Which exam finding is NOT supportive of a perforated gastric ulcer?

The correct answer, indicating a finding that is not supportive of a perforated gastric ulcer, is the absence of pain with withdrawal of palpation. In cases of a perforated gastric ulcer, patients typically exhibit significant abdominal tenderness, and pain is generally exacerbated during palpation and may also persist or intensify when pressure is released. This is indicative of the underlying irritation and inflammation caused by the perforation.

Guarding, rebound tenderness, and rigidity are all associated with acute abdominal conditions, particularly those involving perforation. Guarding refers to the involuntary tensing of the abdominal muscles in response to pain, commonly seen in patients with peritoneal irritation. Rebound tenderness occurs when pain is felt upon the quick removal of pressure from the abdomen, suggesting inflammation or irritation of the peritoneum. Rigidity, or a stiff abdomen, is also a sign of peritoneal irritation and can reflect a more serious underlying condition. Therefore, these findings would strongly support the diagnosis of a perforated gastric ulcer, unlike the absence of pain upon withdrawal of palpation, which is not typical in such cases.