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Postoperative atelectasis — USMLE Step 3 MCQ

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HardSurgery (Post-operative / Follow-up)Postoperative atelectasisUSMLE Step 3

A 36-year-old man intentionally ingests a concentrated alkaline drain cleaner. He has drooling, odynophagia, and oral burns but is hemodynamically stable after airway assessment. Chest radiography shows no free air. What is the best next step?

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Correct answer: A — Stabilize the airway, then arrange early upper endoscopy

The best answer is “Stabilize the airway, then arrange early upper endoscopy”. Symptoms indicate clinically important caustic injury. After airway and hemodynamic stabilization, early upper endoscopy grades esophageal and gastric injury and guides nutrition and surgical consultation. Neutralization, charcoal, emesis, and lavage can worsen injury or obscure assessment. Symptomatic caustic ingestion requires early endoscopic injury assessment after airway and hemodynamic stabilization.

Reference: NCBI Bookshelf: Caustic Ingestions: https://www.ncbi.nlm.nih.gov/books/NBK557442/