<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 51-year-old man alcoholic presents to the emergency department with persistent vomiting. He was found vomiting forcefully next to an empty bottle of vodka. His medical history is significant for Lyme disease, currently being treated with doxycycline. After a prolonged episode of retching, the patient begins choking and coughing forcefully in between bouts of chest pain in the ER. At this point, the patient is unable to communicate. The patient appears toxic. His temperature is 37C 98.6F, respiratory rate is 15min, pulse is 107min, and blood pressure is 9068 mm Hg. A quick physical exam reveals fullness at the base of the neck and a crunching, rasping sound on auscultation of the chest. The attending physician orders an upright chest X-ray, showing free mediastinal air. What is the most likely diagnosis?? A: Esophageal candidiasis, B: Dieulafoys lesion, C: Pill esophagitis, D: Boerhaave syndrome, E: Mallory Weiss tear,  <response>: This is a clinical vignette describing a 51-year-old alcoholic man who presents with persistent vomiting after drinking vodka. He begins choking, coughing forcefully, and having chest pain. On exam, he has fullness at the base of the neck and a crunching, rasping sound on chest auscultation. An upright chest X-ray shows free mediastinal air. The key findings are the history of alcoholism, forceful vomiting, chest pain, subcutaneous emphysema on exam, and free mediastinal air on CXR. This clinical picture is most consistent with esophageal rupture or perforation, known as Boerhaave syndrome. The other choices can cause vomiting but are less likely in this specific scenario. Esophageal candidiasis may cause dysphagia and odynophagia but not necessarily vomiting. Dieulafoys lesion and pill esophagitis can cause bleeding but not perforation. Mallory Weiss tear causes bleeding but is associated with retching, not forceful vomiting.D: Boerhaave syndrome 