Page data
Part of ASAP
SDG Sustainable Development Goals SDG03 Good health and well-being
Authors Manisha
Published 2021
License CC-BY-SA-4.0
Impact Number of views to this page. Views by admins and bots are not counted. Multiple views during the same session are counted as one. 144


This quiz assess your retention of the knowledge necessary to diagnose and treat a patient with acute appendicitis.

1 A 13 year-old girl presents to the emergency department with a 2-day history of abdominal pain that was initially localized around her umbilicus but now has localized to her right lower quadrant. You diagnose appendicitis. Where is her appendix most likely located and given the timing, is it most likely perforated or not?

Postileal, not perforated
Preileal, perforated
Retrocaecal, not perforated
Pelvic, perforated

2 A 28 year-old gentleman presents with abdominal pain. What questions are important when obtaining the history? (Choose all that apply)

Do you have any associated symptoms?
When was the last time you ate or drank anything?
Have you had any previous surgeries?
Do you have any other medical conditions?
Have any of your close contacts had similar symptoms?

3 A 26-year-old female presents with abdominal pain, a pulse of 105, respiratory rate of 18, blood pressure of 120/70, and a temperature of 36.5 C. Which of these vital signs is abnormal?

Pulse of 105
Blood Pressure of 120/70
Respiratory Rate of 18
Temperature of 36.5 C

4 A 45-year-old male presents with right lower quadrant abdominal pain. With the leg in a straight position, you extend his right hip, which exacerbates his pain. What does this physical exam maneuver indicate?

Perforated appendicitis
Retrocecal appendicitis
Intra-pelvic appendicitis
Non-perforated appendicitis

5 A 32-year-old female presents with right lower quadrant and suprapubic pain. You bend her knee and passively rotate and flex the right hip. What is the name of this physical examination manoeuvre?

Intra-pelvic appendicitis
Perforated appendicitis
Retrocecal appendicitis
Non-perforated appendicitis

6 A 21-year-old female presents with pain and a fever of 38.1 C, and you are trying to differentiate between a pyelonephritis and an appendicitis. What would make you suspect she has a pyelonephritis? (Choose all that apply.)

Her urine analysis demonstrates bacteriuria.
She has severe right lower abdominal pain.
She has a positive Rovsing’s sign.
She has colicky retroperitoneal pain.

7 A 54-year-old male presents with abdominal pain, and you are trying to differentiate between a gastroenteritis and an appendicitis. What historical factor would make it more likely he has gastroenteritis?

Anorexia
Sick Contact
Vomiting
Fever

8 A 39-year-old male presents with abdominal pain and nausea. You are trying to differentiate between gastrointestinal tuberculosis and an appendicitis. What additional systemic symptoms might a patient with gastrointestinal tuberculosis present with when compared to appendicitis? (Choose all that apply)

Hepatosplenomegaly
Emesis
Fever
Weight loss
Lymphadenopathy

9 A 33 year old women presents with symptoms of right lower quadrant abdominal pain. You suspect appendicitis. What labs are used to assess the patient status? 

CA 125, CBC, UECs (BMP)
CBC, CEA, UECs (BMP)
CBC, Cross and type, Pregnancy test
CBC, CRP, UECs (BMP)
CBC, Pregnancy test, UECs (BMP)

10 A 33-year-old female presents with symptoms that are consistent with an appendicitis. You are considering taking her to surgery and you have availability of ultrasound imaging. What ultrasound sign would be most consistent with simple acute appendicitis?

A tubular structure with a 4 mm diameter and 1 mm wall thickness
A hypoechoic fluid-filled lumen with hyperechoic mucosa/submucosa and hypoechoic muscularis layer
An ovoid-shaped organ with homogenous echotexture and central echogenic medulla
Oblong hypoechoic structure with hyperechoic debrie and septa

11 If a 50 kg female with simple appendicitis has a potassium of 3.2 mmol/L and a creatinine of 1.4 mg/dL preoperatively. What should you do prior to operating?

Order 2 L of 5% dextrose, 0.45 Normal Saline with 20 mEq of potassium over 24 hours
Order 1 L bolus of Ringer’s Lactate and 80 mEq of potassium prior to surgery 
Order 2 L bolus of Normal Saline over 24 hours
Order 1 L of 5% dextrose, 0.45 Normal Saline with 40 mEq of potassium before surgery

12 You are getting ready to perform an open appendectomy on a patient with an unruptured appendicitis. Where should you center your incision? 

Periumbilical extending in the midline superior to the umbilicus
The medial third on the line between the anterior superior iliac pine and the umbilicus
The lateral third on the line between the posterior superior iliac spine and the umbilicus
The lateral third on the line between the anterior superior iliac spine and the umbilicus

13 You are preparing a patient for surgery for simple acute appendicitis. What should your antibiotic regimen be?

No antibiotics are needed
A beta-lactamase penicillin and metronidazole 4 hours before the surgical incision
A 2nd generation cephalosporin 1 hour before the surgical incision
Linezolid for 24 hours

14 You have just completed an open appendectomy for simple appendicitis. Which antibiotic and what duration should the patient be dosed? |type="()"

A third generation cephalosporin with metronidazole for 14 days
A 2nd generation cephalosporin for less than 24 hours
Meropenem until patient’s WBC level has normalized
Oral amoxicillin until you receive culture results

15 As you are making your abdominal wall incision to evaluate a probable appendicitis, the first muscle layer you encounter is the external oblique muscle. Which way do the right external oblique muscle fibres point?|type="()"

Transversely
Angled upward to the left
Angled downward to the left
Longitudinally

16 During an appendectomy, what is the most appropriate response if you encounter purulent fluid upon entering the abdominal cavity? | type="()"

No action needs to be taken; proceed with the appendectomy
Aspirate the purulent fluid out of the abdomen and proceed with the appendectomy
Suction the purulent fluid out of the abdomen and send it for culture; then proceed with the appendectomy
Immediately abort the appendectomy procedure

17 You have safely entered the peritoneal cavity. The first structure you see is a worm-like organ. How do you confirm the identity of the appendix? (choose all that apply).

Identify a tubular structure extending from the cecum with a blind end
Identify attachment to a muscular organ
Follow the convergence of the taenia coli
Identify the ileum, which is another tubular structure attached to the cecum

18 The mesoappendix is the peritoneal fold encasing the appendix. What structure do you clamp, cut and ligate within the mesoappendix during an appendectomy procedure?| type="()"

Ureter
Appendiceal artery
Fallopian tube
Ileocecal artery
External oblique aponeurosis
External and internal oblique muscles
Subcutaneous tissue including Scarpa’s layer
Skin

19 You have completed an appendectomy without any complications. What are typical post-operative orders for a patient with a simple appendicitis? | type “()”

72 hours of antibiotics to prevent surgical site infection
Immobilization until abdominal pain resolves
Regular diet once anaesthesia is metabolized
Keep the wound in an operative dressing for 7 days