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Perforated peptic ulcer — SCE Acute Medicine MCQ

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HardAcute Gastrointestinal PresentationsPerforated peptic ulcerSCE Acute Medicine

A 42-year-old woman presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show rigid abdomen and free subdiaphragmatic air. What is the most appropriate next step in management?

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Correct answer: D — Give IV antibiotics, resuscitate and arrange emergency surgery

The key discriminator is that rigid abdomen and free subdiaphragmatic air, which makes Give IV antibiotics, resuscitate and arrange emergency surgery the single best answer. Give targeted antidote or reversal therapy is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Optimise chronic medication and discharge and Arrange routine outpatient follow-up are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG253; emergency surgery standards