Appendicitis Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Appendicitis. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Appendicitis Indian Medical PG Question 1: A patient with right lower quadrant pain shows target sign on ultrasound. Diagnosis?
- A. Intussusception (Correct Answer)
- B. Diverticulitis
- C. Mesenteric cyst
- D. Appendicitis
Appendicitis Explanation: ***Intussusception***
- The **target sign** on ultrasound is a classic radiological finding in **intussusception**, indicating a segment of bowel telescoping into an adjacent segment.
- This condition is a common cause of **acute abdominal pain** and bowel obstruction, particularly in young children, though it can occur in adults.
*Diverticulitis*
- Diverticulitis presents with **inflammation of diverticula**, often in the left lower quadrant, but can occur in the right.
- Ultrasound findings typically include **thickened bowel wall**, pericolic fat stranding, and sometimes abscesses, not a target sign.
*Mesenteric cyst*
- A mesenteric cyst is a **fluid-filled mass** located within the mesentery and would appear as a well-defined, anechoic (fluid-filled) structure on ultrasound.
- It would not exhibit the characteristic concentric layers of the target sign.
*Appendicitis*
- Acute appendicitis is characterized by a **dilated, non-compressible appendix** with a thickened wall and surrounding inflammation on ultrasound.
- While it causes right lower quadrant pain, the specific **target sign** is not typical for appendicitis.
Appendicitis Indian Medical PG Question 2: Alvarado score is used for
- A. Acute epididymitis
- B. Acute appendicitis (Correct Answer)
- C. Acute pancreatitis
- D. Acute cholecystitis
Appendicitis Explanation: ***Acute appendicitis***
- The **Alvarado score**, also known as the MANTRELS score, is a clinical prediction rule used to assist in the diagnosis of **acute appendicitis**.
- It assigns points based on symptoms (migratory pain, anorexia, nausea/vomiting), signs (tenderness in the right iliac fossa, rebound tenderness), and laboratory findings (elevated temperature, leukocytosis, left shift of neutrophils).
*Acute epididymitis*
- Diagnosis typically relies on clinical findings like **unilateral testicular pain and swelling**, often associated with dysuria or urethral discharge.
- While it has scoring systems (like the Epididymitis Severity Score), the **Alvarado score** is not used for its diagnosis.
*Acute pancreatitis*
- Diagnosed based on characteristic **epigastric pain**, elevated serum amylase or lipase levels, and imaging findings.
- Severity is often assessed using scoring systems like **Ranson's criteria** or APACHE II, not the Alvarado score.
*Acute cholecystitis*
- Diagnosed by symptoms such as **right upper quadrant pain**, fever, and leukocytosis, often with **positive Murphy's sign** and imaging evidence (e.g., gallbladder wall thickening on ultrasound).
- The **Alvarado score** is not relevant to the diagnosis or severity assessment of acute cholecystitis.
Appendicitis Indian Medical PG Question 3: A 25-year-old patient presents with RLQ pain, fever, and vomiting. CT shows a ruptured appendix. What is the next step?
- A. Percutaneous drainage
- B. Open appendectomy (Correct Answer)
- C. Conservative treatment
- D. Laparoscopic appendectomy
Appendicitis Explanation: ***Open appendectomy***
- For a **ruptured appendix** with generalized peritonitis, **open appendectomy** is the traditional gold standard and most appropriate approach.
- Open surgery allows for **thorough peritoneal lavage**, better visualization of the entire abdominal cavity, and effective drainage of contaminated fluid.
- In the setting of **perforation with peritoneal contamination**, open approach ensures complete source control and reduces risk of missed abscesses or inadequate irrigation.
*Laparoscopic appendectomy*
- While laparoscopic appendectomy can be used in **selected cases** of perforated appendicitis, it is not the first-line approach for a ruptured appendix with generalized peritonitis.
- Laparoscopic approach may be limited in cases with **extensive contamination** and may not allow adequate peritoneal toilet.
- It is more appropriate for **uncomplicated appendicitis** or **early/localized perforation** in experienced hands.
*Percutaneous drainage*
- This is typically reserved for patients with a **well-defined appendiceal abscess** presenting late (>5 days after symptom onset) where a phlegmon or organized abscess has formed.
- Used as part of **interval appendectomy** approach: drain abscess, treat with antibiotics, then perform appendectomy 6-8 weeks later.
- Not appropriate for **acute rupture** with active peritonitis requiring immediate surgical source control.
*Conservative treatment*
- **Antibiotics alone** might be considered for **uncomplicated appendicitis** in select cases or when surgery is contraindicated.
- A **ruptured appendix** is a surgical emergency requiring operative intervention to prevent sepsis, abscess formation, and other life-threatening complications.
- Conservative management is contraindicated in the presence of perforation and peritonitis.
Appendicitis Indian Medical PG Question 4: In a female with appendicitis in pregnancy the treatment of choice is:
- A. Continue pregnancy with medical Rx
- B. Surgery after delivery
- C. Surgery at earliest (Correct Answer)
- D. Abortion with appendectomy
Appendicitis Explanation: ***Surgery at earliest***
- **Prompt surgical intervention** is crucial for appendicitis in pregnancy to prevent complications such as perforation, peritonitis, and maternal or fetal morbidity and mortality.
