question: Q:A 25-year-old man presents to the emergency department after numerous episodes of vomiting. The patient states that he thinks he ‘ate something weird’ and has been vomiting for the past 48 hours. He says that he came to the hospital because the last few times he "threw up blood". He is hypotensive with a blood pressure of 90/55 mm Hg and a pulse of 120/min. After opening an intravenous line, a physical examination is performed which is normal except for mild epigastric tenderness. An immediate endoscopy is performed and a tear involving the mucosa and submucosa of the gastroesophageal junction is visualized. Which of the following is the most likely diagnosis?? 
  {'A': 'Boerhaave syndrome', 'B': 'Gastric ulcer', 'C': 'Esophageal varices', 'D': 'Hiatal hernia', 'E': 'Mallory-Weiss tear'},