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Appendicitis — USMLE Step 3 MCQ

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HardSurgery (Post-operative / Follow-up)AppendicitisUSMLE Step 3

A 55-year-old man has 7 days of right-lower-quadrant pain and fever. CT shows a well-circumscribed 5-cm periappendiceal abscess without appendicolith, free perforation, or diffuse peritonitis. He is hemodynamically stable after IV fluids. What is the best initial management?

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Correct answer: D — Give IV antibiotics with image-guided percutaneous abscess drainage

The best answer is “Give IV antibiotics with image-guided percutaneous abscess drainage”. A stable patient with a mature 5-cm periappendiceal abscess is initially treated nonoperatively with IV antibiotics and image-guided drainage. Immediate operation carries greater technical morbidity in the inflamed field, while antibiotics alone provide less reliable source control for a collection of this size. A stable, drainable appendiceal abscess is managed initially with antibiotics and image-guided drainage.

Reference: NCBI Bookshelf: Appendicitis: https://www.ncbi.nlm.nih.gov/books/NBK493193/