bing e drinking often to the
L. L. L. L. L. L. L. L. L. L. L. L. L.
point of vomiting. His current vitals are: HR 110 bpm, BP 120/74 mmHg, R 22/
L. L. L. L. L. L. L. L. L. L. L. L. L. L. L .
min and T 99.3°F. What is the likely cause of his symptoms?
L. L. L. L. L. L. L. L. L. L. L.
A. Peptic L. ulcer disease L.
B. Esophageal L. varices
C. Esophageal L. perforation
D. Esophageal L. cancer
CORRECT ANSWERS 2026 guide
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 pment of concerning signs may ultimately
warrant intervention such as CT-
guided drainage or operative management. Attempting PO trial or discharge
would be inappropriate a nd premature at this time.
A 35-year-
old male presents to the ER complaining of chest pain. He went out to dinner 2
nights ago and rapidly developed abdominal cramps, emesis and diarrhea;
however, he did not notice blood in his vomit or stools. This morning he woke up
with acute onset of 10/10 chest pain and described feeling lighthead ed and
dizzy. He denies any recent alcohol use. Current vital signs are: HR 120 bpm, BP
100/68 mmHg
, R 24/min and T 101.6°F. Which test is most likely to identify the diagnosis?
A. EKG
B. Flat plate and upright of the abdomen
C. Esophagram
D. Stool pathogens
E. Urea breath test - CORRECT ANSWER -
Esophagram Correct.
The correct diagnosis is spontaneous esophageal perforation, or Boerhaave
syndrome. The stem identi fies a recent episode of food poisoning with significant
emesis. Although this patient doesn't drink, alc oholism and binge drinking with
emesis is another red flag for esophageal spontaneous perforation. C ontrast
esophagram is the test most likely to identify the diagnosis. CT scan, although
not listed, is als o helpful. EKG would be helpful to identify a cardiac etiology
such as MI, but in our patient would likel y just show sinus tachycardia.
Abdominal series would help diagnose bowel obstruction or pneumoper itoneum
from a hollow viscus perforation. Stool pathogen may be positive given recent
gastroenteritis; however, this is not the cause of delayed sepsis. Urea breath test
is used to diagnose H. pylori related to peptic ulcer disease.
A 45-year-
, old male presents to the ER complaining of nausea and vomiting. He smells of
L. L. L. L. L. L. L. L. L. L. L. L. L. L.
alcohol and notes a cha nge in emesis from bilious to bloody acutely this
L. L. L. L. L . L. L. L. L. L. L. L. L. L.
evening. Upon further questioning, he admits to bing e drinking often to the
L. L. L. L. L. L. L. L. L. L. L. L. L.
point of vomiting. His current vitals are: HR 110 bpm, BP 120/74 mmHg, R 22/
L. L. L. L. L. L. L. L. L. L. L. L. L. L. L .
min and T 99.3°F. What is the likely cause of his symptoms?
L. L. L. L. L. L. L. L. L. L. L.
A. Peptic L. ulcer disease L.
B. Esophageal L. varices
C. Esophageal L. perforation
D. Esophageal L. cancer
