FCS(SA) Final Practice Questions - Fellowship Of The College Of Surgeons Of South Africa Final Examination FCS(SA) Final Exam

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A 54-year-old male presents with severe lower retrosternal pain, fever, and subcutaneous emphysema of the neck 4 hours after a bout of violent emesis following heavy alcohol ingestion. Chest X-ray demonstrates a left-sided pleural effusion and pneumomediastinum. What is the most definitive initial diagnostic investigation to confirm the clinical suspicion?
Correct Answer:
Water-soluble contrast swallow fluoroscopy (or contrast-enhanced CT with oral water-soluble contrast)

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