Surgery 02: Appendicitis

Front 1

appendicitis usually presents with ___ pain first, then ___ pain

Back 1

diffuse periumbilical
RLQ

Front 2

obturator sign is

Back 2

pain on internal rotation of R thigh (pt lies on back, R ankle rotating laterally)

Front 3

psoas sign is

Back 3

pain on R hip extension

Front 4

dunphy's sign is

Back 4

RLQ pain on coughing

Front 5

gyn conditions in the DD of acute appendicitis (4)

Back 5

ruptured ectopic preg
PID
ovarian torsion
ruptured ovarian follicle/mittelschmerz

Front 6

in appendicitis ___ typically comes first, then ___

Back 6

pain
nausea

Front 7

T/F: repeated vomiting is characteristic of appendicitis

Back 7

F (usually single bout)

Front 8

T/F: appendicitis can present with small bowel obstruction

Back 8

T

Front 9

US is used for patients with ___ level of suspicion for appendicitis

Back 9

intermediate

Front 10

leukocytosis of >___ is present in 75% of appendicitis

Back 10

10000

Front 11

urinalysis in appendicitis may show ___ (2)

Back 11

mild hematuria
mild pyuria

Front 12

triple antibiotics for appendicitis

Back 12

metronidazole
gentamicin
ampicillin

Front 13

antibiotics are given for ___ days post-op after simple appendicitis,
___ after perforated, and ___ days after diffuse peritonitis.

Back 13

1
5--7
7--10

Front 14

___% of patients have normal appendix at laparotomy

Back 14

10--20

Front 15

probability of perforation 24h after onset of symptoms
36h after
48h after

Back 15

25%
50%
75%

Front 16

4 specific indications for lap appy

Back 16

women
elderly
obese
perforation

Front 17

most common position of appendix is ___ followed by ___

Back 17

retrocecal
pelvic

Front 18

perforated appendix has a ___ presentation

Back 18

severe

Front 19

before surgery for perforated appendix do ___ (2)

Back 19

intensive fluid resuscitation
broad-spectrum ABs

Front 20

in case of suspected perforated appendix surgery starts with ___

Back 20

diagnostic laparoscopy

Front 21

if ___ during diagnostic laparoscopy for perforated appendix, do ___.

Back 21

exposing appendix is difficut
convert to open appy

Front 22

do ___ during surgery for perforated appendix

Back 22

take cultures from pus if present

Front 23

appendiceal abcess typically presents with ___ (3). it should be confirmed via ___.

Back 23

extended duration of symptoms
fever
mass
US

Front 24

before surgery for a large appendiceal abcess it is vital to ___. do this via ___ (3)

Back 24

control sepsis
NPO
broad-spectrum ABs
drainage

Front 25

drainage for large appendiceal abcesses can be ___ (3)

Back 25

transrectal
transvaginal
percutaneous

Front 26

all appendiceal abcesses require

Back 26

broad-spectrum ABs

Front 27

if appendiceal abcess improves after ___, do ___. otherwise do ___.

Back 27

broad-spectrum ABs
interval appy
early open appy

Front 28

T/F: white appendix should be removed

Back 28

true

Front 29

a white appendix should be ___ed, because ___.

Back 29

sent to pathology
microscopic anomaly may be present

Front 30

if a white appendix is found at surgery, do ___(4)

Back 30

check for Meckel's
check for mesenteric lymphadenopathy
check for pelvic abscess
check for ovarian torsion