A 14-year-old male presents to the emergency department with a 24-hour history of abdominal pain. The pain started periumbilically and has now localized to the right lower quadrant. He reports nausea and a low-grade fever. Physical examination reveals tenderness at McBurney's point. Which of the following is the BEST next step in management?
Discharge home with instructions to follow up with primary care provider
Give pain medication and order a CT scan of the abdomen
The correct answer is to obtain a surgical consult. This patient's presentation is highly suggestive of acute appendicitis, with classic symptoms including periumbilical pain migrating to the right lower quadrant, nausea, and low-grade fever. The physical exam finding of tenderness at McBurney's point further supports this diagnosis.
While laboratory tests and imaging studies can be helpful in confirming the diagnosis, they should not delay surgical evaluation in a case with high clinical suspicion. Appendicitis is a surgical emergency, and prompt consultation with a surgeon is crucial to prevent complications such as perforation.
Administering pain medication or antibiotics without surgical evaluation could mask symptoms and delay necessary treatment. Similarly, discharging the patient home with follow-up would be inappropriate given the high likelihood of appendicitis and the potential for rapid progression to a more severe condition.
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BCEN CEN
Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
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