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A. MLA Map Paediatrics > Appendicitis > Flashcards

Appendicitis Flashcards

1
Q

What is appendicitis?

1 - inflammation of the veriform appendix
2 - inflammation of the ovaries
3 - inflammation of the mesoappendix
4 - inflammation of the ileocaecal valve

A

1 - inflammation of the veriform appendix

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2
Q

The mesentery is a fold of membrane that attaches the intestine to the abdominal wall and holds it in place. Which mesentery anchors the appendix to the ileum?

1 - mesovarium
2 - lesser omentum
3 - mesoappendix
4 - greater omentum

A

3 - mesoappendix

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3
Q

What is the blood vessel supplying the appendix?

1 - superior mesenteric artery
2 - ileocolic artery
3 - appendicular artery
4 - posterior caecal artery

A

3 - appendicular artery

  • appendicular vein drains the appendix
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4
Q

What is the incidence appendicitis?

1 - 1 / 100000 a year
2 - 10 / 100000 a year
3 - 100 / 100000 a year
4 - 1000 / 100000 a year

A

3 - 100 / 100000 a year

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5
Q

At what age is appendicitis most likely to occur?

1 - 1st decade
2 - 2nd decade
3 - 3rd decade
4 - 4th decade

A

3 - 3rd decade

  • approximately ages 18 to 30
  • rare in <9 y/o
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6
Q

What is the most common cause for appendicities?

1 - appendiceal obstruction
2 - idiopathic
3 - acute inflammation
4 - trauma

A

1 - appendiceal obstruction

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7
Q

Appendiceal obstruction is the most common cause for appendicities. What is the most common cause of this blockage?

1 - colorectal neoplasia (polyp or cancer)
2 - faecolith (mass of hard stool)
3 - Lymphoid tissue hyperplasia
4 - abscess

A

2 - faecolith (mass of hard stool)

  • higher incidence in patients with lower dietary fibre
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8
Q

Appendiceal obstruction is the most common cause for appendicities caused by faecolith (mass of hard stool). If the appendix is not removed it can lead to complications. Which of the following is NOT a common complication?

1 - gangrene with perforation
2 - localised abscess
3 - generalised peritonitis
4 - small bowel distension

A

4 - small bowel distension

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9
Q

Patients with an acute appendicitis can have a variety of symptoms. Where does pain generally start?

1 - right iliac fossa
2 - left iliac fossa
3 - epigastric region
4 - umbilical region

A

4 - umbilical region

  • central/non-specific pain from involvement of visceral peritoneum (visceral/autonomic innervation)
  • pain moves due to embryology as appendix was once part of midgut
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10
Q

Patients with acute appendicitis start with a generalised pain in the umbilical region of the abdomen. From here the pain becomes more specific to where?

1 - right iliac fossa
2 - left iliac fossa
3 - epigastric region
4 - left lumbar region

A

1 - right iliac fossa

  • RIF pain when parietal peritoneum involved (somatic nervous system)
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11
Q

Pain in the right iliac fossa is the most common presentation in appendicitis. Which of the following is NOT a common symptom of appendicitis?

1 - anorexia (not wanting to eat)
2 - nausea and vomiting
3 - dysuria (from serosal irritation of the bladder)
4 - small bowel distension
5 - mild temperature

A

4 - small bowel distension

  • dysuria is pain when urinating
  • serosa is outer lining of organs
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12
Q

Why are children <10 y/o at a greater risk of infection and complications?

1 - immune system not full developed
2 - caecum not able to protect appendix
3 - greater omentum not full developed
4 - GIT walls are more fragile

A

3 - greater omentum not full developed

  • in adults greater omentum protects other organs
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13
Q

There are a number of clinical signs of an acute appendicitis. One of these is tenderness at McBurneys point. What is this location?

ASIS = anterior superior iliac spine

AIIS = anterior inferior iliac spine

1 - half way between umbillicus and ASIS
2 - 2/3 between umbilicus and ASIS
3 - 2/3 between umbilicus and AIIS
4 - halfway between ASIS and coccyx

A

2 - 2/3 between umbilicus and ASIS

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14
Q

There are a number of clinical signs of an acute appendicitis. One of these is Rovsings sign, which is pain felt in RIF when pressing on the LIF. Why is this?

1 - nerves for RIF are on the LIF
2 - contents of LIF push into RIF distending RIF parietal peritoneum
3 - serratus muscle crosses pelvic here

A

2 - contents of LIF push into RIF distending RIF parietal peritoneum

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15
Q

There are a number of clinical signs of an acute appendicitis. One of these is psoas sign. What is this?

1 - pain on right hip extension when laying on left side
2 - pain on left hip extension when laying on right side
3 - pain on right hip extension when laying on right side
4 - pain on left hip extension when laying on left side

A

1 - pain on right hip extension when laying on left side

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16
Q

There are a number of clinical signs of an acute appendicitis. One of these is obturator sign. What is this?

1 - pain on extension and internal rotation of right hip
2 - pain on flexion and internal rotation of right hip
3 - pain on flexion and external rotation of right hip
4 - pain on extension and external rotation of right hip

A

2 - pain on flexion and internal rotation of right hip

17
Q

During surgery for the removal of an appendicitis, Meckels Diverticulum may be discovered. What is this?

1 - congenital diverticulum
2 - growth of small bowel
3 - growth of caecum
4 - appendage of ileum

A

1 - congenital diverticulum

  • most common congenital anomaly of the gastrointestinal tract
18
Q

Meckels Diverticulum is the most common congenital anomaly of the gastrointestinal tract. Does it always have to be removed?

