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Perforated viscus — SCE Acute Medicine MCQ

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EasyAcute GI PresentationsPerforated viscusSCE Acute Medicine

A 58-year-old man is assessed on the acute medical unit. He has sudden severe epigastric pain and rigid abdomen after NSAID use. Chest radiograph shows free subdiaphragmatic air. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: B — Perforated peptic ulcer

Perforated peptic ulcer is the best answer because peritonitis with free air after NSAID-associated pain is most consistent with perforated peptic ulcer. Toxic megacolon is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: This requires urgent surgical assessment and resuscitation.

Reference: NICE CKS dyspepsia; surgical guidance