- Delaying surgery increases the risk of rupture, which can be devastating for both the mother and the fetus.
*Continue pregnancy with medical Rx*
- **Medical management (antibiotics alone)** is generally ineffective for acute appendicitis in pregnant women and carries a high risk of progression to perforation.
- This approach would expose the mother and fetus to serious complications, including sepsis and preterm labor, without addressing the underlying surgical pathology.
*Surgery after delivery*
- Delaying surgery until after delivery is unsafe and potentially fatal, as **appendiceal rupture could occur at any time** during pregnancy.
- The risk of **perforation, peritonitis, and subsequent complications** is too high to justify waiting.
*Abortion with appendectomy*
- **Therapeutic abortion** is not indicated for uncomplicated appendicitis in pregnancy and does not improve the maternal prognosis for the appendicitis itself.
- The focus is on treating the underlying medical condition (appendicitis) while preserving the pregnancy, if possible.
Appendicitis Indian Medical PG Question 5: Which of the following nerves is commonly damaged during McBurney's incision?
- A. Subcostal nerve
- B. Iliohypogastric nerve (Correct Answer)
- C. 11th thoracic nerve
- D. 10th thoracic nerve
Appendicitis Explanation: ***Iliohypogastric nerve***
- The **iliohypogastric nerve** is most commonly injured during **McBurney's incision** due to its superficial position and transverse course at the level of the incision.
- Damage can lead to **numbness** or altered sensation in the suprapubic region, and sometimes **weakness of the lower abdominal wall**.
*Subcostal nerve*
- The **subcostal nerve** (T12) runs inferior to the 12th rib and is generally superior to the typical site of a McBurney's incision.
- Injury to this nerve is less common during this procedure compared to the iliohypogastric and ilioinguinal nerves.
*10th thoracic nerve*
- The **10th thoracic nerve** (T10) provides sensation around the umbilicus.
- While it contributes to innervation of the abdominal wall, its location is typically well above the area of a standard McBurney's incision, making injury unlikely.
*11th thoracic nerve*
- The **11th thoracic nerve** (T11) innervates the abdominal wall and is located superior to the typical incision site for appendectomy.
- Injury to T11 during a McBurney's incision is uncommon as the nerve's course lies cephalad to the surgical field.
Appendicitis Indian Medical PG Question 6: A 25 year old male is receiving conservative management for an appendicular mass since 3 days now presents with a rising pulse rate, tachycardia and fever. The mode of management must be -
- A. Proceed to laparotomy and appendicectomy (Correct Answer)
- B. Intravenous antibiotics
- C. Continue Ochsner Sherren regimen with close monitoring
- D. Continue conservative management
Appendicitis Explanation: ***Proceed to laparotomy and appendicectomy***
- A **rising pulse rate, tachycardia, and fever** indicate **worsening sepsis** or **perforation** of the appendicular mass, necessitating urgent surgical intervention.
- Continuing conservative management in the face of these signs carries a high risk of **morbidity and mortality** from peritonitis or widespread sepsis.
*Continue Ochsner Sherren regimen with close monitoring*
- The Ochsner Sherren regimen is a **conservative approach** for a stable appendicular mass, which is no longer the case with signs of deterioration.
- **Clinical worsening** (tachycardia, rising fever, increased pulse) signifies failure of conservative management and requires a shift to surgical intervention.
*Continue conservative management*
- Continuing conservative management despite **signs of deterioration** (rising pulse, tachycardia, fever) would lead to further progression of the disease and potential life-threatening complications.
- These symptoms suggest that the infection is **not contained** and is likely spreading, indicating the need for immediate surgical treatment.
*Intravenous antibiotics*
- While intravenous antibiotics are part of the initial conservative management, they are **insufficient** alone for an appendicular mass showing signs of deterioration.
- The worsening clinical picture suggests a **failed antibiotic response** or a more severe underlying issue (e.g., abscess rupture) that requires surgical drainage or removal.
Appendicitis Indian Medical PG Question 7: Match the following drugs in Column A with their contraindications in Column B.
| Column A | Column B |
| :-- | :-- |
| 1. Morphine | 1. QT prolongation |
| 2. Amiodarone | 2. Thromboembolism |
| 3. Vigabatrin | 3. Pregnancy |
| 4. Estrogen preparations | 4. Head injury |
- A. A-1, B-3, C-2, D-4
- B. A-4, B-1, C-3, D-2 (Correct Answer)
- C. A-3, B-2, C-4, D-1
- D. A-2, B-4, C-1, D-3
Appendicitis Explanation: ***A-4, B-1, C-3, D-2***
- **Morphine** is contraindicated in **head injury** as it can increase intracranial pressure and mask neurological symptoms.
- **Amiodarone** is contraindicated in patients with **QT prolongation** due to its risk of inducing more severe arrhythmias like Torsades de Pointes.
- **Vigabatrin** is contraindicated during **pregnancy** due to its potential for teratogenicity and adverse effects on fetal development.
