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Oesophageal food bolus obstruction — SCE Acute Medicine MCQ

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ModerateAcute Gastrointestinal PresentationsOesophageal food bolus obstructionSCE Acute Medicine

A 71-year-old woman presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show inability to swallow saliva after steak meal. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Arrange urgent endoscopic removal of oesophageal food bolus

The key discriminator is that inability to swallow saliva after steak meal, which makes Arrange urgent endoscopic removal of oesophageal food bolus the single best answer. Arrange urgent CT imaging is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Call critical care for escalation and Provide supportive care and close monitoring are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSG endoscopy guidance