ROSH Gastrointestinal Practice Exam

What is the common clinical presentation of a patient with appendicitis?

1. Persistent vomiting

2. Severe lower left quadrant pain

3. Rebound tenderness in the right lower quadrant

4. Radiating pain to the back

The correct answer is: Rebound tenderness in the right lower quadrant

The common clinical presentation of a patient with appendicitis typically includes not only abdominal pain but also specific physical examination findings. In appendicitis, rebound tenderness is an important sign, found in the right lower quadrant of the abdomen. This is because the inflamed appendix, when palpated, causes pain upon release of pressure, indicating peritoneal irritation. Patients often present with a pattern of abdominal pain that usually starts around the umbilical area and then migrates to the right lower quadrant. This is known as "classic" appendicitis. However, it is the presence of rebound tenderness in this specific area that is particularly indicative of appendiceal inflammation, further differentiating it from other conditions. While vomiting can occur and pain might be severe, these can be seen in various other abdominal pathologies and aren't specific to appendicitis. Pain radiating to the back is more characteristic of conditions like pancreatitis or renal colic, rather than appendicitis. Therefore, rebound tenderness in the right lower quadrant stands out as a hallmark finding in cases of appendicitis, strengthening the case for it being the correct answer.