- **Estrogen preparations** are contraindicated in patients with a history of **thromboembolism** due to their increased risk of blood clot formation.
*A-1, B-3, C-2, D-4*
- This option incorrectly matches **Morphine** with QT prolongation and **Estrogen preparations** with head injury, which are not their primary contraindications.
- It also incorrectly links **Vigabatrin** with thromboembolism and **Amiodarone** with pregnancy.
*A-3, B-2, C-4, D-1*
- This choice incorrectly associates **Morphine** with pregnancy and **Vigabatrin** with head injury, which are not the most critical or direct contraindications.
- It also misaligns **Amiodarone** with thromboembolism and **Estrogen preparations** with QT prolongation.
*A-2, B-4, C-1, D-3*
- This option incorrectly matches **Morphine** with thromboembolism and **Amiodarone** with head injury, which are not their most significant contraindications.
- It also incorrectly links **Vigabatrin** with QT prolongation and **Estrogen preparations** with pregnancy.
Appendicitis Indian Medical PG Question 8: A 40-year-old male with right iliac fossa pain, fever. CT shows 4cm appendix with faecolith. Best management?
- A. Conservative treatment
- B. Interval appendectomy
- C. Percutaneous drainage
- D. Immediate appendectomy (Correct Answer)
Appendicitis Explanation: ***Immediate appendectomy***
- The presence of **right iliac fossa pain, fever**, and a **4cm appendix with a faecolith** on CT scan strongly indicates acute appendicitis, which requires urgent surgical intervention.
- A faecolith suggests **luminal obstruction**, increasing the risk of perforation and complications if not treated promptly.
*Conservative treatment*
- While some cases of uncomplicated appendicitis can be managed conservatively with antibiotics, this patient's presentation with a **faecolith and inflamed appendix (4cm)** suggests a higher risk of progression and complications.
- Delaying surgery could lead to **abscess formation** or **perforation**, increasing morbidity.
*Interval appendectomy*
- This approach is typically considered for patients who initially present with a **well-contained appendiceal mass or abscess** that is managed non-operatively in the acute phase.
- The current presentation is one of **acute appendicitis** requiring immediate attention, not deferred surgery after initial conservative management.
*Percutaneous drainage*
- **Percutaneous drainage** is primarily indicated for patients with a **well-defined appendiceal abscess** large enough to be drained.
- This patient's CT shows an inflamed appendix with a faecolith, but not explicitly a drained abscess, making immediate appendectomy the most appropriate first-line treatment for the acute inflammation.
Appendicitis Indian Medical PG Question 9: A patient presents with acute appendicitis. What is NOT to be done?
- A. Give antibiotics
- B. Do primary survey
- C. Perform appendectomy
- D. Check for visual acuity (Correct Answer)
Appendicitis Explanation: ***Check for visual acuity***
- **Visual acuity** assessment is not relevant to the diagnosis or management of **acute appendicitis**.
- This examination is typically performed in cases of suspected eye injury, vision changes, or neurological issues that affect vision.
- In the context of acute appendicitis, checking visual acuity would be inappropriate and waste valuable time.
*Give antibiotics*
- **Antibiotics** are crucial in managing **acute appendicitis** to prevent progression to perforation and reduce postoperative infection risk.
- They are typically administered preoperatively and continued postoperatively, especially in cases of complicated appendicitis.
- Broad-spectrum antibiotics covering **gram-negative organisms and anaerobes** are standard practice.
*Do primary survey*
- A **primary survey** (ABCDE approach) is essential in any emergent patient presentation to assess and manage immediate **life-threatening conditions**.
- While appendicitis itself may not be immediately life-threatening, ensuring patient stability and ruling out other serious conditions is critical.
- This is standard emergency medicine practice and should always be performed.
*Perform appendectomy*
- **Appendectomy** (surgical removal of the appendix) is the definitive treatment for **acute appendicitis**.
- This is the standard of care and should be performed once the diagnosis is confirmed and the patient is stable.
- Either open or laparoscopic approach can be used depending on clinical factors and surgeon expertise.
Appendicitis Indian Medical PG Question 10: Which of the following is NOT a classical symptom of acute appendicitis ?
- A. Periumbilical colic
- B. Anorexia
- C. Constipation (Correct Answer)
- D. Nausea
Appendicitis Explanation: ***Constipation***
- While patients with appendicitis may experience altered bowel habits, **constipation is not a classic or defining symptom**; **diarrhea** can even be present.
- The primary symptoms relate to inflammation and irritation of the appendix, not typically leading to significant constipation.
*Periumbilical colic*
- This is a very common early symptom, often described as a **vague, dull pain around the umbilicus** as the appendix initially becomes inflamed.
- The pain later **migrates to the right lower quadrant** as the inflammation localizes to the parietal peritoneum.
*Anorexia*
- **Loss of appetite** is a highly characteristic and almost universal symptom in patients with acute appendicitis.
- It often precedes the onset of abdominal pain and is considered a significant diagnostic indicator.
*Nausea*
- **Nausea and vomiting** are very common symptoms, often following the onset of abdominal pain.
- These gastrointestinal symptoms are due to the visceral irritation caused by the inflamed appendix.
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