ABSTRACT
Q1 A 4-year-old boy presents with severe abdominal pain with right lower quadrant tenderness and guarding. A clinical diagnosis is made of appendicitis and he proceeds to appendicectomy, with normal findings at operation and on histology. He is making a good postoperative recovery the following day but is noted to have purpuric lesions surrounding his incision. What further test/investigation is not required? A blood pressure measurement B blood test for urea, creatinine, electrolytes and serum albumin C lumbar puncture D urine dipstick E wound swab
A1 C This patient has presented with severe abdominal pain with right lower quadrant tenderness and guarding with a clinical diagnosis of appendicitis, but no evidence of this at time of appendicectomy. He has a rash around his wound postoperatively, which is not typical for a wound infection but a wound swab is worthwhile. However, all the clinical symptoms and signs together may suggest a vasculitis for which all the investigations are warranted, except that lumbar puncture is not required to check for meningitis at this stage (if severe sepsis was evident with him being unwell, then blood cultures and commencing intravenous antibiotics would be the first step).
