Peptic ulcer disease: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Peptic ulcer disease

Sample item

A 50-year-old man has sudden severe epigastric pain, a board-like rigid abdomen and absent bowel sounds. He has long used NSAIDs. What is the most appropriate initial investigation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Erect chest radiograph

The picture is a perforated peptic ulcer with generalised peritonitis. An erect chest film often shows free gas under the diaphragm, which confirms perforation quickly. Contrast studies and endoscopy are inappropriate because they delay surgery or insufflate air.

Option by option

  • A. Endoscopic retrograde cholangiopancreatography

    ERCP examines the bile ducts and could worsen a perforation.

  • B. Barium swallow

    A barium swallow is not used for suspected perforation and delays management.

  • C. Erect chest radiograph (correct)

    Correct. Free subdiaphragmatic gas is a rapid and simple sign of a perforated viscus.

  • D. Upper gastrointestinal endoscopy

    Endoscopy insufflates air into a perforated stomach and does not help the acute diagnosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Erect chest radiograph. The picture is a perforated peptic ulcer with generalised peritonitis.

Why is "Endoscopic retrograde cholangiopancreatography" not the answer?

ERCP examines the bile ducts and could worsen a perforation.

Why is "Barium swallow" not the answer?

A barium swallow is not used for suspected perforation and delays management.

Why is "Upper gastrointestinal endoscopy" not the answer?

Endoscopy insufflates air into a perforated stomach and does not help the acute diagnosis.

What concept does this question test?

It tests Peptic ulcer disease in General Surgery. An erect chest film often shows free gas under the diaphragm, which confirms perforation quickly. Contrast studies and endoscopy are inappropriate because they delay surgery or insufflate air.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Peptic ulcer disease?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.