BM41 Y4 IU MCQ- ANSWERS : ACUTE APPENDICITIS

MCQ

Clinical
1- What is the localization of appendix the most frequency?
A. Iliac
B. Pelvis
C. Mesocoeliac
D. Subhepatic

2- What is the triad clinical biologic of diagnosis of appendicitis?
A. Pain and Guarding Right Iliac Fossa
B. Abdominal distension.
C. Fever at 38 C
D. Leucocytes>10.000/mm3

3- What gestures regarding an acute appendicitis?
A. Abdominal palpation
B. Rectal palpation
C. Examination testes
D. Hernia orifice examination

4- What is the right proposition which accompany all attack acute appendicitis?
A. Pain right flank
B. Guarding exquisite
C. Pain of pouch
D. Infectious syndrome
E. Vomiting

5- What appendicular localization evokes a feverish obstruction?
A. Right iliac
B. Retrocaecal
C. Pelvis
D. Mesocoeliac

6- In infant, what’re the signs evocative of acute appendicitis?
A. Diarrhea.
B. Vomiting.
C. Insomnia.
D. Anorexia.
E. Abdominal pain.

7- Pain in the hypogastrium when internal rotation of the hip is :
A. The pointing sign.
B. The psoas sign.
C. The obturator sign.
D. Rovsing's sign.
E. Blumbert’s sign

8- Pain felt in the right iliac fossa when you press deeply in his left iliac fossa is:
A. The pointing sign.
B. The psoas sign.
C. The obturator sign.
D. Rovsing's sign.
E. Blumbert’s sign

9- Pressing the abdomen at Mc Burney's point and then rapidly released, the patient may increase in pain, is:
A. The pointing sign.
B. The psoas sign.
C. The obturator sign.
D. Rovsing's sign.
E. Blumbert’s sign.

10- Move the patient's legs the pain felt in the right iliac fossa on extension of the hip, and the right hip flexed for pain relief, is:
A. The pointing sign.
B. The psoas sign.
C. The obturator sign.
D. Rovsing's sign.
E. Blumbert’s sign.

11- The patient is then asked to point to where the pain began and to where it move,is:
A. The pointing sign.
B. The psoas sign.
C. The obturator sign.
D. Rovsing's sign.
E. Blumbert’s sign.

12. Which of the following is the least common position of appendix?
A. Retroileal.
B. Retroceacal.
C. Postileal.
D. Pelvic.
E. Subhepatic.

13- Clinical features likely in 23-year-old man with an acutely inflamed retrocaecal appendix include
A- Right iliac tenderness.
B- Temperature 37.5 C.
C- Anoerxia.
D- Back pain.
E- Macroscopic haematuria.

14- Regarding appendicitis
A. The risk of developing the illness is greatest in childhood
B. Mortality increases with age and is greatest in the elderly
C. 20% of appendices are extraperitoneal in a retrocaecal position
D. Faecoliths are present in 75-80% of resected specimens
E. Appendicitis is a possible diagnosis in the absence of abdominal tenderness

15. Which of the following is the least common position of appendix?
A. Retroileal
B. Retroceacal
C. Postileal
D. Pelvic
E. Subhepatic.

16- Concernant l’appendicite aiguë
A. L’appendicite mésocoeliaque peut simuler une salpingite aiguë
B. L’appendicite pelvienne peut être révélée par des signes urinaires.
C. Le toucher rectal est toujours douloureux
D. Il existe souvent une hyperleucocytose à PNN.

17- Regarding acute appendicitis
A. Mesocoeliac appendicitis can mimic an acute salpigitis.
B. Pelvic appendicitis can be revealed by urinary sign.
C. Rectal examination is always pain.
D. There is often polymorphonuclear neutrophil hyperleukocytosis.
Answer: BD

18- A ppendix shows the histology of the necrotic area, images of vascular thrombosis, an inflammatory infiltrate small. They are:
A. A normal appendix.
B. A catarrhal appendicitis.
C. A gangrenous appendix.
D. An appendiceal abscess.
E. A subacute endoappendicite.

19- With regard to eliciting tenderness on examination of patient with acute abdominal pain
A- Rebound tenderness can be assessed by finger percussion.
B- Tenderness associated with colonic disease is usually present in the midline suprapubically.
C- If tenderness is present without guarding, then peritonitis will not be present.
D- Tenderness on rectal examination is highly suggestive of a pelvic abscess.
E- Localised tenderness in the right iliac fossa is the most important single clinical sign of acute appendicitis.

20- A 79-year-old man has had abdominal pain for 4 days. An operation is performed, and a gangrenous appendix is removed. The stump is inverted. Why does acute appendicitis in elderly patients and in children have a worse prognosis?
A. The appendix is retrocecal.
B. The appendix is in the preileal position.
C. The appendix is in pelvic position.
D. The omentum and peritoneal cavity appear to be less efficient in localizing the disease in this age group.

