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Case 1:A 22 year old woman presented to the emergency room with a two day history of abdominal pain and crampy diarrhea. On physical examination she had tenderness in both lower quadrants, more on the right than the left. She was afebrile. White blood count was 12,000. Other labs were unremarkable. She underwent diagnostic laparoscopy. The findings are shown in the picture below:

[] (a) acute diverticulitis
[] (b) viral gastroenteritis
[] (c) ruptured ovarian cyst
[] (d) acute appendicitis
[] (e) terminal ileitis
[] (f) Don't Know

Question 2: What should be done operatively?

[] (a) laparoscopically remove the appendix
[] (b) convert to open incision
[] (c) remove trocars and close
[] (d) lavage pelvis, leave drain in right lower quadrant
[] (e) Don't Know

Question 3: The incidence of incorrectly diagnosing acute appendicitis in women of reproductive age (negative appendix found at operation) have been reported as high as:

[] (a) 20%
[] (b) 25%
[] (c) 40%
[] (d) 65%
[] (e) Don't Know

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Case 2: A 19 year old male was seen in the emergency room and found to have right lower quadrant pain of two days duration, becoming worse on the second day. He was nauseated. No other GI complaints. Physical exam showed a fever to 38.2 degrees Celsius, and marked tenderness to palpation in the right lower quadrant of the abdomen. A diagnostic laparoscopy was performed. Findings are in the photograph below:

Question 4: This patient has:

[] (a) mesenteric diverticulitis
[] (b) Meckel's diverticulitis
[] (c) acute appendicitis
[] (d) cecal perforation
[] (e) Don't Know

Question 5: In experienced hands, the conversion rate for this type of operative finding would be:

[] (a) under 10%
[] (b) 10-20%
[] (c) 30%
[] (d) 40%
[] (e) Don't Know

Question 6: Criticisms of laparoscopic appendectomy by surgeons preferring to use an open approach include:
SELECT ALL THAT APPLY

[] (a) it takes longer to perform
[] (b) it is not cost effective
[] (c) it limits diagnostic accuracy

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Technique of laparoscopic appendectomy:
The photo below shows the dissecting instrument having been passed through a window made in the mesoappendix near the base of the cecum. Such a maneuver facilitates the placement of the endoscopic stapler.

[] (a) Roeder loops
[] (b) monopolar cautery
[] (c) monopolar cautery and fibrin glue
[] (d) none of the above
[] (e) Don't Know

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The picture above shows the mesoappendix being divided. Once the appendix is free, it is delivered from the abdominal cavity using a wound protector or the port tube to prevent trocar site contamination.

[] (a) bipolar cautery
[] (b) clips
[] (c) Roeder loops
[] (d) all of the above
[] (e) none of the above
[] (f) Don't Know

Question 9: Laparoscopic appendectomy has been shown to have the following advantage over open appendectomy in a majority of controlled randomized studies:

[] (a) shorter hospitalization
[] (b) less recurrent pelvic abscesses
[] (c) lower wound infection rate
[] (d) all of the above
[] (e) none of the above
[] (f) Don't Know

Question 10: Proponents of laparoscopic appendectomy emphasize a major advantage of the approach is:

[] (a) lower operative time
[] (b) greater diagnostic accuracy upon finding a negative appendix
[] (c) lower costs
[] (d) none of the above
[] (e) all of the above
[] (f) Don't Know