🚨 Appendicitis: The Surgical Abdomen Favorite on the USMLE

Appendicitis is a common surgical emergency that presents with right lower quadrant (RLQ) pain, nausea, and fever. It’s a favorite on Step 1 and Step 2, especially in abdominal pain questions or pediatric surgery vignettes.

USMLE Tip: Early pain at the umbilicus that migrates to the RLQ = classic appendicitis.

🧬 Pathophysiology Snapshot

• Obstruction of appendiceal lumen (fecalith, lymphoid hyperplasia)

• Bacterial overgrowth → inflammation → ischemia

• Risk of perforation and peritonitis if untreated

🔍 Classic Signs and Symptoms

Symptom/Sign	Description
Abdominal pain	Starts periumbilical, migrates to RLQ
Nausea/vomiting	Often follows onset of pain
Anorexia	Common and early
Fever	Low-grade, may worsen
Rebound tenderness	Increased pain on release of pressure
Rovsing’s sign	RLQ pain with LLQ palpation
Psoas sign	RLQ pain on hip extension
Obturator sign	RLQ pain on hip flexion and internal rotation

🧪 Labs & Imaging

Test	Utility
CBC	Leukocytosis with neutrophilia
CRP	Often elevated in inflammation
Ultrasound	First-line in children or pregnancy
CT abdomen/pelvis	Most accurate in adults

⏱ When to Suspect Perforation

• High fever, diffuse peritonitis, rebound pain

• Leukocytosis > 18,000

• Free air or fluid on imaging

⚠️ Delayed diagnosis = risk of rupture and abscess!

💊 Management Overview

Scenario	Management
Uncomplicated	NPO, IV fluids, laparoscopic appendectomy
Perforated	IV antibiotics, surgery, drain if abscess
Non-surgical candidate	IV antibiotics, close monitoring

📚 Sample USMLE Vignette

A 19-year-old male presents with abdominal pain that started near the umbilicus and moved to the RLQ. He has nausea, fever, and rebound tenderness. WBC count is 14,000. What is the next best step?

✅ Answer: CT scan of abdomen and pelvis → likely appendicitis

📲 Call to Action

✂️ Cut the confusion — don’t miss this surgical classic.

📲 Download the King of the Curve App to:

• Review surgical emergencies

• Practice abdominal vignettes

• Learn with visual mnemonics

• Track mastery with Curve Coins

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Frequently Asked Questions (FAQs)

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