TEST 4-GI PART I (ABDOMINAL PAIN &
APPENDICITIS EXAM QUESTIONS WITH
CORRECT ANSWERS
Diseases that may cause acute abdominal pain include: - Answer-Appendicitis
• Cholecystitis
• Diverticulitis
• Small bowel obstruction
• Perforated peptic ulcer
• Peritonitis
• Ruptured ectopic pregnancy
• Ruptured abdominal aortic aneurysm
• Hypercalcemia
• Superior mesenteric artery syndrome
• Acute intermittent porphyria
• Pelvic inflammatory disease (especially in female patients)
Acute diseases of the chest, including myocardial infarction, congestive heart failure,
pulmonary infarction, and pneumonia, may mimic primary disease of the abdomen.
Appendicitis - Answer-An inflammatory disease of the wall of the appendix that may
result in perforation with subsequent peritonitis. Diagnosis is primarily based on the
history and physical examination.
Appendicitis -Patho - Answer-Thought to be caused by the blockage of the appendiceal
lumen, leading to distention of the appendix as a result of accumulated intramural fluid
with secondary bacterial infection.
Appendicitis-Clinical Presentation - Answer-The most reliable historical feature in the
diagnosis of acute appendicitis is the sequence of symptoms. Three s/s most predictive
of acute appendicitis include pain that starts in the epigastrium or periumbilical are,
migration of the pain to the RLQ and abdominal rigidity. The pain can be diffuse or
occur at other sites of the abdomen, including LLQ. Anorexia, N/V, constipation or rarely
diarrhea accompanied by low grade fever follows the onset of pain. Pain perception
may be decreased in the elderly, s/s may be vague in elderly which is why they have an
increase incidence of perforation.
Appendicitis-Physical Examination - Answer-DX requires a detail history and PE
including pelvic exam in females. Low grade fever is usually present. Localized
tenderness is a valuable physical finding, and the patient can often specify the painful
spot with one finger. Localized tenderness is usually in the RLQ between the umbilicus
and the anteriorsuperior iliac spine (McBurney's point). There may be signs of peritoneal
irritation, including guarding, rebound tenderness and obturator and psoas sign. The
, psoas sign is elicited by asking the supine pt to raise the straightened right leg against
resistance by the practitioner. The obturator sign is elicited by passive rotation of the
right leg with the patient supine and the right hip and knee flexed.
Appendicitis-DX - Answer-Diagnosis based on History and PE. The health care provider
should immediately refer patient with suspected acute appendicitis for surgical
consultation/ER. Elevated WBC usually present, R/O ectopic pregnancy with ß-HCG. If
CRP is normal with a pt c/o abdominal pain for more than 24 hours is not suggestive of
appendicitis, finding is even greater if WBCs are not elevated. Ultrasound can be done
but CT scan has increased specificity and sensitivity.
Appendicitis-DD - Answer-Gastroenteritis
Mesenteric lymphadenitis
Acute salpingittis
Mitteschmerz
Ruptured ectopic pregnancy
Ureteral colic
Perforated Peptic ulcer
Basilar pneumonia
Appendicitis-Management - Answer-Treatment includes prompt appendectomy,
preferably within 24 hrs of symptom onset to prevent perforation and peritonitis.
Perioperative abx treatment with Metronidazole and ceftrizoxime.
If appendix perforated triple abx required: Ampicillin, Gentamicin and clindamycin or
monotherapy with Cefotetan
Appendicitis-Complications - Answer-Gangrene
Perforation with peritonitis
Abscess formation
Septicemia
Urinary retention
Small bowel obstruction
Fistula
Inguinal hernia
All of the following are typically noted in a young adult with the diagnosis of acute
appendicitis except: - Answer-A. epigastric pain.
