This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: NEET Jan 2020, Subject name: Surgery
[{'content': 'A middle aged man complains of upper abdominal pain after a heavy meal. There is tenderness in the upper abdomen and on X-ray, widening of the mediastinum is seen with pneumo-mediastinum. What is the diagnosis? \nSelect and explain. \nA. Spontaneous perforation of the esophagus, B. Perforated peptic ulcer, C. Foreign body in esophagus, D. Rupture of emphysematous bulla', 'role': 'user'}, {'content': "Answer: A \nExplanation: Above clinical scenario is suggestive of diagnosis of spontaneous perforation of the esophagus. Aka BOERHAAVE Syndrome - Caused by Forceful vomiting Repeated vomiting - Clinical features - Characterized byMackler's triad Thoracic Pain Vomiting Cervical subcutaneous emphysema Investigation - On CXR - Hydropneumothorax - IOC for Dx - Water soluble contrast esophagogram (Gastrograffin > Hypaque)", 'role': 'assistant'}]