21- A 17-year-old boy complains of pain in the lower abdomen (mainly on the right side). Symptoms commenced 12 hours before admission. He had noted anorexia in this period. Examination reveals tenderness in the right iliac fossa, which was maximal 1cm below Mc Burney’s point. In appendicitis, where does the pain frequently commence?
A. In the right iliac fossa and remains there.
B. In the back and moves to the right iliac fossa.
C. In the rectal region and moves to the right iliac fossa.
D. In the umbilical region and moves to the right iliac fossa.
E. In the right flank.

22- On examination, patients presenting with appendicitis typically show maximal tenderness over which of the following?
A. Inguinal region.
B. Immediately above the umbilicus.
C. At a point between the outer one-third and the inner two-third of a line between the umbilicus and the anterior superior iliac spine.
D. At a point between the outer two-thirds and the inner one-third of a line between the umbilicus and the anterior superior iliac spine.
E. At the midpoint of a line between the umbilicus and the anterior superior iliac spine.

23- A 79-year-old man has hade abdominal pain for 4 days. An operation is performed, an a gangrenous appendix is removed. The stump is inverted. Why does acute appendicitis in elderly patients and in children have a worse prognosis?
A. The appendix is retrocecal.
B. The appendix is perileal position.
C. The appendix is in the pelvic position.
D. The omentum and peritoneal cavity appear to be less efficient in localizing the disease of these age groups.
E. The appendix is longer in these age groups.

24- Acute appendicitis is most commonly associated with which of the following signs?
A. Temperature above 104؛ F.
B. Frequent loose stools.
C. Anorexia, abdominal pain, and right lower quadrant tenderness.
D. White blood cell count greater than 20,000 per cu.mm.

25. True statements regarding the pathophysiology of acute appendicitis include which of the following:
A. Fecaliths are responsible for the disease process in approximately 30% of adult patients.
B. Lymphoid hyperplasia is a rare cause of appendicitis in young patients.
C. Clostridium difficile is implicated as a pathogenic organism.
D. Carcinoid tumors account for approximately 5% of all cases of acute appendicitis.

26- A 12- year-old boy complains of pain in the lower abdomen (mainly on the right side). Symptoms commenced at 12 hours before admission. He had noted anorexia during this period. Examination revealed tenderness in the right iliac fossa, which was maximal 1 cm below McBurney’s point. In appendicitis, where does the pain frequently commence?
A. In the right iliac fossa and remains there.
B. In the back and move to the right iliac fossa.
C. In the rectal region and moves to the right iliac fossa.
D. In the umbilical region and then moves to the right iliac fossa.
E. In the right flank.

27- A 28-year-old man is admitted in emergency department complaining of pain in the umbilical region that moves to the right iliac fossa. Which is a corroborative sign of acute appendicitis?
A. Referred pain in the right side with pressure on the left (Rovsing’s sign).
B. Increased of pain with testicular elevation.
C. Relief pain in the lower abdomen with extent of thigh.
D. Relief pain in the lower abdomen with internal rotation of right thigh.
E. Hyperanesthesia in the right lower abdomen.

28. Among the different landforms (topographic) of appendicitis, one can find:
A - Retro-caecal.
B - Sub-liver.
C - Intra hernia.
D - Meso-celiac.
E - Pelvic.

29- The diagnosis of acute appendicitis is most difficult to establish in:
A. Persons aged 60 and older.
B. Women aged 18 to 35.
C. Infants younger than 1 year.
D. Pregnant women.

30. Regarding appendicitis
A. The risk of developing the illness is greatest in childhood.
B. Mortality increases with age and is greatest in the elderly.
C. 20% of appendices are extraperitoneal in a retrocaecal position.
D. Faecoliths are present in 75-80% of resected specimens.
E. Appendicitis is a possible diagnosis in the absence of abdominal tenderness.

31. Special populations of people that may have delayed diagnosis of acute appendicitis due to atypical presentation include:
A. Very young patients.
B. Elderly patients.
C. AIDS patients.
D. Pregnant patients.
E. All of the above.

32- On examination, patients presenting with appendicitis typically show maximal tenderness over which of the following?
A. Inguinal region.
B. Immediately above the umbilicus.
C. At a point between the outer one-third and inner two-third of a line between the umbilicus and the anterior superior iliac spine.
D. At a point between the outer two-third and inner one-third of a line between the umbilicus and the anterior superior iliac spine.
E. At the midpoint of a line between the umbilicus and the anterior superior iliac spine.

33. A patient presents with a subacute syndrome appendix. On abdominal examination, you can not find such clear physical signs that you expect, you're not sure, but the patient is obese and the review difficult. You remember from the following:
A - The lack of defense of the right iliac fossa cripple the diagnosis discussed.
B - The very furred tongue is a sign recognized guidance.
C - A normal number of white blood lymphocytosis but with a confirmed diagnosis.
D - In the absence of an emergency, a barium enema provides useful information to confirm the achievement appendix.
E - Low-grade fever of 38 ° C encouraged to prescribe rest and antibiotic treatment a few days.

