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Complicated appendicitis in an older adult — SCE Acute Medicine MCQ

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HardAcute Gastrointestinal PresentationsComplicated appendicitis in an older adultSCE Acute Medicine

A 76-year-old man presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show CT shows inflamed appendix with periappendiceal collection. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Start IV antibiotics and refer for urgent surgical management

The key discriminator is that CT shows inflamed appendix with periappendiceal collection, which makes Start IV antibiotics and refer for urgent surgical management the single best answer. Give analgesia and antiemetic therapy is less appropriate because it does not address the dominant acute risk in the vignette; Give controlled oxygen and senior review would fit a different presentation or later stage of care. Start anticoagulation after assessing bleeding risk and Provide supportive care and close monitoring are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Emergency surgery standards