Appendicitis Fitz

Question 1

15. All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except:
A. epigastric pain.
B. positive obturator sign.
C. rebound tenderness.
D. marked febrile response.

Answer 1

D. marked febrile response.

Question 2

16. 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:

A. total WBCs, 4500/mm3; neutrophils, 35%; bands, 2%; lymphocytes, 45%.

B. total WBCs, 14,000/mm3; neutrophils, 55%; bands, 3%; lymphocytes, 38%.

C. total WBCs, 16,500/mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%.

D. total WBCs, 18,100/mm3; neutrophils, 55%; bands, 3%; lymphocytes, 28%.

Answer 2

C. total WBCs, 16,500/mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%.

Question 3

17. You see a 72-year-old woman who reports vomiting and abdominal cramping occurring over the past
    24 hours. In evaluating a patient with suspected appendicitis, the clinician considers that:

A. the presentation can differ according to the anatomical location of the appendix.

B. this is a common reason for acute abdominal pain in elderly patients.

C. vomiting before onset of abdominal pain is often seen.

D. the presentation is markedly different from the presentation of pelvic inflammatory disease.

Answer 3

A. the presentation can differ according to the anatomical location of the appendix

Question 4

18. The psoas sign can be best described as abdominal pain elicited by:
    A. passive extension of the hip.
    B. passive flexion and internal rotation of the hip.
    C. deep palpation.
    D. asking the patient to cough.

Answer 4

A. passive extension of the hip.

Question 5

19. The obturator sign can be best described as abdominal pain elicited by:
    A. passive extension of the hip.
    B. passive flexion and internal rotation of the hip.
    C. deep palpation.
    D. asking the patient to cough.

Answer 5

B. passive flexion and internal rotation of the hip.

Question 6

20. An 18-year-old man with a BMI = 40 kg/m2 presents with periumbilical pain, vomiting, and abdominal cramping over the past 48 hours. Physical examination
    reveals rebound tenderness, and laboratory analysis shows the presence of bandemia and a total WBC of 28,000/mm3.

To support the diagnosis of
acute appendicitis with suspected appendiceal rupture, you consider obtaining the following abdominal imaging study:

A. magnetic resonance image (MRI).
B. computed tomography (CT) scan.
C. ultrasound.
D. flat plate.

Answer 6

B. computed tomography (CT) scan.

Question 7

21. Which of the following WBC forms is an ominous finding in the presence of severe bacterial infection?

A. neutrophil
B. lymphocyte
C. basophil
D. metamyelocyte

Answer 7

D. metamyelocyte

Question 8

22. Which of the following best represents the peak ages
    for occurrence of acute appendicitis?

A. 1 to 20 years
B. 20 to 40 years
C. 10 to 30 years
D. 30 to 50 years

Answer 8

C. 10 to 30 years

Question 9

23. Clinical findings most consistent with appendiceal rupture include all of the following except:

A. abdominal discomfort less than 48 hours in duration.
B. fever greater than 102°F (>38°C).
C. palpable abdominal mass.
D. marked leukocytosis with total WBC greater than 20,000/mm3.

Answer 9

A. abdominal discomfort less than 48 hours in duration.

Question 10

24. Which of the following imaging studies potentially exposes the patient being evaluated for abdominal
    pain to the lowest ionizing radiation burden?

A. ultrasound
B. barium enema
C. CT scan
D. abdominal flat plate

Answer 10

A. ultrasound

Question 11

25. Commonly encountered diagnoses other than acute appendicitis can include which of the following in a 28-year-old with a 2-day history of lower abdominal
    pain and with right-sided pain slightly worse than left?
    (More than one can apply.)

A. constipation
B. pelvic inflammatory disease
C. ectopic pregnancy
D. splenic infarct

Answer 11

A. constipation
B. pelvic inflammatory disease
C. ectopic pregnancy

Question 12

26. Rebound tenderness is best described as abdominal pain that worsens with:

A. light palpation at the site of the discomfort.
B. release of deep palpation at the site of the discomfort.
C. palpation on the contralateral side of the abdomen.
D. deep palpation at the site of the discomfort.

Answer 12

B. release of deep palpation at the site of the discomfort.

Question 13

27. Abdominal palpation that yields rebound tenderness is also known as a positive _______ sign.

A. Markel’s
B. Murphy’s
C. Blumberg’s
D. Nikolsky’s

Answer 13

C. Blumberg’s

Question 14

28. Which of the following findings would you expect to encounter in a 33-year-old man with appendiceal abscess?

A. leukopenia with lymphocytosis
B. positive Cullen’s sign
C. protracted nausea and vomiting
D. dullness to percussion in the abdominal right lower quadrant

Answer 14

D. dullness to percussion in the abdominal right lower quadrant