34. In the case of acute appendicitis, pelvic position, the adolescent:
A - Bradycardia, when it exists, is a good sign of diagnostic orientation.
B - The pain may be epigastric early.
C - Nausea and vomiting are symptoms often found.
D - Coated tongue (furred tongue) is a good diagnostic feature.
E - Signs of local review are, in most cases, peri-umbilical.

35. Regarding an acute generalized peritonitis, we note for the appendicular origin (not ectopic)
A - A history of painful crisis in the right iliac fossa.
B - A digital rectal pain.
C - Existence of fever at the beginning.
D - The early signs in the right iliac fossa.
E - The existence of a defense of the right upper quadrant.

36. A patient presents suprapubic pain, urinary frequency and dysuria. The temperature is 38.2 °, leukocytosis is 12 000 with polynucleosis. On examination, there is a suprapubic pain with defense at this level. The right iliac fossa is smooth and painless. Digital rectal examination is painful on the right side. The urine is clear and the sediment normal. What is your diagnosis?
A - Cystitis.
B - Retro-cecal appendicitis.
C - Appendicitis pelvic.
D - Appendicitis mésocœliaque.
E - subhepatic appendicitis.

37. Acute appendicitis in a young adult, free of other pathology, may be by:
A - Intestinal obstruction.
B - An intermittent dysphagia.
C - Peritonitis.
D - Vomiting.
E - A Gram-sepsis.

38. Among the following statements about acute appendicitis include the usual position (s) is (are) true (s):
A - The onset of symptoms may be epigastric.
B - The diagnosis of acute appendicitis is clinic.
C - The leukocytosis is uncommon.
D - Digital rectal examination is always painful.
E - The defense of the right iliac fossa confirms the diagnosis.

39- Which of the following most often initiates the development of acute appendicitis?
A. A viral infection.
B. Acute gastroenteritis.
C. Obstruction of the appendiceal lumen.
D. A primary clostridial infection.

40. Among the physical signs following, indicate that (those) that can be found on clinical examination of a patient with intestinal dysfunction:
A - Swelling firm the right iliac fossa.
B - Pain on the right side face of the rectum.
C - Epigastric thickening.
D - Cordon painful downwards and inwards, at the side and the left iliac fossa.
E - Pain caused by the right iliac fossa.

41. The usual manifestations of appendicitis pelvic position include:
A - Acute retention of urine.
B - An abscess in the cul-de-sac.
C - A psoïtis.
D - A pain accurate in the digital rectal.
E - A pneumaturia.

42- Acute appendicitis is most commonly associated with which of the following signs?
A. Temperature above 104؛ F.
B. Frequent loose stools.
C. Anorexia, abdominal pain, and right lower quadrant tenderness.
D. White blood cell count greater than 20,000 per cu.mm.

43. Remember, one of the following clinical signs, those usually found in acute appendicitis in children aged 5 to 10 years:
A. Pain in the right iliac fossa.
B. Fever.
C. Nausea or vomiting.
D. Diarrhea.
E. Defense on palpation of the right iliac fossa.

44. Among the following statements about acute appendicitis in usual position, the quote (s) is (are) true (s):
A. The onset of symptoms may be epigastric.
B. Diagnosis of acute appendicitis is clinical.
C. Leukocytosis is uncommon.
D. DRE is always painful.
E. The defense of the right iliac fossa confirms the diagnosis.

45. A patient presents Suprapubic pain, urinary frequency and dysuria. The temperature is 38.2 C, leukocytosis is 12 000 with polynucleosis. On examination, there is a suprapubic pain with defense at this level. The right iliac fossa is smooth and painless. Digital rectal examination is painful on the right. The urine is clear. What is your diagnosis?
A. Cystitis.
B. Retrocaecal appendicitis.
C. Appendicitis pelvic.
D. Meso-celiac appendicitis.
E. Subhepatic appendicitis.

46. You are prompted to do an emergency 25 year old woman who complained for several hours, lower abdominal pain. Her temperature is 38.5 C and vomited twice. On examination, her stomach is flat without scarring: the pain is at maximum in the suprapubic region with a slight defense. On digital rectal examination, the cul-de-sac is painful on the right. What (s) diagnostic (s) can we talk?
A. Acute cholecystitis.
B. Right pelvic inflammatory disease.
C. Acute appendicitis.
D. Ulcerative colitis.
E. Attack of renal colic right.

47. Acute appendicitis in retro-caecal position includes:
A. Right flank pain.
B. An attitude in flexion of the thigh on the pelvis (psoïtis).
C. Urinary frequency.
D. Rectal pain.
E. Lleukocytosis with polymorphonuclear.

48. Among the different landforms of appendicitis, one can find:
A. Retrocaecal form.
B. Subhepatic form.
C. Intrahernial form.
D. Mesocœliac form.
E. Pelvic shape.

