必修問題
医師国家試験 第113回 問109
109 / 400
A25-year-old man comes to your clinic complaining of abdominal pain for the past two days. Yesterday, the pain was periodic and located around the periumbilical area. Today the pain is persistent and located in the right lower quadrant. He feels feverish. He does not smoke or drink alcohol. His body temperature is 37.7°C, blood pressure is 126/62mmHg, and pulse rate is 94/min, regular. Which one of the following should be done next?
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正解 b
examine for peritoneal irritation
臍周囲の間欠的な痛みが右下腹部の持続痛へ移動し発熱を伴う経過は、急性虫垂炎に典型的です。次に行うべきは腹膜刺激徴候の有無を確かめる身体診察で、反跳痛や筋性防御の評価は診断と緊急性の判断に直結します。血液検査や造影CTはその後に行うもので、診断確定前の抗菌薬投与や上部消化管内視鏡は適切ではありません。