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Appendicitis Exam Questions with Complete Answers
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Appendicitis Exam Questions with Complete Answers
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Appendicitis Exam Questions withComplete Answers
A 25 year old woman is seen in the clinic three weeks following an appendectomy for
acute appendicitis. The wound is well - healed. The pathology report identifies a 1.2 cm
well-differentiated carcinoid tumor at the tip of the appendix, as well as acute
appendicitis.
What would be the next most appropriate step in diagnosis?
Ultrasonography
MRI
CT-scan
Pet-scan
No further diagnostic studies - Answer-No further diagnostic studies
Well-differentiated carcinoid tumors, less than 2cm in diameter, that are incidentally
found with a clear margin do not require additional diagnostic studies or workup. -
Answer-
A 24 year old woman presents to the office with a fever seven days following a
laparoscopic appendectomy. She doesn't feel well and complains of mild nausea. Vital
signs include a blood pressure of 140/75 mmHg, a pulse of 102 per minute, respirations
of 16 per minute, and a temperature of 38.5° C. On physical examination, the wound is
well healed. There is tenderness in the RLQ without rebound. A digital rectal
examination and bimanual examination of the pelvis suggest the presence of pelvic
tenderness. There is no evidence of a palpable mass. The next most appropriate step
is:
CT scan
Send the patient home with follow-up in one week
Admit the patient for observation
Intravenous antibiotics
, Flat and upright films of the abdomen
Chest x-ray - Answer-CT scan
CT scan is the best way to assess for the presence of an intra abdominal abscess. If an
abscess is documented, IV antibiotics should be started and a percutaneous drainage
procedure, if possible, should be performed. Observation alone, whether at home or in
the hospital is inadequate care. - Answer-
You are discharging a 35 year old, otherwise healthy man following a laparoscopic
appendectomy for an uncomplicated acute appendicitis. The patient has been
ambulating and tolerated breakfast. On examination the wounds appear to be clean,
without drainage. Vital signs include a blood pressure of 120/75 mmHg, pulse of 75 per
minute, respirations of 12 per minute. Which of the following is the most appropriate
advice for this patient on discharge?
Do not shower or bathe for three days
Continue with a liquid diet until the 1st post op visit
A low grade fever is normal in the first 24-48 hrs after surgery
Redness and drainage from the incisions is normal
Come to the Emergency Department if you experience mild pain or constipation -
Answer-A low grade fever is normal in the first 24-48 hrs after surgery
A low grade (<38.0° C) fever is not uncommon after any surgical procedure due to the
triggering of the stress response system. A higher fever or chills should be concerning.
Patients should be alerted to potential complications such as wound infection
characterized by erythema, increasing pain or purulent drainage. Constipation can be
common while patients are taking narcotic pain medication. Showers are permitted
beginning 24 hours after the procedure, once the skin has sealed. Submerging the
incision underwater in a tub or pool is usually discouraged until sutures/staples are
removed at the post-operative office visit. - Answer-
One week following surgery, a patient should have appropriate incisional pain and
tenderness that are improving daily. Many patients will note pruritis as a healthy wound
heals; in the absence of a pathologic cause (i.e., contact dermatitis secondary to
surgical tape) they should be reassured. Increasing erythema of the wound or drainage
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