A 1-year-old boy is brought to the emergency room by his parents because of inconsolable crying and diarrhea for the past 6 hours. As the physician is concerned about acute appendicitis, she consults the literature base. She finds a paper with a table that summarizes data regarding the diagnostic accuracy of multiple clinical findings for appendicitis: Clinical finding Sensitivity Specificity Abdominal guarding (in children of all ages) 0.70 0.85 Anorexia (in children of all ages) 0.75 0.50 Abdominal rebound (in children ≥ 5 years of age) 0.85 0.65 Vomiting (in children of all ages) 0.40 0.63 Fever (in children from 1 month to 2 years of age) 0.80 0.80 Based on the table, the absence of which clinical finding would most accurately rule out appendicitis in this patient?
AGuarding
BVomiting
CAnorexia
DFever
ERebound
A 12-year-old boy is brought to the emergency department late at night by his worried mother. She says he has not been feeling well since this morning after breakfast. He skipped both lunch and dinner. He complains of abdominal pain as he points towards his lower abdomen but says that the pain initially started at the center of his belly. His mother adds that he vomited once on the way to the hospital. His past medical history is noncontributory and his vaccinations are up to date. His temperature is 38.1°C (100.6°F), pulse is 98/min, respirations are 20/min, and blood pressure is 110/75 mm Hg. Physical examination reveals right lower quadrant tenderness. The patient is prepared for laparoscopic abdominal surgery. Which of the following structures is most likely to aid the surgeons in finding the source of this patient's pain and fever?
AMcBurney's point
BLinea Semilunaris
CTransumbilical plane
DArcuate line
ETeniae coli
A 19-year-old man comes to the emergency department because of abdominal pain, nausea, and vomiting for 4 hours. Initially, the pain was dull and located diffusely around his umbilicus, but it has now become sharper and moved towards his lower right side. He has no history of serious illness and takes no medications. His temperature is 38.2°C (100.7°F) and blood pressure is 123/80 mm Hg. Physical examination shows severe right lower quadrant tenderness without rebound or guarding; bowel sounds are decreased. His hemoglobin concentration is 14.2 g/dL, leukocyte count is 12,000/mm3, and platelet count is 280,000/mm3. Abdominal ultrasonography shows a dilated noncompressible appendix with distinct wall layers and echogenic periappendiceal fat. Intravenous fluid resuscitation is begun. Which of the following is the most appropriate next step in management?
APrescribe oral amoxicillin and clavulanic acid
BPerform laparoscopic appendectomy
CPerform percutaneous drainage
DPerform interval appendectomy
EBegin bowel rest and nasogastric aspiration
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