| What is Rovsing’s sign in the context of appendicitis? | pain at RIF with sudden thurst of palpation at left flank of abdomen | Muscle guard at right iliac fossa (RIF) 5. Rovsing’s sign – pain at RIF with sudden thurst of palpation at left flank of abdomen 6. Rebound tenderness – pain at RIF with sudden withdrawal of the maintained pressure with hand 7. | 60 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | Rovsing’s sign – pain at RIF with sudden thurst of palpation at left flank of abdomen 6. | 1 | page=1,block=3 | 0.700 | valid |
| What is the pointing sign in acute appendicitis? | The patient points with the index finger the site of maximum pain at region of Mc Burney’s point | PRESENTATION OF APPENDICITIS MAY BE AS 1) Acute appendicitis - early / delayed 2) Appendicular mass 3) Recurrent appendicitis SYMPTOMS OF ACUTE APPENDICITIS 1) Pain a) Periumbilical or epigastric colic (in nonobstructive type the pain may start at RIF) b) Shifting of pain from periumbilical region or begins from this site 2) Nausea/ vomiting 3) Pyrexia (usually absent in first 6 hours) 4) Loss of appetite NB: a) Pain always precedes vomiting (Murphy). Onset of symptom is more acute and abrupt in acute obstructive appendicitis b) If the patient has rigor and high fever within 24hrs of the onset of pain, appendicitis is most unlikely SIGNS OF ACUTE APPENDICITIS 1. Pointing sign – The patient points with the index finger the site of maximum pain at region of Mc Burney’s point 2. Cough test – C/O pain at right iliac fossa on coughing 3. Tenderness at Mc Burney’s point 4. | 687 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | Pointing sign – The patient points with the index finger the site of maximum pain at region of Mc Burney’s point 2. | 1 |
| What does rebound tenderness indicate in appendicitis? | pain at RIF with sudden withdrawal of the maintained pressure with hand | Muscle guard at right iliac fossa (RIF) 5. Rovsing’s sign – pain at RIF with sudden thurst of palpation at left flank of abdomen 6. Rebound tenderness – pain at RIF with sudden withdrawal of the maintained pressure with hand 7. | 153 | definition | 0.980 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | Rebound tenderness – pain at RIF with sudden withdrawal of the maintained pressure with hand 7. | 1 | page=1,block=3 | 0.700 | valid |
| What factors should guide the decision to operate on a patient with acute appendicitis? | Clinical state and experience of the clinician | The essential preoperative investigations including routine blood sugar, urea, creatinine, Hb%, chest X-ray and ECG in all elderly patients. Intravenous fluid and broad-spectrum antibiotics to be started on admission 2) Acute appendicitis should be recognized early before it is allowed to reach the stage of peritonitis or an abscess formation. Clinical state and experience of the clinician should guide when to operate and when not to operate CHECKLIST FOR AN UNWELL PATIENT (HAVING FEVER, ANOREXIA ETC) FOLLOWING APPENDICECTOMY 1) Examine the operation wound for induration, collection or purulent discharge 2) Consider residual abscess (pelvis, RIF or Hepatorenal pouch of Morrison 3) Examine iungs for pneumonia or collapse 4) Thrombophlebitis 5) Any jaundice or enlarged liver 6) Urinary tract infection if any | 346 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | Intravenous fluid and broad-spectrum antibiotics to be started on admission 2) Acute appendicitis should be recognized early before it is allowed to reach the stage of peritonitis or an abscess formation. Clinical state and experience of the clinician should guide when to operate and when not to operate CHECKLIST FOR AN UNWELL PATIENT (HAVING FEVER, ANOREXIA ETC) FOLLOWING APPENDICECTOMY 1) Examine the operation wound for induration, collection or purulent discharge 2) Consider residual abscess (pelvis, RIF or Hepatorenal pouch of Morrison 3) Examine iungs for pneumonia or collapse 4) |
| What is the main method of diagnosing appendicitis? | mainly clinical | Diagnosis is mainly clinical. Usually a past history suggestive of acute appendicitis is present and latter shows a history of recurrent acute pain at RIF or it may follow a chronic course. Signs of indigestion, flatulence may be present. Mc Burney’s point tender. Ultrasonography often compliment the clinical diagnosis. CT-Scan and barium follow through X-ray are often required to confirm the diagnosis. Treatment is appendicectomy - open or laparoscopic | 13 | definition | 0.940 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | Diagnosis is mainly clinical. | 1 | page=1,block=48 | 0.700 | valid |
