This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: FMGE 2019, Subject name: Surgery
28-year-old alcoholic patient walks to hospital with the complaints of binge vomiting, chest pain, fever and X ray shows hydropneumothorax. The most probable condition; 
Select and explain. 
A. Boerhaave syndrome, B. Tension pneumo thorax, C. PUD perforation, D. Mallory Weiss tear
A: Boerhaave syndrome
Answer: A: Boerhaave syndrome 
Explanation: BOERHAAVE Syndrome- Aka Spontaneous esophageal perforation- Caused by* Forceful vomiting* Repeated vomiting- MC site of perforation - Lower 1/3rd of esophagus along Left posterolateral direction- More common in malesClinical features- Characterized by Mackler's triad* Thoracic Pain* Vomiting* Cervical subcutaneous emphysema- In case of massive contamination / inflammation* Fever* SepsisInvestigation- On CXR - Hydropneumothorax- IOC for Dx - Water soluble contrast esophagogram (Gastrograffin > Hypaque) Management- Depends on Time of Presentation Within 24 hours After 24 hours * Golden period of repair Esophagostomy + ICD inseion + feeding jejunostomy * Repair of Perforation + ICD inseion + Feeding jejunostomy Moality rate upto 20% Moality rate > 50%