KROK 2 Medicine

Practice session

A 19-year-old male presents with acute abdominal pain that began 14 hours ago as a dull, periumbilical discomfort accompanied by anorexia and nausea. Over the past 4 hours, the pain has localized to the right lower quadrant, becoming sharp, constant, and exacerbated by coughing and walking. On physical examination, temperature is 38.2°C and pulse is 98 bpm. There is localized tenderness and involuntary muscular guarding at McBurney's point. Pain is elicited in the right lower quadrant when palpating the left lower quadrant (positive Rovsing sign), and extension of the right hip elicits severe pain (positive psoas sign). Laboratory evaluation shows a leukocyte count of 14.8 x 10^9/L with 82% neutrophils. What is the most likely diagnosis and definitive management?

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