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A 53-year-old man is brought to the Emergency Department with repetitive vomiting for four hours, despite his efforts to hold it back, followed by sudden pain in the upper abdomen and left lower chest. He has a history of prolonged heavy alcohol intake. On examination he is sweating and looks unwell. His BP is 100/80mmHg. pulse rate is 110/min and regular, temperature is 36°C and there is slight peripheral cyanosis. Breath sounds are absent over the left side of the chest. There is moderate tenderness in the epigastrium. Which one of the following is the most likely diagnosis?
(A) Perforated ulcer
(B) Acute pancreatitis
(C) Spontaneous pneumothorax
(D) Myocardial infarct
(E) Perforated oesophagus
A 53-year-old man is brought to the Emergency Department with repetitive vomiting for four hours, despite his efforts to hold it back, followed by sudden pain in the upper abdomen and left lower chest. He has a history of prolonged heavy alcohol intake. On examination he is sweating and looks unwell. His BP is 100/80mmHg. pulse rate is 110/min and regular, temperature is 36°C and there is slight peripheral cyanosis. Breath sounds are absent over the left side of the chest. There is moderate tenderness in the epigastrium. Which one of the following is the most likely diagnosis?
(A) Perforated ulcer
(B) Acute pancreatitis
(C) Spontaneous pneumothorax
(D) Myocardial infarct
(E) Perforated oesophagus
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