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Aquifer Surgery Cases questions with correct answers 2024/2025
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Aquifer Surgery CasesB (Correct Answer B. The pathophysiology of appendicitis often begins with an obstruction of
the lumen of the appendix caused by lymphoid hyperplasia or a fecalith. This obstruction is
thought to lead to increased intraluminal pressure with decreased blood flow and venous
obstruction. The resulting swelling and edema leads to ischemia followed by gangrene and
perforation if left undiagnosed and untreated.)
The first step in the pathophysiology of appendicitis is:
A. Gangrene of appendix
B. Obstruction of the lumen of the appendix by lymphoid hyperplasia or fecalith
C. Venous obstruction
D. Ischemia
E. Perforation of the appendix lumen
D (Correct Answer D. A splenic infarct is a rare condition that usually presents with abdominal
pain that tends to be in the LUQ. It is most often seen accompanied by hematologic or VTE
disorders. Ureteral stone, Crohn's disease, ovarian torsion, and ectopic pregnancy may all
present with RLQ pain and need to be considered when entertaining the diagnosis of
appendicitis.)
All of the following should be in the differential diagnosis of right lower quadrant pain except:
A. Ureteral stone
B. Crohn's disease
C. Ovarian torsion
D. Splenic infarct
E. Ectopic pregnancy
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, appendicitis
-initially caused by an obstruction of the lumen of the appendix either by a fecalith or by
lymphoid hyperplasia
-The mucosa of the appendix will continue to secrete and this will eventually lead to distention of
the appendix which in turn will lead to impaired venous return and edema of the appendiceal
wall
-As this happens, the arterial blood supply will become compromised and this will lead to
ischemia, and eventual gangrene of the appendix
-It is a short step from here to perforation
peritonitis
A free perforation into the abdominal cavity will lead to ____ which is a surgical emergency.
However, the extravasation can be contained, usually by the omentum, to form either a localized
phlegmon, which is just a mass of inflammatory tissue, or a more discrete abscess.
A (Correct Answer A. Rovsing's sign applies to physical maneuvers in appendicitis patients. The
obturator sign is RLQ pain with hip and knee flexion with internal hip rotation. The psoas sign is
RLQ pain with passive right hip extension. McBurney's point is midway between the umbilicus
and the anterior superior iliac spine. Murphy's sign is for RUQ pain with palpation during
inspiration that is used to diagnose cholecystitis.)
Which of the following statements about physical exam maneuvers in a patient with appendicitis
is true?
A. Rovsing's sign: Right lower quadrant pain with palpation of the left lower quadrant
B. Psoas sign: Right lower quadrant pain with right hip and knee flexion with internal rotation of
the hip
C. Obturator sign: Right lower quadrant pain with right hip extension
D. McBurney's point: Maximal tenderness in the suprapubic region
E. Murphy's sign: Right lower quadrant tenderness with deep inspiration
C (Correct Answer C. The differential diagnosis is very broad for patients, especially women,
with RLQ pain. In the past, patients were taken for surgery just based on the physical exam
findings. Currently, patients receive imaging to make the definitive diagnosis.)
Which of the following statements about the physical exam in appendicitis is not true?
A. Retrocecal appendicitis may present without right lower quadrant pain.
B. Retrocecal appendicitis may be mistaken for adnexal tenderness on pelvic exam.
C. Appendicitis can be definitively diagnosed with physical exam alone.
D. Early appendicitis may present without tenderness.
E. Appendicitis in the elderly often have atypical physical exams.
appendicitis
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