B. positive obturator sign.
C. rebound tenderness.
D. marked febrile response.
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: - Answer-A. total WBCs, 4500 mm3; neutrophils, 35%;
bands, 2%; lymphocytes, 45%
B. total WBCs, 14,000 mm'; neutrophils, 55%; bands, 3%; lymphocytes, 38%
APPENDICITIS EXAM QUESTIONS WITH
CORRECT ANSWERS
Diseases that may cause acute abdominal pain include: - Answer-Appendicitis
• Cholecystitis
• Diverticulitis
• Small bowel obstruction
• Perforated peptic ulcer
• Peritonitis
• Ruptured ectopic pregnancy
• Ruptured abdominal aortic aneurysm
• Hypercalcemia
• Superior mesenteric artery syndrome
• Acute intermittent porphyria
• Pelvic inflammatory disease (especially in female patients)
Acute diseases of the chest, including myocardial infarction, congestive heart failure,
pulmonary infarction, and pneumonia, may mimic primary disease of the abdomen.
Appendicitis - Answer-An inflammatory disease of the wall of the appendix that may
result in perforation with subsequent peritonitis. Diagnosis is primarily based on the
history and physical examination.
Appendicitis -Patho - Answer-Thought to be caused by the blockage of the appendiceal
lumen, leading to distention of the appendix as a result of accumulated intramural fluid
with secondary bacterial infection.
Appendicitis-Clinical Presentation - Answer-The most reliable historical feature in the
diagnosis of acute appendicitis is the sequence of symptoms. Three s/s most predictive
of acute appendicitis include pain that starts in the epigastrium or periumbilical are,
migration of the pain to the RLQ and abdominal rigidity. The pain can be diffuse or
occur at other sites of the abdomen, including LLQ. Anorexia, N/V, constipation or rarely
diarrhea accompanied by low grade fever follows the onset of pain. Pain perception
may be decreased in the elderly, s/s may be vague in elderly which is why they have an
increase incidence of perforation.
Appendicitis-Physical Examination - Answer-DX requires a detail history and PE
including pelvic exam in females. Low grade fever is usually present. Localized
tenderness is a valuable physical finding, and the patient can often specify the painful
spot with one finger. Localized tenderness is usually in the RLQ between the umbilicus
and the anteriorsuperior iliac spine (McBurney's point). There may be signs of peritoneal
irritation, including guarding, rebound tenderness and obturator and psoas sign. The
, psoas sign is elicited by asking the supine pt to raise the straightened right leg against
resistance by the practitioner. The obturator sign is elicited by passive rotation of the
right leg with the patient supine and the right hip and knee flexed.
Appendicitis-DX - Answer-Diagnosis based on History and PE. The health care provider
should immediately refer patient with suspected acute appendicitis for surgical
consultation/ER. Elevated WBC usually present, R/O ectopic pregnancy with ß-HCG. If
CRP is normal with a pt c/o abdominal pain for more than 24 hours is not suggestive of
appendicitis, finding is even greater if WBCs are not elevated. Ultrasound can be done
but CT scan has increased specificity and sensitivity.
Appendicitis-DD - Answer-Gastroenteritis
Mesenteric lymphadenitis
Acute salpingittis
Mitteschmerz
Ruptured ectopic pregnancy
Ureteral colic
Perforated Peptic ulcer
Basilar pneumonia
Appendicitis-Management - Answer-Treatment includes prompt appendectomy,
preferably within 24 hrs of symptom onset to prevent perforation and peritonitis.
Perioperative abx treatment with Metronidazole and ceftrizoxime.
If appendix perforated triple abx required: Ampicillin, Gentamicin and clindamycin or
monotherapy with Cefotetan
Appendicitis-Complications - Answer-Gangrene
Perforation with peritonitis
Abscess formation
Septicemia
Urinary retention
Small bowel obstruction
Fistula
Inguinal hernia
All of the following are typically noted in a young adult with the diagnosis of acute
appendicitis except: - Answer-A. epigastric pain.
B. positive obturator sign.
C. rebound tenderness.
D. marked febrile response.
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: - Answer-A. total WBCs, 4500 mm3; neutrophils, 35%;
bands, 2%; lymphocytes, 45%
B. total WBCs, 14,000 mm'; neutrophils, 55%; bands, 3%; lymphocytes, 38%