| What are potential locations for a residual abscess after an appendicectomy? | pelvis, RIF or Hepatorenal pouch of Morrison | The essential preoperative investigations including routine blood sugar, urea, creatinine, Hb%, chest X-ray and ECG in all elderly patients. Intravenous fluid and broad-spectrum antibiotics to be started on admission 2) Acute appendicitis should be recognized early before it is allowed to reach the stage of peritonitis or an abscess formation. Clinical state and experience of the clinician should guide when to operate and when not to operate CHECKLIST FOR AN UNWELL PATIENT (HAVING FEVER, ANOREXIA ETC) FOLLOWING APPENDICECTOMY 1) Examine the operation wound for induration, collection or purulent discharge 2) Consider residual abscess (pelvis, RIF or Hepatorenal pouch of Morrison 3) Examine iungs for pneumonia or collapse 4) Thrombophlebitis 5) Any jaundice or enlarged liver 6) Urinary tract infection if any | 642 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | Clinical state and experience of the clinician should guide when to operate and when not to operate CHECKLIST FOR AN UNWELL PATIENT (HAVING FEVER, ANOREXIA ETC) FOLLOWING APPENDICECTOMY 1) Examine the operation wound for induration, collection or purulent discharge 2) Consider residual abscess (pelvis, RIF or Hepatorenal pouch of Morrison 3) Examine iungs for pneumonia or collapse 4) Thrombophlebitis 5) Any jaundice or enlarged liver 6) Urinary tract infection if any |
| What are the three main presentations of appendicitis? | 1) Acute appendicitis - early / delayed 2) Appendicular mass 3) Recurrent appendicitis | PRESENTATION OF APPENDICITIS MAY BE AS 1) Acute appendicitis - early / delayed 2) Appendicular mass 3) Recurrent appendicitis SYMPTOMS OF ACUTE APPENDICITIS 1) Pain a) Periumbilical or epigastric colic (in nonobstructive type the pain may start at RIF) b) Shifting of pain from periumbilical region or begins from this site 2) Nausea/ vomiting 3) Pyrexia (usually absent in first 6 hours) 4) Loss of appetite NB: a) Pain always precedes vomiting (Murphy). Onset of symptom is more acute and abrupt in acute obstructive appendicitis b) If the patient has rigor and high fever within 24hrs of the onset of pain, appendicitis is most unlikely SIGNS OF ACUTE APPENDICITIS 1. Pointing sign – The patient points with the index finger the site of maximum pain at region of Mc Burney’s point 2. Cough test – C/O pain at right iliac fossa on coughing 3. Tenderness at Mc Burney’s point 4. | 39 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | PRESENTATION OF APPENDICITIS MAY BE AS 1) Acute appendicitis - early / delayed 2) Appendicular mass 3) Recurrent appendicitis SYMPTOMS OF ACUTE APPENDICITIS 1) Pain a) Periumbilical or epigastric colic (in nonobstructive type the pain may start at RIF) b) Shifting of pain from periumbilical region or begins from this site 2) Nausea/ vomiting 3) Pyrexia (usually absent in first 6 hours) 4) Loss of appetite NB: a) Pain always precedes vomiting (Murphy). |
| What imaging techniques are often required to confirm a diagnosis of appendicitis? | CT-Scan and barium follow through X-ray | Diagnosis is mainly clinical. Usually a past history suggestive of acute appendicitis is present and latter shows a history of recurrent acute pain at RIF or it may follow a chronic course. Signs of indigestion, flatulence may be present. Mc Burney’s point tender. Ultrasonography often compliment the clinical diagnosis. CT-Scan and barium follow through X-ray are often required to confirm the diagnosis. Treatment is appendicectomy - open or laparoscopic | 322 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | Ultrasonography often compliment the clinical diagnosis. CT-Scan and barium follow through X-ray are often required to confirm the diagnosis. | 1 | page=1,block=48 | 0.700 | valid |
| What investigations are considered essential before surgery for elderly patients? | routine blood sugar, urea, creatinine, Hb%, chest X-ray and ECG | The essential preoperative investigations including routine blood sugar, urea, creatinine, Hb%, chest X-ray and ECG in all elderly patients. Intravenous fluid and broad-spectrum antibiotics to be started on admission 2) Acute appendicitis should be recognized early before it is allowed to reach the stage of peritonitis or an abscess formation. Clinical state and experience of the clinician should guide when to operate and when not to operate CHECKLIST FOR AN UNWELL PATIENT (HAVING FEVER, ANOREXIA ETC) FOLLOWING APPENDICECTOMY 1) Examine the operation wound for induration, collection or purulent discharge 2) Consider residual abscess (pelvis, RIF or Hepatorenal pouch of Morrison 3) Examine iungs for pneumonia or collapse 4) Thrombophlebitis 5) Any jaundice or enlarged liver 6) Urinary tract infection if any | 52 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | The essential preoperative investigations including routine blood sugar, urea, creatinine, Hb%, chest X-ray and ECG in all elderly patients. | 1 | page=1,block=18 |
| What is a potential risk of surgery in the presence of an appendicular mass? | more bleeding, injury to caecum and ileum; faecal fistula may develop | Ochsner sherren regimen S/S Improving conservative treatment continued S/S Deteriorating asses by USG for pus collection USG guided aspiration/ open drainage OCHSNER-SHERREN CONSERVATIVE TREATMENT (In the presence of appendicular mass, surgery may cause more bleeding, injury to caecum and ileum; faecal fistula may develop). Conservative treatment includes • IV fluid: • Broad spectrum antibiotics • Vitamins • No purgative • No Enema | 254 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726567743_appendicitis.pdf | Ochsner sherren regimen S/S Improving conservative treatment continued S/S Deteriorating asses by USG for pus collection USG guided aspiration/ open drainage OCHSNER-SHERREN CONSERVATIVE TREATMENT (In the presence of appendicular mass, surgery may cause more bleeding, injury to caecum and ileum; faecal fistula may develop). | 1 | page=1,block=32 | 0.700 | valid |