49- Regarding appendicitis
A. The risk of developing the illness is greatest in childhood
B. Mortality increases with age and is greatest in the elderly
C. 20% of appendices are extraperitoneal in a retrocaecal position
D. Faecoliths are present in 75-80% of resected specimens
E. Appendicitis is a possible diagnosis in the absence of abdominal tenderness

50- The diagnosis of acute appendicitis is most difficult to establish in:
A. Persons aged 60 and older.
B. Women aged 18 to 35.
C. Infants younger than 1 year.
D. Pregnant women.

51. The appendicular lump
A - Is a localized peritonitis.
B - is due to an agglutination of intestinal loops and omentum around the appendix .
C - is often favored by antibiotics.
D - resulting in mass of the right iliac fossa
E - Requires an emergency surgery.

52. Abscess cul-de-sac may:
A - To be due a pelvic appendix.
B - Give urinary frequency.
C - manifest as a febrile occlusion.
D - To be due a pyosalpynx.
E - Provide mucus made by the anus.

53. For the origin of appendicular peritonitis, you hold:
A - The early age.
B - The existence of a heartburn.
C - The absence of pneumoperitoneum.
D - Irradiation to the basic right thoracic pain.
E - The early signs in the RIF.

54. The plastron appendix (Appendicular lump):
A. is a localized peritonitis.
B. is due to an agglutination of intestinal loops and omentum around the appendix.
C. is often promoted by antibiotics.
D. reveals by a mass of the right iliac fossa.
E. requires emergency surgery.

55. Indicate the (the) proposal (s) exact (s) concerning the abscess cul-de-sac:
A. It may follow peritonitis.
B. It is accompanied by an oscillating fever.
C. Is the digital rectal examination, which often allows diagnosis?
D. Pelvic ultrasound can help in the diagnosis.
E. It may be accompanied by dysuria in men.

56. An appendix to his swollen distal part shows a destruction of the inner part of the wall with many polymorphonuclear altered in histology. What diagnosis should you of the following?
A. Appendix subacute.
B. Appendix bluetongue.
C. Appendiceal abscess.
D. Appendix chronic obliterans.
E. Gangrenous appendix.

57. Eight days after appendectomy, a patient complains of dysuria, urinary frequency, a slowing of transit who had taken the third postoperative day. Note the presence of mucus rectal temperature of 38.9 C, 20 000 white cells per mm3, with 90% neutrophils. What you evoke the first diagnosis?
A. Abscess of the wall.
B. Cecal fistula.
C. Hemoperitoneum.
D. Abscess cul-de-sac.
E. Abscess meso-celiac.


Etiology

1- In patient with an appendix abscess, which of the following organisms is least likely to be found in the abscess?
A- Bacteroides fragilis.
B- Bacteroides melanococcus.
C- Streptococcus faecalis.
D- Escherichia coli.
E- Staphylococcus aureus.

2. True statements regarding the pathophysiology of acute appendicitis include which of the following:
A. Fecaliths are responsible for the disease process in approximately 30% of adult patients.
B. Lymphoid hyperplasia is a rare cause of appendicitis in young patients.
C. Clostridium difficile is implicated as a pathogenic organism.
D. Carcinoid tumors account for approximately 5% of all cases of acute appendicitis.

3. Acute appendicitis is due to?
A. Fecoliths.
B. Worms of ileo caecal region.
C. Streptococcal infections.
D. Abuse of purgatives.
E. None.

4- Which of the following most often initiates the development of acute appendicitis?
A. A viral infection.
B. Acute gastroenteritis.
C. Obstruction of the appendiceal lumen.
D. A primary clostridial infection.

5. True statements regarding the pathophysiology of acute appendicitis include which of the following:
A. Fecaliths are responsible for the disease process in approximately 30% of adult patients.
B. Lymphoid hyperplasia is a rare cause of appendicitis in young patients.
C. Clostridium difficile is implicated as a pathogenic organism.
D. Carcinoid tumors account for approximately 5% of all cases of acute appendicitis.

6. Abscess cul-de-sac may:
A. be due to a pelvic appendix.
B. to urinary frequency.
C. manifest as a febrile occlusion.
D. be due to a pyosalpynx.
E. give mucus made by the anus.


Investigation

1- All are Ultrasonic features of Acute Appendicitis except?
A. A compressible blind ending tube.
B. Diameter of more than 7 mm.
C. Loss of submucosal echogenicity.

2- The best type of x-ray to locate free abdominal air is:
A. A posteroanterior view of the chest.
B. A flat and upright view of the abdomen.
C. Computed tomograph (CT) of the abdomen.
D. A lateral decubitus x-ray, right side up.

3. Regarding imaging in acute apendicitis:
A. US finding of a blind tubular structure 7 mm or more in diameter is characteristic.
B. On graded compression U/S the appendix is compressible.
C. Appendicolith seen on plain X-ray in 50 percent cases.
D. Localized ileus (on US) often seen in rif.
E. MR imaging is more accurate than US.

4- A primary appendiceal neoplasm underlying acute appendicitis would be suggested by which imaging finding?
A. A dilated appendix.
B. An appendiceal soft-tissue mass.
C. Inflammation surrounding the appendix.
D. Calcifications in the appendix.
E. Free air in the peritoneum.

