Practice Quiz

Women’s Health Nurse Practitioner Exam Prep

Category - Women's Health Nurse Practitioner

Start a Study Session Sign up for Question of the Day

A 27-year-old woman with a history of bulimia nervosa comes to the clinic with a complaint of chest pain. The patient describes the pain as sharp, substernal, and occurring during an episode of vomiting.

On exam, the patient appears ill and diaphoretic. Vital signs show a blood pressure 135/85, pulse of 90, respiratory rate of 30, temperature of 98.6, and oxygen saturation of 98% on room air. The remainder of the physical exam is ordinary. Laboratory tests are normal.

Chest x-ray shows a small left pleural effusion.

What is the next best diagnostic step?

  1. Esophagogastroduodenoscopy
  2. Barium swallow study
  3. Helical CT of the chest without contrast
  4. Gastrografin swallow study
  5. Thoracentesis
Explanation

Answer: D - The diagnostic step of choice to confirm esophageal rupture (Boerhaave syndrome) is a gastrografin swallow study.

Gastrografin is preferred over a barium swallow study due to the more toxic nature of barium if it leaks into the pleural cavity. Esophagogastroduodenoscopy is contraindicated in the setting of suspected perforation. Thoracentesis and further imaging would not yield any useful information.

Previous Next
Was this helpful? Upvote!
Login to contribute your own answer or details
Start a Study Session Sign up for Question of the Day

Top questions

Related questions

Most popular on PracticeQuiz