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Perforated peptic ulcer — ABEM Board MCQ

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ModerateGI/Abdominal emergenciesPerforated peptic ulcerABEM Board

A 43-year-old man presents as triage level 2 with sudden severe epigastric pain radiating to the shoulder after NSAID use. He is tachycardic, rigid on exam, and upright chest radiograph shows free air under the diaphragm. Which of the following is the most likely diagnosis?

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Correct answer: D — Perforated peptic ulcer

Peritonitis with pneumoperitoneum after ulcer risk factors indicates perforated viscus, commonly perforated peptic ulcer.

Reference: ABEM EM Model; surgical emergency guidance