5- What examination to different an acute appendicitis subhepatic with acute gallstone cholecystitis?
A. PFA
B. Abdominal sonography
C. Bilirubinemia
D. WBC counted
Answer: B

6- Which gynaecologic condition most commonly mimics appendicitis both clinically and on CT?
A. Uterine leiomyoma.
B. Endometriosis.
C. Hemorrhagic ovarian cyst.
D. Cervical carcinoma.
E. Adenomyosis.

7- Which CT finding helps differentiate acute appendicitis from Crohn’s disease?
A. Long-segment thickening of the terminal ileum.
B. Intraabdominal abscess formation.
C. Inflammatory stranding in right lower quadrant fat.
D. Enhancement of the cecal wall.
E. Free intraperitoneal air.

8- On CT of the abdomen in a woman with clinically suspected appendicitis, which diagnosis is suggested by a right lower quadrant lesion with a fat-fluid level?
A. Perforated peptic ulcer.
B. Ruptured ovarian dermoid.
C. Acute pancreatitis.
D. Ovarian torsion.
E. Ruptured ectopic pregnancy.

9- An enlarged appendix in the right lower quadrant of the abdomen can be simulated on CT by which condition?
A. Epiploic appendagitis.
B. Acute pyelonephritis.
C. Right-sided diverticulitis.
D. Pelvic inflammatory disease.
E. Mesenteric adenitis.

10- On CT of the pelvis in a postpartum woman, a dilated tubular structure extending caudad from the inferior vena cava into the pelvis most strongly suggests which diagnosis?
A. Pelvic inflammatory disease.
B. Ureteral obstruction.
C. Crohn's disease.
D. Typhlitis.
E. Ovarian vein thrombosis.

11- In a patient with suspected appendicitis, layered densities of fat and soft tissue inside the bowel lumen on CT of the abdomen suggest which diagnosis?
A. Intussusception.
B. Pseudomembranous colitis.
C. Appendix mucocele.
D. Cytomegalovirus colitis.
E. Meckel's diverticulum.

Differential diagnosis

1- Acute salpingitis occurs most often:
A. After menopause.
B. In patients with unilateral lower abdominal pain.
C. During the menstrual cycle.
D. In patients with cervical tenderness and vaginal discharge.

2- Most Common malignancy of appendix is?
A. Carcinoid Tumor.
B. Adenocarcinoma.
C. Squmaous Cell carcinoma.
D. Mixed Cellularity.

3- Which of the following statements about acute salpingitis are true?
A. The disease rarely occurs after menopause.
B. Gonococcal infection is most common.
C. There is minimal cervical tenderness to palpation.
D. Vaginal discharge occurs rarely.

4. Acute appendicitis in a young adult, free of other pathology, may be by:
A. Intestinal obstruction.
B. Intermittent dysphagia.
C. Peritonitis.
D. Vomiting.
E. Gram negative sepsis.

5. What examination to different an acute appendicitis subhepatic with acute gallstone cholecystitis?
A. PFA
B. Abdominal sonography
C. Bilirubinemia
D. WBC counted

6- What is not true as differentail diagnosis for appendicits in the elderly
A. Adenocarcinoma appendix
B. Diverticulitis
C. Pyelonephritis
D. Colitis

7- Regarding acute appendicitis
A. Mesocoeliac appendicitis can mimic an acute salpigitis.
B. Pelvic appendicitis can be revealed by urinary sign.
C. Rectal examination is always pain.
D. There is often polymorphonuclear neutrophil hyperleukocytosis.
Answer: BD

8. The diagnosis of acute appendicitis is most difficult to establish in:
A. Persons aged 60 and older.
B. Women aged 18 to 35.
C. Infants younger than 1 year.
D. Pregnant women.

9. Of adult patients presenting to the emergency room for evaluation of acute abdominal pain, which one of the following answers includes the most common diagnoses?
A. Urologic problems, cholelithiasis, pelvic inflammatory disease.
B. Mittelschmerz, appendicitis, ureterolithiasis.
C. Nonspecific abdominal pain, appendicitis, intestinal obstruction.
D. Appendicitis, pelvic inflammatory disease, perforated ulcer.

10- Which is the most likely explanation for right hydronephrosis and right hydroureter that occur in the setting of acute appendicitis with perforation and abscess formation?
A. Right ureteral obstruction caused by an intraluminal lesion.
B. Concurrent pyelonephritis involving the right kidney.
C. Underlying mucinous appendiceal tumor with direct engulfment of the ureter.
D. Extrinsic compression with periureteral inflammation.
E. Ureteral stone disease, because the incidence of appendicitis is significantly increased in the presence of renal stones.

11. You are prompted to do an emergency 25 year old woman who complained for several hours of lower abdominal pain. It was 38.5 degrees and she vomited twice. On examination, her stomach is flat without scarring: the pain is at maximum in the suprapubic region with a slight defense. On digital rectal examination, the cul-de-sac is painful on the right. What (s) diagnostic (s) can we talk?
A - Acute cholecystitis.
B - Acute Salpingitis right.
C - acute appendicitis.
D - Ulcerative Colitis.
E - Torsion of an ovarian cyst right.

