GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 55-year-old man with a 10-year history of GERD presents with sudden-onset severe epigastric pain, forceful vomiting, and subcutaneous emphysema of the neck. Vital signs show BP 145/92, HR 112, RR 22, temperature 37.8°C, and SpO2 98% on room air. Upright chest X-ray reveals pneumomediastinum. Laboratory studies show elevated amylase at 180 U/L. He denies recent alcohol use. He recently took a large dose of NSAIDs. Which of the following is the most likely diagnosis?
Answer choices
- ARuptured esophageal varices
- BBoerhaave syndromeCorrect answer
- CPerforated peptic ulcer
- DEsophageal candidiasis with perforation
- EAcute coronary syndrome with pneumomediastinum
- FMallory-Weiss tear with mediastinal extension
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