Appendicitis

Question 1

Acute appendicitis is most common in patients age

Answer 1

10 to 19 years

Question 2

most frequent cause of atraumatic abdominal pain in children >1 year old

Answer 2

Acute appendicitis

Question 3

most common nonobstetric surgical emergency in pregnancy, complicating up to 1 in 1500 pregnancies

Answer 3

Acute appendicitis

Question 4

True or false

consider appendicitis in any patient with acute atraumatic abdominal pain without prior appendectomy

Answer 4

True

Question 5

McBurney’s point is located where?

Answer 5

one third of the distance from the anterior superior iliac spine to the umbilicus.

Question 6

How many percent of patients may have an atypical presentation due in part to anatomic variation

Answer 6

50%

Question 7

retrocecal appendix produces___________pain whereas malrotation of the colon results in transposition of the appendix and, subsequently, pain to the_____________

Answer 7

right flank or pelvic pain

left upper quadrant

Question 8

location of pain remains the most common location of pain in pregnant women with appendicitis

Answer 8

Right lower quadrant

Question 9

worsening pain with deep inspiration may be present if there is

Answer 9

peritoneal irritation

Question 10

exception to right lower quadrant pain is ____________, which does not contact the anterior parietal peritoneum.

Answer 10

retrocecal appendix

Question 11

Rovsing’s sign

Answer 11

reproduces pain over McBurney’s point as the clinician palpates the descending colon in the left lower quadrant

Question 12

psoas sign is elicited if

Answer 12

abdominal pain is produced with passive extension of the right leg at the hip while the patient lies on the left side

Question 13

obturator test elicits

Answer 13

pain with passive internal and external rotation of the flexed right thigh at the hip

Question 14

True or false

In both children and adults, however, no single historical or physical examination finding is sufficient to rule in or rule out appendicitis. Their utility is increased in combination

Answer 14

True

Question 15

True or false

 Acute appendicitis is largely a clinical diagnosis, and no one adjunctive test is universally indicated

Answer 15

 True

Question 16

True or false

 Consider appendicitis in any patient with atraumatic right-sided abdominal, periumbilical, or flank pain who has not previously undergone appendectomy

Answer 16

True

Question 17

Modified Alvarado score for acute appendicitis

Answer 17

Symptoms

migration, 1 point
anorexia or urinary acetone, 1 point
nausea or vomiting, 1 point

signs

right lower quadrant tenderness, 2 points
rebound, 1 point
fever, 1 point

WBC count (>10,000/mm3, 2 points)

low-risk appendicitis (score, 1 to 4)

possible or probable appendicitis (score, 5 to 9).

Question 18

should be the initial imaging modality of choice in both pregnant females and children. It should likewise be considered in young, nonobese adults

Answer 18

Graded compression US

Question 19

Typical US findings in appendicitis are a thickened, noncompressible appendix______ in diameter

Answer 19

> 6 mm

Question 20

US Perforation

Answer 20

may lead to disappearance of specific imaging hallmarks and difficult visualization of the appendix on US.

Question 21

In most adult males and nonpregnant females for whom the diagnosis of appendicitis is not sufficiently clear, consider which imaging

Answer 21

abdominal CT that includes the abdomen and pelvis

Question 22

stable, reliable patient without significant comorbidities may be a candidate for discharge provided they have a scheduled return visit to the ED or their primary physician (typically within _____hours) for repeat examination

Answer 22

12 hours