A
  • no
  • 94-96% are asymptomatic
  • if pathological always removed
19
Q

Meckels Diverticulum is the most common congenital anomaly of the gastrointestinal tract. Which of the following is NOT one of the rule of 2s for Meckels Diverticulum?

1 - if removed if can return twice
2 - 2% prevalence
3 - 2 inches long
3 - 2 feet from ileocaecal valve along SI

A

1 - if removed if can return twice

20
Q

Meckels Diverticulum is the most common congenital anomaly of the gastrointestinal tract and if pathological it must be removed. It can cause a number of problems, which of the following does it NOT generally cause?

1 - post-rectal bleeding
2 - volvulus obstruction
3 - inflammation mimicking appendicitis
4 - can be lined with gastric mucosa causing ulceration
5 - dysuria due to inflammation of the serosa of the bladder

A

5 - dysuria due to inflammation of the serosa of the bladder

  • does not typically cause this
21
Q

Which of the following is NOT useful when trying to diagnose appendicitis?

1 - CRP
2 - WBC
3 - RBC
4 - ESR

A

3 - RBC

22
Q

Imaging can be useful in patients with a suspected appendicitis. What aged patients should receive an ultrasound instead of a CT due to radiation levels?

1 - <20 y/o
2 - <30 y/o
3 - <40 y/o
4 - <50 y/o

A

4 - <50 y/o

23
Q

Imaging can be useful in patients with a suspected appendicitis. What aged patients should receive an CT scan instead of an ultrasound?

1 - >20 y/o
2 - >30 y/o
3 - >40 y/o
4 - >50 y/o

A

4 - >50 y/o

24
Q

Which of the following liver markers can be raised in patients with appendicitis?

1 - AST
2 - ALT
3 - Bilirubin
4 - GGT

A

3 - Bilirubin

  • stress and inflammation leads to hyperbilirubinaemia
  • likely to be due to portal sepsis or empyema resulting in liver hepatocytes dysfunction or damage
  • common oriental ethnicities
25
Q

Treatment for an appendicitis can be subdivided into medical and surgical treatment. What is the medical conservative approach?

1 - wait and see
2 - antibiotics, IV fluids and analgesia
3 - corticosteroids
4 - ultrasound guided aspiration

A

2 - antibiotics, IV fluids and analgesia

  • 40% reoccurrence within 5 years, BUT useful if unable to have surgery immediately
26
Q

Treatment for an appendicitis can be subdivided into medical and surgical treatment. Medical conservative approach involves administering antibiotics. What antibiotic is most commonly prescribed?

1 - Doxycycline
2 - Clarithromycin
3 - Gentamicin
4 - Metronidazole

A

4 - Metronidazole

27
Q

Treatment for an appendicitis can be subdivided into medical and surgical treatment. What is the surgical approach?

1 - laparoscopy
2 - open
3 - robotic

A

1 - laparoscopy

  • most common, but depending on field of view open surgery can be performed
28
Q

An inflamed retrocaecal appendix may irritate all of the following structures, EXCEPT which one?

1 - right ureter
2 - psoas muscle
3 - gall bladder pain
4 - left ureter

A

4 - left ureter

29
Q

In an appendicitis a fibrinopurulent exudate on the serosal surface extends to any adjacent peritoneal surface (bowel or abdominal wall, causing localised peritonitis. Organise the points below in the order they occur that ultimately leads to the appendix becoming gangrene?

1 - appendix becomes distended with pus
2 - appendix becomes necrotic and gangrenous and begins to disintegrate
3 - end arteries become inflamed and thrombose
4 - glandular mucosa becomes necrotic and
sloughs into the lumen

A

4 - glandular mucosa becomes necrotic and
sloughs into the lumen
1 - appendix becomes distended with pus
3 - end arteries become inflamed and thrombose
2 - appendix becomes necrotic and gangrenous and begins to disintegrate

30
Q

An appendicitis can often have lots of differentials. Which of the following is NOT a a common differential in a female that must be ruled out before an appendicitis?

1 - endometriosis
2 - salpingitis
3 - menorrhagia
4 - torsion of ovarian cyst

A

3 - menorrhagia

  • salpingitis = inflammation of fallopian tubes
31
Q

During an acute appendicitis which of the following is NOT commonly observed?

1 - rigid abdomen
2 - mass
3 - tender abdomen
4 - liver tenderness

A

4 - liver tenderness

32
Q

Why is it important to ask a patient if they have recently had a sore throat or viral-type illness?

1 - can present as mesenteric adenitis
2 - can cause UTIs
3 - can link with E.coli
4 - can cause ulcerative colitis

A

1 - can present as mesenteric adenitis

  • inflammation of the mesenteric lymph nodes that could present as an appendicitis
33
Q

Which of the following is NOT a common differential of appendicitis?

1 - small or large bowel obstruction
2 - acute pancreatitis
3 - gastroenteritis
4 - UTI
5 - hepatomegaly
6 - gynaecological disorder

A

5 - hepatomegaly

34
Q

An appendicitis can be surgically removed by laparotomy or laparoscopy. Match the description to the name below:

  • large insertion open incision in the abdomen
  • multiple small incisions for medical equipment
A

1 - laparotomy = large insertion open incision in the abdomen

2 - laparoscopy = multiple small incisions for medical equipment

A. MLA Map Paediatrics (75 decks)

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