Migrating Pain in a Young Man: Acute Appendicitis
A branching clinical case simulation for a patient presenting with 24 hours of periumbilical pain migrating to the right iliac fossa. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 3easy20 min5 stages
- Patient
- 22 years, male
- Presenting complaint
- 24 hours of periumbilical pain migrating to the right iliac fossa
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment
The presentation
You are a Year 3 medical student on placement in the Emergency Department of a district general hospital. A 22-year-old man has been triaged with abdominal pain. The pain started around the umbilicus 24 hours ago and has now moved to the right lower quadrant. He feels feverish and has vomited once. He is waiting to be assessed. Your task is to take a focused history, examine him, arrange appropriate investigations, and make a clinical decision.
What this case teaches
Take a focused surgical history; examine for peritonism; keep the patient nil by mouth with analgesia and fluids; refer for appendicectomy; exclude alternative diagnoses.
How the case unfolds
- 1Focused surgical historyHistory
- 2Focused abdominal examinationExamination
- 3Investigations and immediate managementInvestigations
- 4Formulate a diagnosisDiagnosis
- 5Perioperative managementTreatment
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.