12. Which of the following relating to the diagnosis of acute appendicitis, the statement (s) is (are) true (s):
A - Appendicitis mésocœliaque can simulate an acute salpingitis.
B - Pelvic Appendicitis can be revealed by urinary symptoms.
C - The defense of the right iliac fossa clinical signs is an essential.
D - Digital rectal examination is always painful.
E - There is often a leukocytosis with neutrophils in the blood count.

13- Which is the most likely explanation for right hydronephrosis and right hydroureter that occur in the setting of acute appendicitis with perforation and abscess formation?
A. Right ureteral obstruction caused by an intraluminal lesion.
B. Concurrent pyelonephritis involving the right kidney.
C. Underlying mucinous appendiceal tumor with direct engulfment of the ureter.
D. Extrinsic compression with periureteral inflammation.
E. Ureteral stone disease, because the incidence of appendicitis is significantly increased in the presence of renal stones.

14. True statements regarding appendiceal neoplasms include which of the following?
A. Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy.
B. Appendiceal carcinoma is associated with secondary tumors of the GI tract in up to 60% of patients.
C. Survival following right colectomy for a Dukes’ stage C appendiceal carcinoma is markedly better than that for a similarly staged colon cancer at 5 years.
D. Mucinous cystadenocarcinoma of the appendix is adequately treated by simple appendectomy, even in patients with rupture and mucinous ascites.
E. Up to 50% of patients with appendiceal carcinoma have metastatic disease, with the liver as the most common site of spread.


Complication

1- Quote the 3 late complications of acute appendicitis?
A. Adhesive intestinal obstruction.
B. Eventration.
C. Sterility.
D. Hemorrhage.
E. Faecal fistulae.

2- What are the 3 causes the most frequency of pain in RF in pregnancy women?
A. Acute appendicitis
B. Ectopic pregnancy
C. Right acute pyelonephritis
D. Adenopathy.
E. Twisting ovarian cyst

3- Acute appendicitis in pregnancy
A- Is very often fatal.
B- Is more common than in the non-pregnant state due to a reduction in cellular immunity.
C- Is easier to diagnose than in the non-pregnancy state.
D- Occurs with the same symptom and signs as in the non-pregnant woman.
E- Occurs, but the side of maximal tenderness is higher the later the condition occurs in pregnancy.

4. What is the mortality rate from acute appendicitis?
A. In the general population, it is 4/10.000.
B. After rupture, appendicitis is 4-5%.
C. For nonruptured appendicitis, it is 2%.
D. It is 80% if an abscess has formed.
E. It is increased in the past 40 years.

5- Which statement is true regarding recurrent appendicitis?
A. Less than 1% of patients who undergo appendectomy for appendicitis will have evidence of previous appendicitis.
B. CT findings of recurrent appendicitis are indistinguishable from those of acute appendicitis.
C. The recurrence rate after nonoperative percutaneous drainage for acute appendicitis is less than 5%.
D. Unrecognized malignancy is found in more than 5% of surgical specimens removed for appendicitis.
E. The recurrence rate after appendectomy is similar to the recurrence rate after nonoperative percutaneous drainage.

6. Appendicitis, without prejudice to its clinicopathological forms, operated by a Mac Burney incision, in a young adult free of any other disease, can be complicated:
A. A wound infection.
B. Evisceration
C. A hernia.
D. A cecal fistula.
E. A small bowel fistula.

7. Among the early complications (less than 6 days) that may follow an appendectomy, the name (s) is (are) true (s):
A - Occlusion flange.
B - Postoperative peritonitis.
C – Paralytic ileus.
D - Eventration on the scar.
E - Wound infection.

8- Most Common malignancy of appendix is?
A. Carcinoid Tumor
B. Adenocarcinoma
C. Squmaous Cell carcinoma
D. Mixed Cellularity

9- A 79-year-old man has hade abdominal pain for 4 days. An operation is performed, a gangrenous appendix is removed. The stump is inverted. Why does acute appendicitis in elderly patients and in children have a worse prognosis?
A. The appendix is retrocecal.
B. The appendix is perileal position.
C. The appendix is in the pelvic position.
D. The omentum and peritoneal cavity appear to be less efficient in localizing the disease of these age groups.
E. The appendix is longer in these age groups.

10. True statements regarding appendiceal neoplasms include which of the following?
A. Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy.
B. Appendiceal carcinoma is associated with secondary tumors of the GI tract in up to 60% of patients.
C. Survival following right colectomy for a Dukes’ stage C appendiceal carcinoma is markedly better than that for a similarly staged colon cancer at 5 years.
D. Mucinous cystadenocarcinoma of the appendix is adequately treated by simple appendectomy, even in patients with rupture and mucinous ascites.
E. Up to 50% of patients with appendiceal carcinoma have metastatic disease, with the liver as the most common site of spread.

