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

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?

Your FY2 asks you about the appendix. What do you tell them?

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?

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

What would be the best management strategy?

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?

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?

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?

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?

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

Which of the following are correct?