Appendicitis and surgical abdomen — formative SAQs

SAQ 1 — The school-aged child with migratory pain (10 marks, 15 minutes)

A previously well nine-year-old boy has eighteen hours of peri-umbilical pain that has moved to the right iliac fossa, with anorexia, nausea and a temperature of 38.4 degrees. He is tender at McBurney point with rebound and wince on hopping. His white cell count is 13 with a neutrophilia. ^[1]

a) Calculate his Pediatric Appendicitis Score, stating how many points each feature earns, and interpret the result. (3 marks) ^[1]

b) Name the most appropriate first-line investigation and the diagnostic finding you expect, and state the next investigation if it is non-diagnostic. (3 marks) ^[6]

c) Outline your resuscitation and analgesia before any operation, including the fluid you would give. (2 marks) ^[3]

d) Describe the definitive treatment options for his uncomplicated appendicitis, the evidence that frames the choice, and how you would involve the family in the decision. (2 marks) ^[5]