11- A primary appendiceal neoplasm underlying acute appendicitis would be suggested by which imaging finding?
A. A dilated appendix.
B. An appendiceal soft-tissue mass.*
C. Inflammation surrounding the appendix.
D. Calcifications in the appendix.
E. Free air in the peritoneum.

12- Which statement is true regarding recurrent appendicitis?
A. Fewer than 1% of patients who undergo appendectomy for appendicitis will have evidence of previous appendicitis.
B. CT findings of recurrent appendicitis are indistinguishable from those of acute appendicitis.
C. The recurrence rate after nonoperative percutaneous drainage for acute appendicitis is less than 5%.
D. Unrecognized malignancy is found in more than 5% of surgical specimens removed for appendicitis.
E. The recurrence rate after appendectomy is similar to the recurrence rate after nonoperative percutaneous drainage.

13. What is the mortality rate from acute appendicitis?
A. In the general population, it is 4/10.000.
B. After rupture, appendicitis is 4-5%.*
C. For nonruptured appendicitis, it is 2%.
D. It is 80% if an abscess has formed.
E. It is increased in the past 40 years.

Treatment

1- What’s the treatment of acute appendicitis uncomplicated?
A. Surgical emergency.
B. Bacteriologic swab.
C. Appendicectomy.
D. Drainage.
E. Antibiotique, antalgique.

2- What’s the treatment of appendicitis complicated of abscess?
A. Surgical urgency.
B. Bacteriological sample.
C. Abscess drainage, AB, Antalgic.
D. Anatomopathological piece.
E. Appendicectomy at 2 month.

3- If a pregnant patient has an exploratory laparotomy for possible appendicitis and the appendix and other abdominal contents appear normal for the stage of gestation, what is the treatment of choice?
A- Close incision and observe.
B- Close incision and administer appropriate antibiotics and tocolytics,
C- Obtain peritoneal cytology and close incision.
D- Appendicectomy and incision closure.
E- Caesarean section if past 36 weeks gestation.

4- Once a diagnosis of acute appendicitis has been made and appendectomy decided upon, which of the following is/are true?
A. Prophylactic antibiotics should be administered.
B. Prophylactic antibitics are not necessary unless there is evidence of perforation.
C. If the appendix is not ruptured and not gangrenous, antibiotics may be discontinued after 24 hours.
D. Multiple antibiotics are in all cases preferable to a single agent.

5- Prospective studies have shown incidental appendectomy to be advantageous in which of the following patient groups?
A. Children undergoing staging laparotomy for malignancy who are then to enter chemotherapy.
B. HIV infected patients.
C. Patients over 50 years of age.
D. Patients with spinal cord injuries.
E. None of the above.

6. A patient is seen in the emergency room with reproducible right lower quadrant tenderness. The approximate incidence of finding a normal appendix on right lower quadrant exploration in similar nonselected patients is which of the following:
A. 5%.
B. 10%.
C. 20%.
D. 40%.

7. A 26-year old woman in her first trimester of pregnancy presents with a 2-day history of right lower quadrant pain and fever. Physical examination reveals a tender, palpable, right lower quadrant mass. There is no evidence of peritonitis or systemic sepsis. Laboratory evaluation is remarkable for mild leukocytosis, and abdominal ultrasound demonstrates an inflammatory mass but no evidence of abscess. As the surgeon on call, your recommendation would be:
A. Intravenous hydration, antibiotic prophylasis, and urgent appendectomy.
B. Intravenous hydration, antibiotics, bowel rest, and interval appendectomy in 4 to 6 weeks.
C. Intravenous hydration, antibiotics, and appendectomy if no improvement in 12 to 24 hours.
D. Intravenous hydration, antibiotics, and interval appendectomy when fever has subsided, leukocyte count has returned to normal, and the patient is pain free.
E. Emergent obstetrical consultation for evaluation and treatment of possible ectopic pregnancy.

8. Oschner sherren regime is used in the management of?
A. Appendicular mass.
B. Appendicular abscess.
C. Acute appendicitis.
D. Chronic appendicitis.

9- A 29-year- old woman presents to her physician’s office with pain in iliac fossa. Examination reveals tenderness in this region. Her last menstrual cycle was 2 weeks previously and finding on gynecologic examination and leukocyte count are normal. A provisional diagnosis of acute appendicitis is made. She should be informed that operations to treat this condition reveal acute appendicitis in what percentage of cases?
A. A small percentage of cases.
B. 50-89% of cases.
C. 90-99 % of cases.
D. More than 99% of cases.
E. No reliable statistics are avalaible.

10. Eight days after appendectomy, the patient complains of dysuria, urinary frequency, a slowing of transit which had resumed in the third postoperative day. We note the appearance of mucus rectal temperature is 38 ° 9C, count 20 000 counts GB/mm3 90% neutrophils. What you evoke diagnosis in the first place?
A - Abscess of the wall.
B - Cecal fistula.
C - Hemoperitoneum.
D - Douglas abscess.
E - Abscess meso-celiac.

