Abdominal radiograph and acute imaging decisions — branching viva

Opening branch — the imaging decision for suspected appendicitis

The candidate is expected to define the clinical question (is this appendicitis?), to state that ultrasound is the first-line imaging modality because it uses no ionising radiation, and to explain that the abdominal radiograph has a very low yield and is not the appropriate first test. ^[3]

The examiner probes the pARC calculator, which stratifies the probability of appendicitis from the age, the sex, the pain duration and migration, the right-lower-quadrant tenderness, the guarding, the rebound, the anorexia, and the nausea. The high-probability child proceeds to surgical review, the intermediate-probability child has the ultrasound as the deciding test, and the low-probability child is observed or discharged with a safety net. ^[4]