Q1. Which of the following is the least common position of appendix?
a) Retroileal
b) Retroceacal
c) Postileal
d) Pelvic
Q2. Most Common malignancy of appendix is?
a) Carcinoid Tumor
b) Adenocarcinoma
c) Squmaous Cell carcinoma
d) MIxed Cellularity
Q3. All are features of Acute Appendicitis on Ultrasound examination except?
a) A compressible blind ending tube
b) Diameter of more than 7 mm
c) Loss of submucosal echogenicity
d)
Q4. What is not true as differentail diagnosis for appendicits in the elderly
a) Adenocarcinoma appendix
b) Diverticulitis
c) Pyelonephritis
d) Colitis
Q5. Not true about appendicitis in pregnancy?
a) Risk of appendicitis in pregnancy remains the same as in non pregnant woman of same age group.
b) Appendicitis ocurs more commonly in the 1st two trimesters.
c) The effect of negative laparotomy for appendicitis in pregnant patient is significant
d) Early appendectomy is the appropriate therapy in suspected appendicitis during all stages of pregnancy.
Answers
1.a
Retroileal position of appendix is the least common. It is seen in only 0.2% of all cases.
Most common position of appendix is retrocaecal 65% followed by Pelvic (20%).
Other common positions are preileal and post ileal.
2. b
It was previously believed that carcinoid tumors are the most common tumors of the appendix ( Sabiston 17th) but now data from SEER ( Surveillane, epidimology and End results) show that mucinous adenocarcinomas are more common.
Sabiston 18th page 1344.
3.
All these are true
4.a
Altough adenocarcinoma of appendix can present as appendicitis, it is never kept as a differential diagnosis when appendicits is contemplated
5. c
The risk of negative laparotomy in suspected appendicitis in pregnancy is minor. However a ruptured appendicitis could be catastrophic. Early diagnosis and surgery for appendicitis should be performed in pregnancy.
There may be diagnostic confusion as during the third trimester of pregnancy, the cecum and appendix are displaced laterally and are rotated by the enlarged uterus. Pain occurs more laterally in the flank, leading to delay in diagnosis and an increased incidence of perforation.
