Perforated viscus — MCCQE Part 1 MCQ

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ModerateAbdominal PainPerforated viscusMCCQE Part 1

A 58-year-old man has sudden severe epigastric pain, a rigid abdomen and free air under the diaphragm on upright chest radiograph. Which of the following is the most appropriate next step?

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Correct answer: C — Start resuscitation, broad-spectrum antibiotics and urgent surgical consultation

Start resuscitation, broad-spectrum antibiotics and urgent surgical consultation is the single best answer because the age, timing, examination findings and investigations in the vignette fit Perforated viscus better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian Association of General Surgeons guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian Association of General Surgeons guidance