A 20 year old young male presents to your clinic with 12 hour history of severe right lower abdominal pain. It has started earlier around the umbilicus and is associated with nausea and low grade fever. On examination he has a temperature of 100 F and has tenderness in right illiac fossa with rebound tenderness.
1. What is the provisional diagnosis?
2. Enlist 4 investigations you would order?
3. Outline your management plan?
( Question from MCPS Family Medicine October 19th 2016 paper)
Solution:
1. What is the provisional diagnosis?
Answer: Acute Appendicitis.
Answer:
- Complete blood count (look for a high WBC count which indicates infection)
- Urinalysis ( to rule out UTI )
- Ultrasound of the abdomen
- Chest X ray ( to rule out right lower lobe pneumonia )
3. Outline your management plan?
Answer:
- Keep the patient NPO ( nothing per oral)
- Arrange for referral to Surgical department for Appendectomy.
- Start I/V fluids to treat and prevent dehydration.
- Give first dose of I/V antibiotics before the patient leaves for surgical referral.
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