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Perforated viscus — USMLE Step 2 CK MCQ

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HardSurgeryPerforated viscusUSMLE Step 2 CK

A 51-year-old Native American man comes to the emergency department because of abdominal pain or gastrointestinal symptoms. History and focused examination are notable for sudden severe abdominal pain with rigid abdomen and free air under the diaphragm. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and imaging support an acute surgical process without suggesting a safer outpatient approach. Which of the following is the most likely diagnosis?

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Correct answer: D — Perforated viscus

The vignette describes Perforated viscus, supported by sudden severe abdominal pain with rigid abdomen and free air under the diaphragm. Perforated viscus is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: https://www.ncbi.nlm.nih.gov/books/#stage-9-order-18