Final answer:
A 19-year-old woman with bulimia nervosa exhibits symptoms suggestive of Boerhaave syndrome, an esophageal rupture that requires immediate medical attention and typically needs urgent surgical repair. The correct option is d.
Step-by-step explanation:
A 19-year-old woman with bulimia nervosa presents with severe retrosternal chest pain immediately after vomiting and is found to have crepitus upon chest wall palpation.
While acute myocardial infarction (MI) is also associated with retrosternal pain, the acute onset following vomiting and the physical finding of crepitus are highly suggestive of esophageal rupture, also known as Boerhaave syndrome.
This condition is a medical emergency, and bulimia nervosa increases the risk due to repeated episodes of forceful vomiting, which can lead to increased intra-esophageal pressure and subsequent rupture.
Boerhaave syndrome typically presents with severe chest pain, subcutaneous emphysema (as indicated by crepitus), and vomiting. The chest pain may worsen with swallowing.
A barium swallow study, which the patient underwent, can help confirm the diagnosis by demonstrating leakage of barium outside the esophagus. Urgent surgical intervention is usually required to repair the esophageal tear and prevent further complications such as mediastinitis or sepsis. Option d. is the correct one.