Question 1

What is the Alvarado score and how does it help diagnose appendicitis?

Accepted Answer

The Alvarado score (MANTRELS) helps predict acute appendicitis: Migration of pain to RIF (1), Anorexia (1), Nausea/vomiting (1), RIF tenderness (2), Rebound tenderness (1), Elevated temperature >37.3°C (1), Leukocytosis WBC >10 (2), Left shift neutrophilia (1). Total 10 points. Score 1–4: Unlikely appendicitis — discharge with safety netting. Score 5–6: Possible — admit for observation and imaging. Score 7–10: Probable appendicitis — surgical review. Note: A normal Alvarado score does not exclude appendicitis in women (always consider gynaecological cause). CT has >95% sensitivity for appendicitis.

Question 2

What are the NICE NG12 2-week wait criteria for suspected bowel cancer?

Accepted Answer

NICE NG12 urgent 2-week wait (2WW) referral for suspected colorectal cancer: Age ≥40 with unexplained rectal bleeding AND either abdominal pain or weight loss; Age ≥50 with unexplained rectal bleeding; Age ≥60 with iron-deficiency anaemia or change in bowel habit; Positive FIT (faecal immunochemical test) result; Rectal or abdominal mass on examination; Unexplained anal mass or ulceration. Consider 2WW for: Age <40 with rectal bleeding AND at least one of — abdominal pain, change in bowel habit, weight loss, or iron-deficiency anaemia. FIT testing: a positive result (>10 µg/g) should trigger urgent referral regardless of age or symptoms.

Question 3

When should a GP suspect a strangulated hernia and what is the management?

Accepted Answer

Strangulated hernia warning signs: Sudden onset of severe pain in a previously reducible hernia; Hernia becomes irreducible (will not go back); Overlying skin becomes red, warm, oedematous; Systemic signs — fever, tachycardia, vomiting; Signs of bowel obstruction — absolute constipation, distension, vomiting. GP action: Do NOT attempt manual reduction of a painful, tender, irreducible hernia — this risks reducing necrotic bowel. Call 999 or arrange emergency admission immediately. Analgesia, IV access, and nil by mouth pending surgical assessment. Femoral hernias have the highest strangulation risk due to narrow femoral ring.

General Surgery

Acute Abdomen

Differential Diagnosis by Region

Alvarado Score — Appendicitis Calculator

Peritonism & Clinical Signs Reference