Appendicitis in a patient with Right Iliac Fossa Pain

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Question 1 of 9

1. Question
A 45-year-old male presents with 12 hours of right iliac fossa (RIF) pain, vomiting and diarrhoea. He is examined by a junior doctor. On examination they elicit RIF tenderness and wonder about appendicitis.

Which of the following is true?
- Appendicitis is most prevalent in this age group
- The mortality of appendicitis is in the region of 5%
- The incidence of appendicitis is rising
- Diverticulitis is likely
- Appendicitis is more common in the Western world than in the developing world
Correct

Incorrect
Question 2 of 9

2. Question
Your FY2 asks you about the appendix. What do you tell them?
- The appendix is attached to the ascending colon
- The appendix normally lies within the pelvis
- Appendicitis is normally due to obstruction of the lumen of the appendix
- The appendix perforates in 80% of patients with appendicitis
- Appendicitis is normally due to blood-borne sepsis settling in the appendix
Correct

Incorrect
Question 3 of 9

3. Question
You go to see the patient with the junior doctor and are able to elicit some additional history; the pain started in the midline and moved to RIF after 6 hours and has been constantly present there since. The patient is anorexic and feels feverish. On examination there is tenderness, guarding and rigidity in the RIF.

Initial results:

White cell count (WCC) 18, CRP 30, urinalysis – negative.

Which one of the following most strongly suggests appendicitis?
- Tenderness, rigidity and guarding in the RIF
- Negative urinalysis
- Fever
- Migration of pain
- Anorexia
Correct

Incorrect
Question 4 of 9

4. Question
You decide, based on these findings, that the patient has a high likelihood of appendicitis.

What would be the best management strategy?
- Arrange ultrasound scan
- Arrange CT
- Admit and observe
- Refer to the general surgical team and advise the patient they may require an operation
- Administer broad-spectrum intravenous antibiotics
Correct

Incorrect
Question 5 of 9

5. Question
A 25-year-old female presents with a 4-hour history of severe RIF pain and vomiting.

Which is the best first investigation to perform?
- Urinary beta-hCG
- Full blood count
- Abdominal USS
- Diagnostic laparoscopy
- C-reactive protein
Correct

Incorrect
Question 6 of 9

6. Question
A 22-year-old male presents with 2 hours of colicky RIF pain, which has now settled despite no analgesia being taken. In the ED he has a pulse of 60 bpm, blood pressure of 110/80 mmHg and normal WCC and CRP. On examination he has no abdominal tenderness.

Which of the following is the best management plan?
- Admit him under the surgeons for helical CT
- Admit him under the surgeons and keep him fasted
- Allow him home with advice to avoid food and fluids for 24 hours
- Allow him home, advise fluids and explain to him what signs and symptoms mean he must reattend the emergency department with
- Allow him home with no restrictions and tell him he does not have appendicitis
Correct

Incorrect
Question 7 of 9

7. Question
An 85-year-old male presents with 48 hours of intermittent RIF pain. On examination he has a pulse of 110 bpm, BP 90/40 mmHg, respiratory rate 18/min, temperature 38.5oC, SAO2 96%. He has a tender palpable mass in the RIF and initial investigations reveal a normal urinalysis, WCC of 18 and CRP of 80.

With regard to this patient which of the following are correct?
- Perforation of the inflamed appendix is common in this age group
- Appendix abscesses generally require surgical drainage
- An underlying caecal carcinoma is unlikely
- Antibiotics should be withheld until a definitive diagnosis is made
- The diagnosis of appendicitis is likely to be clinically apparent on initial presentation
Correct

Incorrect
Question 8 of 9

8. Question
A 27-year-old female presents with RIF pain, dysuria and vomiting for 24 hours. On examination they have RIF tenderness but no signs of localised peritonism. WCC is 19 and CRP 80 and urinalysis shows a trace of blood and protein.

Which of the following is the best management strategy?
- Discharge home
- Admit for USS
- Open appendicetomy
- Laparoscopic appendicetomy
- Admit for intravenous broad-spectrum antibiotics
Correct

Incorrect
Question 9 of 9

9. Question
An 18-year-old female who is 26 weeks pregnant presents with right upper quadrant pain.

Which of the following are correct?
- Appendicitis is unlikely given the location of the pain
- Appendicitis is more prevalent during pregnancy
- Perforation of the appendix is associated with increased foetal mortality
- Inflammatory markers are unhelpful in these patients
- The diagnosis of appendicitis in pregnant patients will be obvious on USS
Correct

Incorrect

4 Comments

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Dr Ahmed Adel Abdelaziz Hassan September 12, 2023 at 8:43 pm

Informative module

Dr Ivo Nikolov Kolev September 13, 2023 at 9:30 pm

Thank you, very informative module.

Dr Sheril Punnakadan Lathief December 19, 2023 at 8:35 pm

Good learning seasion

Dr Ramesh Kumar May 27, 2024 at 12:34 am

excellent revision

Appendicitis in a patient with Right Iliac Fossa Pain – Post Test

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