Appendix

Question 1

Most common surgical emergency
In case with right-side abdominal pain

Answer 1

Appendicitis

Question 2

Most appropriate investigation for appendicitis:
In pediatrics

Answer 2

US

Question 3

Most appropriate investigation for appendicitis:
In female

Answer 3

ß-hCG
US if inconclusive do transvaginal US
If not pregnant or is obese: CT scan

🤰🏼 YOU MUST R/O ECTOPIC OR OBGYN ISSUES (OVARIAN CYST)

Question 4

Most appropriate investigation for appendicitis:
In Elderly

Answer 4

CT scan
Suspect mass/abscess/perforation

Question 5

Most appropriate investigation for appendicitis:
In male

Answer 5

Alvarado score
🔹 1-6: CT
🔹 7-10: laparoscopy

Question 6

Alvarado score

Answer 6

3 symptoms
1 Anorexia
1 N/V
1 shift pain to RLQ
3 signs
1 Fever
2 Tenderness RLQ
1 Rebound tenderness
2 labs
2 Leukocytosis
1 left shift (Nø)

Question 7

Surgical abdomin during pregnancy
Most likely to be:

Answer 7

Most common Right-side: Appendicitis
RUQ (1st & 2nd trim) = Cholecystitis
RUQ (3rd trim) = Appendicitis

Question 8

During pregnancy in the third trimester appendix location […]

Answer 8

Upward (RUQ)

Question 9

[…] Sign
LLQ Palpation produce RLQ pain

Answer 9

Rovsing sign

Question 10

[…] Sign
Rebound tenderness due to appendicitis

Answer 10

Bluberg

Question 11

[…] sign is positive with retro-cecal inflammed appendix

Answer 11

Psoas

Question 12

[…] sign is positive with pelvic inflammed appendix

Answer 12

Obturator

Question 13

How to find the appendix during the surgery?

Answer 13

Follow the taeniae coli

Question 14

Surgeon go for an appendectomy and during the procedure appendix was normal
You will […]

Answer 14

Search for Meckel’s diverticulum

Question 15

You went for open appendectomy but appendix was normal, Meckel’s was normal
You will […]

Answer 15

Proceed with appendectomy

Question 16

You went for lap appendectomy but appendix was normal, Meckel’s was normal
You will […]

Answer 16

Leave the appendix and close

Question 17

You went for appendectomy but appendix was normal, but there is inflammation in the terminal ileum
You will […]

Answer 17

Do appendectomy and refer to gastroenterology for IBD

Question 18

Post appendectomy abdominal pain
US: Appendiceal mass / abscess
Best action

Answer 18

Small mass: conservative
Large mass: percutaneous drainage

Question 19

If appendiceal mass
You schedule for […] after 6 weeks

Answer 19

Interval laparoscopic appendectomy

Question 20

Appendiceal mass in elderly (50s)
Warrent need for […]

Answer 20

Colonoscopy

Question 21

Regarding pathophysiologic etiology of developing Appendiceal abscess following appendicitis

Answer 21

🩸Redistribution of blood🩸

🪨Appendix obstruction » Inc pressure » Occlusion on BV » Ischemia, necrosis, perforation
🕳️Omentum adhere to perforated area creating abscess

Question 22

Management of Appendix cancer
Adenocarcinoma

Answer 22

Right hemicolecromy

Question 23

Management of Appendix cancer
Carcinoid

Answer 23

1cm, tip of the appendix : observe
2cm, base, + mesothelium invasion, + LN : Right hemicolectomy

Question 24

1 cm carcinoid cancer at the tip of appendix

Answer 24

Observation

Question 25

2 cm carcinoid cancer at the base of appendix

Answer 25

Rt hemicolectomy

Question 26

Antibiotics given preoperatively for appendicitis and stopped […]

Answer 26

Immediately