Sudden Severe Epigastric Pain in Surgery — 45yo Man | General Surgery | SMLE Q#18348

SMLE Question #18348

Surgery General Surgery

Objective: OBJ-TRACH-EMERG-01

Last updated: February 2026
A 45-year-old man presents to the emergency department with sudden severe epigastric pain that rapidly becomes generalized. Examination shows abdominal rigidity and rebound tenderness. He has peptic ulcer disease and has been taking NSAIDs for back pain. He is kept NPO and an upright chest radiograph is obtained to evaluate suspected perforated peptic ulcer. Which radiographic finding most strongly confirms the diagnosis?

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