Test Quiz – Pediatric Surgery

Welcome to your Test Quiz

What is your next step?

Order CBC

Discharge

Would you give him fluids?

Yes

No

What would you do

Please read the following guidelines carefully, then answer the question.

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A 28-year-old male patient presents to the emergency department with a 24-hour history of right lower quadrant abdominal pain, nausea, and low-grade fever. On physical examination, he has localized tenderness in the right lower quadrant with a positive Rovsing's sign. His laboratory results show an elevated white blood cell count (WBC) of 14,000/mm³. The clinical team is considering whether to proceed with imaging or decide on a management plan based on clinical findings alone.

Question:
Based on the WSES Jerusalem guidelines for diagnosing acute appendicitis, what is the most appropriate next step in the management of this patient?

Proceed with a CT scan of the abdomen to confirm the diagnosis of acute appendicitis.

Use a clinical scoring system (such as the Alvarado or AIR score) to determine the risk level and decide on the need for imaging or surgery.

Admit the patient for observation and perform serial abdominal examinations without further imaging.

Proceed directly to laparoscopic appendectomy based on the clinical presentation and elevated WBC count.

Start non-operative management with antibiotics and reassess the patient in 24 hours.