Appendicitis: Pathology review

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Appendicitis: Pathology review



Appendicitis: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 32-year-old man is brought to the emergency department due to severe abdominal pain, fever, nausea, and vomiting. The patient states that the pain started near the umbilicus yesterday evening, but has since moved towards the lower right side. He also reports that the pain increased in severity overnight, rating it up to a 10 on a 10-point scale. However, he now feels that the pain has diminished slightly. He describes the pain as sharp and states that it was especially bad en route to the hospital when the ambulance drove over bumps in the road. The patient has no past medical history and consumes a vegan diet. His temperature is 39.3°C (102.7°F), pulse is 124/min, respirations are 24/min, and blood pressure is 86/60 mmHg. Abdominal examination shows tenderness over the right lower quadrant. The patient is noted to tighten his abdominal muscles to lessen the pain. Which of the following physical examination signs is most likely to be present in this patient?  


While in the Emergency Department, Bella, a 22-year-old woman, presents with abdominal pain that started 6 hours ago. The pain was initially located around the umbilical area but it has migrated to the right lower quadrant in the past few hours. The pain is sharp, like being stabbed with a knife and it gets worse with movement. A physical examination showed tenderness of the right lower quadrant with moderate guarding and a low-grade fever of 100.4°F.

Shortly after, Edward, who’s 11, presents with generalized abdominal pain with vomiting and diarrhea. On examination, he appears ill and has a temperature of 104°F. His abdomen is tense with generalized tenderness and guarding. No bowel sounds are present.

Blood tests were ordered in both cases, detecting an increased white blood cell count of 12,000 cells per microliter with 85 percent neutrophils. Now, both people have appendicitis.

Now the appendix is the little close-ended hollow tube that’s attached to the cecum of the large intestine, and sometimes it’s called the vermiform appendix, where vermiform means “worm-shaped.” Normally, the appendix can be found in a retrocecal location, as well as pre-ileal, post-ileal, pelvic and subcecal. Its function is actually unknown, though some theories suggest it might be a “safe-house” for the gut flora and that it plays a part in the lymphatic and immune system. Okay, so appendicitis usually occurs because something gets stuck and obstructs the appendix. That something could be a fecalith, which is a hardened lump of fecal matter, a piece of undigested material like gum or seeds, or even a clump of intestinal parasites like pinworms.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "APPENDICITIS" Emergency Medicine Clinics of North America (1996)
  4. "Suspected Appendicitis" New England Journal of Medicine (2003)

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