Diagnosis: perforated viscus, the xray appearance and story would go with a likely diagnosis of perforated peptic ulcer, although any perforated hollow organ could cause this picture of free gas under the diaphragm (remember to differentiate it from gas in the hiatus of the stomach)
Priorities: physiological resuscitation/fluid therapy, pain relief, antibiotics. 2 further things to think about, DVT prophylaxis and the prescription of normal medication.
Now please prescribe these on a standard drug and fluid chart
John Smith dob 12.5.1970 X12345
Answers in a couple of days
In order to get some prescribing resources out there we intend to publish a series of prescribing problems on the website. The problems will appear at least weekly with the "answers" appearing a couple of days later. We'll use the standard exam stationery available on the LSE, but also available below in case you haven't got access to the LSE.