Surgery MCQs Q36

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SURGERY • ACUTE ABDOMEN

A patient presents with generalized abdominal pain, rigidity, and features suggestive of generalized peritonitis following a perforated viscus.

Which of the following is the most characteristic feature?

A Intermittent spasmodic abdominal pain

B Elevated temperature and pulse rate

C Repeated vomiting and bleeding from the nose

D Grey Turner sign

E Almost no finding on rectal examination

The correct answer is Elevated temperature and pulse rate.

Decoding the Stem

1

CLUE "Generalized peritonitis"

TRANSLATION Acute abdominal catastrophe → systemic inflammatory response + rigid abdomen.

Explanation

B. Elevated temperature and pulse rate: ✅ Correct. Generalized peritonitis triggers a systemic inflammatory response (SIRS) leading to pyrexia (fever) and tachycardia. These are signs of toxicity and underlying sepsis.

A. Intermittent pain: ❌ This is typical of colic (obstruction). Peritonitis pain is constant and severe.

D. Grey Turner sign: ❌ This indicates retroperitoneal bruising, characteristic of hemorrhagic pancreatitis, not simple peritonitis.

E. Rectal exam: ❌ Rectal examination usually shows tenderness or fullness if there is pelvic involvement/peritonitis.

🧠 High-Yield Pearls

✔ Generalized peritonitis = Surgical Emergency.

✔ Key signs: Rigid abdomen (board-like), rebound tenderness, fever, and tachycardia.

✔ Common causes: Perforated peptic ulcer, perforated appendix, or diverticulitis.

Integrated Clinical Questions

1. Most important abdominal sign?

Answer: Abdominal guarding and rigidity (board-like abdomen).

2. Type of pain experienced?

Answer: Constant, severe, and generalized pain (unlike colicky pain).

3. Most common cause of generalized peritonitis?

Answer: Perforated peptic ulcer.

4. Initial management steps?

Answer: Resuscitation (IV fluids), IV antibiotics, and urgent surgical exploration.

5. Why does tachycardia occur?

Answer: Due to a combination of severe pain, systemic sepsis, and hypovolemia from third-spacing.

⚡ Exam Pearls

• Peritonitis = fever + tachycardia + rigid abdomen.
• Colicky pain is NOT peritonitis.
• Grey Turner = pancreatitis, NOT peritonitis.

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