skip to main content

Perforated Peptic Ulcer — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyGastroenterologyPerforated Peptic UlcerRACP Adult Medicine

A 55-year-old man presents with sudden onset severe epigastric pain radiating to the back. He has a rigid abdomen with generalised peritonism. He is tachycardic (HR 120) and hypotensive (BP 85/50). Upright CXR shows free air under the right hemidiaphragm (pneumoperitoneum). What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Perforated peptic ulcer

Sudden onset severe epigastric pain with generalised peritonism, haemodynamic instability, and free air under the diaphragm (pneumoperitoneum) on erect CXR is a perforated viscus — most commonly perforated peptic ulcer (DU>GU). This is a surgical emergency requiring urgent laparotomy (or laparoscopic repair). Resuscitation with IV fluids, broad-spectrum antibiotics (ceftriaxone + metronidazole), and PPI infusion should be commenced simultaneously.

Reference: eTG Surgical – 2024 – Acute Abdomen; RACS 2024