11. Eight days after appendectomy, the patient complains of dysuria, urinary frequency, a slowing of transit who had taken the third postoperative day. We note the appearance of mucus rectal temperature is 38.9 ° C, counts 20,000 counts GB/mm3 90% neutrophils. What you evoke diagnosis in the first place?
A - Abscess wall.
B - Cecal fistula.
C - Hemoperitoneum.
D - Douglas abscess.
E - Abscess meso-celiac.


Case report: Appendicitis 1
A young 30 year old woman complains of dysuria, a pollakurie, a slowing of transit and abdominal tenderness, TR douloureux.On note a temperature at 39 ° C, NSF counts: 15000 GB/mm3 with 80% neutrophils

A1. What you evoke diagnosis first?
A- Cystitis.
B- Peptic ulcer.
C- Pelvic inflammatory disease.
D- Appendicular peritonitis.
E- Bowel volvulus.

A2. All the following clinical signs can be found in our patient except one which:
A- Stop materials and gases.
B- Vomiting early.
C- Cutaneous hyperesthesia.
D- Contracture generalized abdominal.
E- Audible bowel sounds.

A3. What is the therapeutic approach recommended:
A- Nasogastric tube, and surveillance.
B- Cleansing enema and surveillance.
C- Decompress the colon by a rectal probe.
D- Resuscitation and antibiotic therapy.
E- Electrolyte balance after laparotomy.


Acute appendicitis in pregnancy

1- Acute appendicitis in pregnancy
A- Is very often fatal.
B- Is more common than in the non-pregnant state due to a reduction in cellular immunity.
C- Is easier to diagnose than in the non-pregnancy state.
D- Occurs with the same symptom and signs as in the non-pregnant woman.
E- Occurs, but the side of maximal tenderness is higher the later the condition occurs in pregnancy.

2- If a pregnant patient has an exploratory laparotomy for possible appendicitis and the appendix and other abdominal contents appear normal for the stage of gestation, what is the treatment of choice?
A- Close incision and observe.
B- Close incision and administer appropriate antibiotics and tocolytics,
C- Obtain peritoneal cytology and close incision.
D- Appendicectomy and incision closure.
E- Caesarean section if past 36 weeks gestation.

3- Appendicitis in pregnancy is difficult to diagnose for all of the following reasons except
A- Anorexia, nausea and vomiting are common in pregnancy.
B- Due to uterine enlargement the site of the vermiform appendix is changed in pregnancy.
C- Leucocytosis is the rule in normal pregnancy.
D- There is immunological suppression in pregnancy, leading to the suppression of localising signs.
E- Other diseases during pregnancy are readily confused with appendicitis.

4- Appendicitis in pregnancy is difficult to diagnose for all of the following reasons except
A- Anorexia, nausea and vomiting are common in pregnancy.
B- Due to uterine enlargement the site of the vermiform appendix is changed in pregnancy.
C- Leucocytosis is the rule in normal pregnancy.
D- There is immunological suppression in pregnancy, leading to the suppression of localising signs.
E- Other diseases during pregnancy are readily confused with appendicitis.

5- What are the 3 causes the most frequency of pain in RF in pregnancy women?
A. Acute appendicitis
B. Ectopic pregnancy
B. Right acute pyelonephritis
D. Adenopathy.
E. Twisting ovarian cyst


Answers
Clinical
1- A
2- ACD
3- ABCD
4- D
5- D
6- ABCD
7- C
8- D
9- E
10- B
11- A
12. ABE
13- ABC
14- ABCDE
15. None or B
16- BD
17- BD
18- C
19- AE
20- D
21- D
22- C
23- D
24- C
25. A
26- D
27- A
28. ABCDE
29- C
30. All true
31. E
32- C
33. BD
34. BCD
35. ABCD
36. C
37. ACD
38. ABE
39- C
40. DE
41. D
42- C
43. ABCDE
44. ABE
45. C
46. BC
47. ABDE
48. ABCDE
49- All true: ABCDE
50- C
51. ABCD
52. ABD
53. ACE
54. ABCD
55. ABCDE
56. C
57. D

Etiology
1- E
2. A
3. AB
4- C
5. A
6. ABCDE

Investigation
1- ABC
2- D
3. ADE
4- B
5- B
6- C
7- A
8- B
9- D
10- E
11- A

Differential diagnosis
1- D
2- AB
3- AB
4. ACDE
5. B
6- A
7- BD
8. C
9. C
10- D
11. BCE
12. BCE
13- D
14. A

Complication
1- ABCE
2- ABCE
3- E
4. B
5- B
6. ABCD
7. BCDE
8- AB
9- D
10. A
11- B
12- B
13. B

Treatment
1- ABCE
2- ACE
3- C
4- AC
5- E
6. C
7. A
8. A.
9- C
10. D
11. D

Case report: Appendicitis 1
A1. D
A2. E
A3. E

Acute appendicitis in pregnancy

1- E
2- D
3- E
4- D
5- ABCE