MBBS OSCE · General Surgery

OSCE — acute RIF pain and the Alvarado pathway

Eight-minute OSCE: classic migratory pain, bedside scoring, imaging choice, consent for laparoscopic appendectomy, and mass/peritonitis branch points.

8 min stationVerification in progress
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Exam tags

NEET-PGINICETUSMLEPLAB

Brief (to candidate)

A 24-year-old man has 18 hours of periumbilical pain migrating to the right iliac fossa, anorexia, and low-grade fever. You will examine, score, investigate, and outline management including mass vs peritonitis branches.

Candidate tasks (8 minutes)

  1. Take a focused history (migration, anorexia, vomiting sequence, urinary/gynae symptoms).
  2. Demonstrate RIF examination and name McBurney, Rovsing, psoas, obturator.
  3. Calculate Alvarado (MANTRELS) with given vitals/labs.
  4. Choose imaging (CT adult vs US child/pregnancy).
  5. State resuscitation + antibiotic prophylaxis doses.
  6. Consent for laparoscopic appendectomy and discuss antibiotic-first alternative with recurrence risk.
  7. Manage day-5 appendicular mass and generalised peritonitis forks.

Examiner checklist (pass/fail cues)

DomainPass behaviours
HistoryMigration + anorexia; pain before vomiting; β-hCG if female stem
ExamStarts away from RIF; McBurney; position signs
ScoreCorrect 10-point Alvarado components; T and L = 2 points
ImagingCT adults; US first in children/pregnancy
Pre-opNBM, fluids, analgesia, cefuroxime + metro or co-amoxiclav
ConsentInfection, bleeding, conversion, stump appendicitis
MassOchsner–Sherren → interval 6–8 weeks if stable
PeritonitisEmergency laparotomy / source control, not delay

Model outline

Classic appendicitis is a clinical–radiological diagnosis. Alvarado organises probability; imaging reduces negative appendectomy. Definitive care is usually laparoscopic appendectomy after drip-and-suck preparation. Antibiotics-first is optional only for selected uncomplicated cases with informed recurrence risk (~30%). Mass conservatively if stable; peritonitis is an emergency.

References2Show
  1. [1]Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine, 1986.PMID 3963537
  2. [2]Davidson GH, Flum DR, Monsell SE, et al. Antibiotics versus Appendectomy for Acute Appendicitis - Longer-Term Outcomes. New England Journal of Medicine, 2021.PMID 34694761
OSCE — acute RIF pain and the Alvarado pathway · MBBS OSCE · NeetVellum