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Appendicitis Exam Questions with Latest Update
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Appendicitis Exam Questions with Latest Update
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Appendicitis Exam Questions withLatest Update
Palpation of LLQ that causes pain in RLQ is known as: - Answer-Rovsing' sign
Rotation or right flexed hip is known as what diagnostic maneuver? - Answer-Obturator
sign
Hip extension is known as what diagnostic sign? - Answer-Psoas stretch sign
Lab tests for appendicitis include: - Answer-WBC
Left shift (increase in bands) - sepsis
Combination of WBC count ≥ 10 x 109/L and C-reactive protein level ≥ 8 mg/L may be
diagnostic if both are positive and exclusionary if both are negative
Pregnancy test in all females of childbearing potential
Rule out ectopic pregnancy!
Urinalysis
Diagnostic tests for appendicitis: - Answer-Ultrasound: May diagnose acute appendicitis
- Negative ultrasound does not rule out appendicitis
CT : More accurate - Has high sensitivity and specificity for evaluating suspected acute
appendicitis
Abdominal and pelvic with or without contrast
Addition of IV and oral contrast may increase sensitivity for appendicitis
All of the following are typically noted in a young adult
with the diagnosis of acute appendicitis except:
A. epigastric pain.
B. positive obturator sign.
C. rebound tenderness.
D. marked febrile response. - Answer-D. marked febrile response.
There is no true classic presentation of acute appendicitis. Vague epigastric or
periumbilical pain often heralds its beginning, with the discomfort shifting to the right
lower quadrant over the next 12 hours. Pain is often aggravated by walking or coughing.
A 26-year-old man presents with acute abdominal pain.
As part of the evaluation for acute appendicitis, you
order a white blood cell (WBC) count with differential
and anticipate the following results:
A. total WBCs, 4500 mm3; neutrophils, 35%; bands, 2%;
lymphocytes, 45%.
B. total WBCs, 14,000 mm3; neutrophils, 55%; bands, 3%;
lymphocytes, 38%.
, C. total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%;
lymphocytes, 22%.
D. total WBCs, 18,100 mm3; neutrophils, 55%; bands, 3%;
lymphocytes, 28%. - Answer-C. total WBCs, 16,500 mm3; neutrophils, 66%; bands, 8%;
lymphocytes, 22%.
The most typical WBC count pattern found in this situation is the "left shift." A "left shift"
is usually seen in the presence of severe bacterial infection, such as acute appendicitis,
bacterial pneumonia, and pyelonephritis.
The following are typically noted in the "left shift":
• Leukocytosis: An elevation in the total WBC.
• Neutrophilia: An elevation in the number of neutrophils in circulation.
• Bandemia: An elevation in the number of bands or young neutrophils in circulation.
You see a 72-year-old woman who reports vomiting and
abdominal cramping occurring over the past 24 hours.
In evaluating a patient with suspected appendicitis, the
clinician considers that:
A. the presentation can differ according to the anatomical
location of the appendix.
B. this is a common reason for acute abdominal pain in
elderly patients.
C. vomiting before onset of abdominal pain is often
seen.
D. the presentation is markedly different from the
presentation of pelvic inflammatory disease. - Answer-A. the presentation can differ
according to the anatomical
location of the appendix.
The psoas sign can be best described as abdominal pain
elicited by:
A. passive extension of the hip.
B. passive flexion and internal rotation of the hip.
C. deep palpation.
D. asking the patient to cough. - Answer-A. passive extension of the hip.
The obturator sign can be best described as abdominal
pain elicited by:
A. passive extension of the hip.
B. passive flexion and internal rotation of the hip.
C. deep palpation.
D. asking the patient to cough. - Answer-B. passive flexion and internal rotation of the
hip.
An 18-year-old man presents with periumbilical pain,
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