APPENDICITIS PRACTICE EXAM
QUESTIONS AND ANSWERS
-Appendix wall perforates
-Feces and bacteria spill out (perforated appendicitis) - Answer-Appendicitis
*Symptoms/Signs:*
-Periumbilical pain, nausea, later vomiting, not tender yet
-Pain / tenderness RLQ
-Low grade fever
-Mildly increased WBC
-More pain / tenderness
-More fever, higher WBC - Answer-Appendicitis
*Symptoms and signs of appendicitis*
-PERIUMBILICAL PAIN first (distention), then RLQ pain (inflammation)
-Almost always ANOREXIA, usually VOMITING
-Later develops TENDERNESS
--McBurney's point (if appendix is in iliac fossa)
--Rectal (if appendix is in the pelvis)
--Flank (if appendix is retrocecal)
-These take MANY HOURS to DAYS to develop.
-Appendicitis is generally NOT characterized by *sudden* onset of RLQ pain. - Answer-
Appendicits
Can cause flank pain, CVA tenderness, *positive psoas sign,* few WBCs / RBCs in
urine (near ureter) - Answer-Retrocecal Appendicitis
*What Location of Appendix?*
*Symptoms/Signs:*
-RLQ pain and tenderness
-No psoas sign - Answer-IIiac fossa (anterior) near anterior abdominal wall
*What Location of Appendix?*
*Symptoms/Signs:*
-*Flank pain* and tenderness
-No pain on rectal exam
-Few RBC / WBC in urine (near ureter)
, -Maybe *psoas sign* - Answer-Retrocecal (posterior)
near psoas muscle and ureter
*What Location of Appendix?*
*Symptoms/Signs:*
-Pain below McBurney's point
-Tender rectal / pelvic exam
-Few RBC / WBC in urine
-Maybe *obturator sign* - Answer-Pelvis (low) near rectum or bladder
*More signs and symptoms*
-Fever (not very high initially) / leukocytosis
-Abdominal distention (later)
-Possible superficial hyperesthesia -
--Sensitivity when stroking skin in RLQ
-Right testicular symptoms (depending on location of appendix)
-"Rebound tenderness,"positive heel tap," and other signs of peritonitis are *not
specific* for appendicitis. - Answer-Appendicitis
Pain "goes away" after perforation??
-Distention of the lumen -> peri-umbilical pain
-After perforation, there is no more distention of the lumen, so maybe no more *peri-
umbilical* pain.
-But with pus spilling out into the RLQ, causing peritonitis, there must STILL be RLQ
pain!
-There is no reason for the RLQ pain to "go away" after perforation. - Answer-
Appendicitis
Diagnostic lab tests for Appendicitis usually includes what? - Answer-Mostly CBC, UA,
pregnancy test
*Diagnostic tests - labs*
-Mostly CBC, UA, pregnancy test
--*CBC* - WBC usually mildly elevated
----Might even be normal
----Unusual to be extremely high early on
-*U / A* - might have few RBC or WBC (depending on location of appendix)
--Retrocecal appendicitis - near ureter
--Pelvic appendicitis - near bladder
-*HCG* for young females - to rule out ectopic pregnancy
-Electrolytes? - probably normal, unless there is prolonged vomiting
QUESTIONS AND ANSWERS
-Appendix wall perforates
-Feces and bacteria spill out (perforated appendicitis) - Answer-Appendicitis
*Symptoms/Signs:*
-Periumbilical pain, nausea, later vomiting, not tender yet
-Pain / tenderness RLQ
-Low grade fever
-Mildly increased WBC
-More pain / tenderness
-More fever, higher WBC - Answer-Appendicitis
*Symptoms and signs of appendicitis*
-PERIUMBILICAL PAIN first (distention), then RLQ pain (inflammation)
-Almost always ANOREXIA, usually VOMITING
-Later develops TENDERNESS
--McBurney's point (if appendix is in iliac fossa)
--Rectal (if appendix is in the pelvis)
--Flank (if appendix is retrocecal)
-These take MANY HOURS to DAYS to develop.
-Appendicitis is generally NOT characterized by *sudden* onset of RLQ pain. - Answer-
Appendicits
Can cause flank pain, CVA tenderness, *positive psoas sign,* few WBCs / RBCs in
urine (near ureter) - Answer-Retrocecal Appendicitis
*What Location of Appendix?*
*Symptoms/Signs:*
-RLQ pain and tenderness
-No psoas sign - Answer-IIiac fossa (anterior) near anterior abdominal wall
*What Location of Appendix?*
*Symptoms/Signs:*
-*Flank pain* and tenderness
-No pain on rectal exam
-Few RBC / WBC in urine (near ureter)
, -Maybe *psoas sign* - Answer-Retrocecal (posterior)
near psoas muscle and ureter
*What Location of Appendix?*
*Symptoms/Signs:*
-Pain below McBurney's point
-Tender rectal / pelvic exam
-Few RBC / WBC in urine
-Maybe *obturator sign* - Answer-Pelvis (low) near rectum or bladder
*More signs and symptoms*
-Fever (not very high initially) / leukocytosis
-Abdominal distention (later)
-Possible superficial hyperesthesia -
--Sensitivity when stroking skin in RLQ
-Right testicular symptoms (depending on location of appendix)
-"Rebound tenderness,"positive heel tap," and other signs of peritonitis are *not
specific* for appendicitis. - Answer-Appendicitis
Pain "goes away" after perforation??
-Distention of the lumen -> peri-umbilical pain
-After perforation, there is no more distention of the lumen, so maybe no more *peri-
umbilical* pain.
-But with pus spilling out into the RLQ, causing peritonitis, there must STILL be RLQ
pain!
-There is no reason for the RLQ pain to "go away" after perforation. - Answer-
Appendicitis
Diagnostic lab tests for Appendicitis usually includes what? - Answer-Mostly CBC, UA,
pregnancy test
*Diagnostic tests - labs*
-Mostly CBC, UA, pregnancy test
--*CBC* - WBC usually mildly elevated
----Might even be normal
----Unusual to be extremely high early on
-*U / A* - might have few RBC or WBC (depending on location of appendix)
--Retrocecal appendicitis - near ureter
--Pelvic appendicitis - near bladder
-*HCG* for young females - to rule out ectopic pregnancy
-Electrolytes? - probably normal, unless there is prolonged vomiting
