OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is appendicitis. While this may seem a odd practice, it is useful to see multiple examples of how appendicitis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES:PREGNANCY
Question # 1
A 28 year old G2P1 woman comes to the clinic with nausea, vomiting, and right lower quadrant pain. She is at 20 weeks gestation. She explains that these symptoms all began about 10 hours ago, and have become progressively worse. She denies experiencing any chills, dysuria, or urinary frequency but is unsure if she has a fever. Her temperature is 100.5°F, blood pressure si 125/70 mm Hg, pulse is 96/min, and respirations are 19/min. An abdominal exam shows a uterine height just above the umbilicus. Her fetal hear rate is 140/min. There is slight tenderness to palpation in the right lower quadrant. There is no guarding. Labs are collected and show the values below:
- Hemoglobin: 12.5 g/L
- Leukocytes: 16,500/µL
What is a likely diagnosis in this patient?
Explanation: this could be a number of things, however acute appendicitis should be strongly considered (and could be the answer).
Question # 2
A 29 year old primigravida woman is at 15 weeks gestation when she comes to the emergency department. She has been experiencing nausea and right sided abodminla pain for the past 24 hours. She also explains that she has lost her appetite for the past 2 days. She denies vomiting, and so far her course of pregnancy has been uncomplicated. Her temperature is 100.9°F, pulse is 95/min, respirations are 21/min, and blood pressure is 120/80 mm Hg. Fetal heart tones are heard clearly using doppler sonography. An abodmainl exam shows right lower quadrant tenderness without any rigidity or rebound. Laboratory results are below:
Blood:
- Hemoglobin: 13.3 g/dL
- Leukocyte count: 16,000/mm³
- Segmented neutrophils: 75%
- Bands: 15%
- Lymphocytes: 10%
Urine:
- Specific gravity: 1.029
- Protein: trace
- RBC: 1-2/hpf
- WBC: numerous
- Nitrites: negative
- Bacteria: none
What is the most likely diagnosis?
Explanation: this could be a number of things, however acute appendicitis should be strongly considered (and could be the answer).
Question # 3
A 38 year old woman comes to the ER 10 hours after she has the onset of abdominal pain, nausea, and a decreased appetite. She explains that the pain is localized to the right lower quadrant of the abdomen. The patient’s last menstrual period was last week. Her temperature is 100.5°F. Her abdominal exam is remarkable for RLQ tenderness. A pelvic exam shows no purulent discharge and there is no cervical motion tenderness. The patient’s leukocyte count is 14,000/mm³. A urinalysis is unremarkable. What diagnosis should be considered in this patient?
Explanation: RLQ pain + fever + no pregnancy + no cervical motion tenderness + elevated white count + no UTI = appendicitis
Question # 4
A 25 year old man develops vague periumbilical pain that a few hours later becomes sharp, severe, and constant. It is well localized to the right lower quadrant of the abdomen. A physical examination reveals that he has abdominal tenderness, guarding and rebound on the right and below the umbilicus. He has a temperature of 100.0°F and a WBC of 12,500, with neutrophilia and immature forms.
Explanation: RLQ in young male + elevated white count = appendicitis
Question # 5
A 30 year old male comes to the ER with severe abdominal pain that began 5 hours ago. The pain started in the periumbilical area, but has not migrated to the right lower quadrant. He also mentions that he has had nausea since the onest of the pain and has vomited twice since arriving to the hospital. He is otherwise healthy, has no notable past medical history, and takes no medications. HIs temptauiure is 102.2°F, blood pressure is 125/75 mm Hg, pulse is 100/min, and respirations are 21/min. An abdominal exam shows tenderness in the right lower quadrant. Palpation of the left lower quadrant produces pain in the lower right quadrant. The patient’s urinalysis is unremarkable, however his white count is 15,000. What is the likely diagnosis in this patient?
Explanation: RLQ in young male + Rovsing sign + elevated white count = appendicitis
Page Updated: 10.18.2016