A 45-year-old woman presents with right iliac fossa pain. The Alvarado score is calculated: migratory pain (1), anorexia (1), nausea/vomiting (1), RIF tenderness (2), rebound tenderness (1), elevated temperature (1), leukocytosis (2) = 9/10. Management should be:

• A CT scan before proceeding to confirm diagnosis
• B Diagnostic laparoscopy and appendicectomy ✓
• C Discharge with antibiotics and outpatient follow-up
• D Observation for 24 hours and repeat blood tests

Explanation

An Alvarado score of 7–10 indicates a high probability (> 85%) of acute appendicitis. A score ≥ 7 warrants surgical intervention (appendicectomy) without mandatory CT scan, especially in premenopausal women where diagnostic laparoscopy also excludes gynaecological pathology. CT is recommended for equivocal scores of 5–6 to avoid negative appendicectomy. Observation alone is inappropriate for high-score presentations.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.