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Appendicitis — MCCQE Part 1 MCQ

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EasyAbdominal PainAppendicitisMCCQE Part 1

21-year-old man presents with periumbilical pain migrating to the right lower quadrant. He has anorexia, low-grade fever and focal rebound tenderness. Which of the following is the most appropriate next step?

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Correct answer: D — Provide analgesia, obtain surgical assessment and appropriate imaging/labs

Provide analgesia, obtain surgical assessment and appropriate imaging/labs is best because migration of pain and focal peritonism suggest appendicitis. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Analgesia should not be withheld while awaiting surgical assessment.

Reference: Canadian Association of General Surgeons guidance