Question Bank – Pedi Abdomen

Per the study by Blumfield et al, “Ultrasound for Differentiation Between Perforated and Nonperforated Appendicitis in Pediatric Patients” (2013), which of the following ultrasound findings had the highest SENSITIVITY  for perforated appendicitis?

The pediatric literature has shown the point of care ultrasound for appendicitis by ED providers is associated with which of the following patient centered outcomes: 

Per the study performed by Nah et al, “Clinical relevance of the non-visualized appendix on ultrasonography of the abdomen in children” (2017), on review of 160 patients with suspected appendicitis who had a nonvisualized appendix on ultrasound and NO evidence of secondary inflammatory changes, the likelihood of appendicitis is:

In their study “Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point-of-care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta-analysis” (2017) Benabbas et al reviewed 21 studies of POCUS performed in the emergency department by emergency physicians in the diagnosis of appendicitis in pediatric patients. Which of the following findings, when present, was associated with the highest likelihood ratio of true acute appendicitis?

In the hands of novice providers, ED-performed point of care ultrasound is

When performing POCUS to evaluate a child with suspected appendicitis, you are unable to locate the appendix. Which of the following statements is correct? 

Which of the following characteristics is typical of large bowel?

In distinguishing it from the small bowel, which of the following characteristics is most convincing that you are looking at the appendix?

A transverse view of the right lower quadrant is shown. What structure is circled?

A transverse view of the right lower quadrant is shown. What structure is circled?

A transverse view of the right lower quadrant is shown. What structure is circled?

A transverse view of the right lower quadrant is shown. What structure is circled?

A longitudinal view of the right lower quadrant is shown. What structure is circled?

A longitudinal view of the right lower quadrant is shown. What structure is circled?

A transverse clip of the right lower quadrant is shown below:

 What structure is highlighted in the clip?

A transverse clip of the right lower quadrant is shown below:

A is the large intestine. Identify the structure labeled “B”

A clip of the right lower quadrant is shown. 

Identify the structure labeled by the v’s in the clip.

A transverse view of the right lower quadrant is shown below. What is the peristalsing structure shown in the clip?

A longitudinal view of the right lower quadrant is shown below. Which of the labeled structures is the appendix?

A transverse image of the right lower quadrant is shown in the image. What is the arrow pointing to?

A transverse image of the right lower quadrant is shown. What diagnosis is associated with the finding in the clip:

An 8 year old child presents with <24 hours of fever, nonbilious/nonbloody vomiting, and constant right lower quadrant pain.. A transverse view of the right lower quadrant is shown:

Which of the following diagnoses is the most likely cause of this child’s symptoms?

An 8 year old child presents with <24 hours of fever, nonbilious/nonbloody vomiting, and constant right lower quadrant pain. A longitudinal view of the right lower quadrant is shown:

Which of the following diagnoses is the most likely cause of this child’s symptoms?

An 8 year old child presents with <24 hours of fever, nonbilious/nonbloody vomiting, and constant right lower quadrant pain. A longitudinal view of the right lower quadrant is shown:

Which of the following diagnoses is the most likely cause of this child’s symptoms?

An 8 year old child presents with <24 hours of fever, nonbilious/nonbloody vomiting, and constant right lower quadrant pain. A transverse view of the right lower quadrant is shown:

Which of the following diagnoses is the most likely cause of this child’s symptoms?

A 7 year old non-verbal boy with a history of multiple admissions for inpatient “clean outs” for constipation presents to the emergency department with 2 days of vomiting and poor appetite. He is unable to localize his pain, but parents indicate that he has not eaten all day and is crying and yelling since last night. Exam is significant for an uncomfortable, febrile child who does not relax his abdomen with palpation. You administer analgesia for pain and perform POCUS or appendicitis.

Which of the following diagnoses is suggested by the sonographic findings above?

A 5 year old uncircumcised boy with no medical problems presents to the emergency department with 3 days of vomiting, fever, poor appetite, and abdominal pain. He has not had diarrhea, has not eaten today, and refused to walk into the emergency department. On exam, he is very fearful and cries producing lots of tears the moment the examiner enters the room and pushes the examiner away when the abdominal exam is attempted. Aside from fever of 38.5 C and tachycardia (attributed to crying and fever), his vital signs are normal. You perform a point of care ultrasound with the aid of child life but due to bowel gas you are unable to locate the appendix. You do find the following in multiple locations in the abdomen:

Blood work returns with a WBC of 15 with a neutrophilic predominance. Which of the following is your next step in assessment?