必修問題
医師国家試験 第119回 問110
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A25-year-old man presented with abdominal pain which started two days ago. Yesterday, the pain was periodic and located around the periumbilical area. Today, the pain is persistent and localized in the right lower abdomen. His body temperature is 37.7°C, pulse rate90/min, blood pressure120/62 mmHg, and respiratory rate16/min. Physical examination shows rebound tenderness at the right lower abdomen. Which one of the following should be performed next?
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Abdominal CT
臍周囲の間欠痛が翌日には右下腹部の持続痛へ移動し、微熱と反跳痛(Blumberg徴候)を伴う経過は急性虫垂炎に典型的です。診断の確定と穿孔・膿瘍形成の評価には腹部CTが有用で、次に行う検査として適切です。上部消化管内視鏡やMRCP、経鼻胃管留置、中心静脈カテーテル挿入はこの段階では必要ありません。