NBME Form 15 Practice Test

Barium swallow studies are commonly utilized to diagnose tracheoesophageal fistula (TEF) due to their ability to visualize the passage of barium through the esophagus and any potential abnormal communications with the trachea. In the case of TEF, the barium can leak into the trachea, highlighting the presence of a fistula. This test allows for both functional and structural assessment of the esophagus, making it an effective initial diagnostic tool.

While chest X-rays can be useful for identifying complications associated with TEF, such as aspiration pneumonia, they do not specifically diagnose the fistula itself. Esophagoscopy offers direct visualization of the esophagus and can be useful in cases of TEF, but it is often reserved for cases when further intervention is needed. A CT scan of the chest can help define the anatomy and any associated issues but is not typically the first-line diagnostic test for TEF.

Therefore, the barium swallow is the most appropriate choice for the initial diagnosis of tracheoesophageal fistula among the provided options.