Chapter 81: Acute Appendicitis

Question 1

Acute appendicitis is most common in patients age ____

Answer 1

Acute appendicitis is most common in patients age 10 to 19 years

Question 2

The most common location of pain in pregnant women with appendicitis

Answer 2

Right lower quadrant pain

Question 3

True or False

Worsening pain with deep inspiration may be present if there is peritoneal irritation

Answer 3

True

worsening pain with deep inspiration may be present if there is peri- toneal irritation

Question 4

All acute appendicitis will present right lower quadrant pain except

Answer 4

Retrocecal appendix which presents as right flank pain or pelvic pain

Question 5

The single most useful sign in acute appendicitis for 18 years old and younger?

Answer 5

Fever

Question 6

The single most useful sign in acute appendicitis for adult?

Answer 6

Right lower quadrant pain

Question 7

Scoring system for acute appendicitis

Answer 7

Alvarado and Samuel scores

Question 8

A C-reactive protein ____ in children <6 years old may be of value in predicting acute appendicitis

Answer 8

A C-reactive protein >10 mg/L in children <6 years old may be of value in predicting acute appendicitis

Question 9

True or False

Obtain early surgical consultation before imaging in straightforward cases of suspected appendicitis in adults

Answer 9

True

Obtain early surgical consultation before imaging in straightforward cases of suspected appendicitis in adults

Question 10

The initial imaging modality of choice for acute appendicitis in both pregnant females and children

Answer 10

Graded compression US

Question 11

The appendix is oval in the axial plane, ends blindly in the longitudinal plane, and should be compressible with a maximal diameter not exceeding ____

Answer 11

The appendix is oval in the axial plane, ends blindly in the longitudinal plane, and should be compressible with a maximal diameter not exceeding 6 mm

Question 12

Findings of acute appendicitis in US?

Answer 12

Typical findings in appendicitis are a thickened, noncompressible appendix > 6 mm in diameter

Question 13

Overall the most accurate imaging modality for suspected appendicitis

Answer 13

Abdominopelvic CT scan

Question 14

Preferred laboratory exam over CT for evaluation of appendicitis in the first trimester of pregnancy

Answer 14

MRI

Question 15

True or False

IV gadolinium do not cross the placenta and is used in pregnancy

Answer 15

False

IV gadolinium crosses the placenta and is not used in pregnancy given the teratogenic effects seen in animal studies

Question 16

Why Gadolinium is not given in patient with renal insufficiency

Answer 16

Gadolinium is not given to patients with renal insufficiency because it may cause nephrogenic fibrosing dermopathy

Question 17

Appropriate choices should broadly cover aerobic and anaerobic gram-negative organisms for acute appendicitis

Answer 17

• Ampicillin/sulbactam 3 grams IV (pediatric dose, 75 milligrams/kg IV)
• Piperacillin/tazobactam 4.5 grams IV (100 milligrams/kg IV)
• Cefoxitin 2 grams IV (40 milligrams/kg)
• Metronidazole 500 milligrams IV plus ciprofloxacin 400 milligrams IV

Question 18

The accepted standard of care for acute appendicitis

Answer 18

Surgery

Question 19

The most common surgical emergency in pregnancy

Answer 19

Acute appendicitis