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Perforated viscus — ABEM Board MCQ

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ModerateGI/Abdominal emergenciesPerforated viscusABEM Board

A 57-year-old man arrives with sudden severe epigastric pain after taking high-dose NSAIDs. Triage acuity is ESI 2; BP 96/58 mm Hg, HR 122/min, T 100.6 F. Abdomen is rigid with diffuse rebound. Upright chest radiograph shows free air under the diaphragm. Which of the following is the most likely diagnosis?

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Correct answer: E — Perforated peptic ulcer

Peritonitis with pneumoperitoneum after NSAID exposure strongly suggests perforated peptic ulcer.

Reference: ACS emergency general surgery guidance