Question

A 24-year-old woman presents to the emergency department with sudden onset of severe abdominal pain. She states that the pain first started around her belly button and then migrated to the right lower abdomen. She complains of nausea and non-bloody, non-bilious vomiting. The patient's temperature is 101.3°F (38.5°C), blood pressure is 109/70 mmHg, pulse is 88/min, and respirations are 15/min. On physical examination, there is tenderness at the right lower quadrant with guarding. Which of the following is the next best step?

A) Abdominal radiograph
B) Computed tomography
C) Magnetic resonance imaging
D) Pregnancy test
E) Surgical exploration

Answer 1

A pregnancy test is the next best step for a possible appendicitis diagnosis in a woman of childbearing age to exclude potential pregnancy before exposing her to further diagnostic procedures or surgical intervention.

Step-by-step explanation:

The next best step for the 24-year-old woman presenting with symptoms suggestive of appendicitis is to perform a pregnancy test (option D). This is essential before any imaging or surgical intervention is considered because of the implications for potential pregnancy-related conditions, such as ectopic pregnancy or miscarriage, and because the management might drastically differ for a pregnant patient.

The localization of pain from periumbilical to the right lower quadrant, alongside nausea, vomiting, and fever, are classic signs of appendicitis. Due to the need for a timely diagnosis and the potential for complications such as perforation, a diagnostic imaging test, such as a computed tomography (CT) scan, is often required to confirm the diagnosis after excluding pregnancy. However, since the patient's sexual activity status and last menstrual period are unknown, it is prudent to exclude pregnancy before exposing her to radiation or considering surgical exploration.