The Rational Clinical Examination
David L. Simel, Drummond Rennie
David G. Bundy, Julie S. Byerley, E. Allen Liles, Eliana M. Perrin, Jessica Katznelson, Henry E. Rice
Clinical Scenarios, Why Is This Question Important?, Methods, Results, Scenario Resolution, Clinical Bottom Line, References
appendectomy, appendicitis, acute, child, pediatrics
"A previously healthy 6-year-old boy presents
to his physician with a 1-day history of abdominal pain.
The pain started in his periumbilical area and is now localized
in his right lower quadrant (RLQ). His father states that the child
has complained of anorexia and has had 1 episode of nonbilious emesis
and a fever of 38.3°C. Diarrhea and dysuria are
absent. He appears uncomfortable and has a measured temperature
of 38.8°C orally; there is no tachycardia or tachypnea.
His abdomen is focally tender in the RLQ, with mild distention and
rebound tenderness. His white blood cell (WBC) count is 14 200/L
(67% neutrophils; absolute neutrophil count, 9500/L).
A urinalysis is notable for absence of signs of urinary tract infection...."
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