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Home / Station 7: Acute right-lower-quadrant abdominal pain

NAC OSCE preparation

Station 7: Acute right-lower-quadrant abdominal pain

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Acute right-lower-quadrant abdominal pain

11 minutes

Discipline: Surgery & Perioperative Care
Station type: History + focused examination
Setting: Emergency department

Your task

Take a focused history and describe the abdominal examination. Summarize diagnosis, investigations and management.

Information available at entry

HR 104/minBP 118/72 mm HgRR 18/minSpO₂ 99%T 38.1°C

Coach prompt: Recognize appendicitis and exclude gynecologic emergencies.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 7 of 30

Standardized-patient profile

NameMs. Sara Malik

Age24

Pronounsshe/her

RolePatient

Demeanour: Uncomfortable and guarded.

Opening statement: “The pain started around my belly button and moved to the lower right side.”

History and standardized-patient responses

Pain

Candidate explores	Standardized-patient response
Migration	Periumbilical 14 hours ago, now RLQ.
Character	Constant, sharp, worse with movement/coughing.
Associated	Anorexia, nausea and one vomit; no diarrhea or blood.

Gynecologic/urinary

Candidate explores	Standardized-patient response
LMP	Five weeks ago; usually regular.
Pregnancy risk	Sexually active; inconsistent condoms.
Bleeding/discharge	None.
Urinary	No dysuria or flank pain.

Background

Candidate explores	Standardized-patient response
Surgery/conditions	None.
Medication/allergy	None.
Last intake	Food six hours ago; water two hours ago.

Physical findings

Localized RLQ tenderness, guarding and percussion/cough tenderness.
No generalized rigidity or CVA tenderness.
Pelvic examination only with indication, consent and chaperone.

Examiner prompts

Leading diagnosis?

Acute appendicitis.

Must exclude?

Ectopic pregnancy, ovarian torsion, perforation and generalized peritonitis.

Management?

NPO, analgesia/antiemetic, IV fluid as needed, pregnancy test, targeted blood/urine tests, appropriate imaging and early surgery consultation.

Differential diagnosis

Appendicitis
Ectopic pregnancy
Ovarian torsion
PID
Renal colic/UTI
Crohn disease
Gastroenteritis

Investigations

Pregnancy test
CBC, electrolytes, renal function and urinalysis
Ultrasound when appropriate
CT when indicated after pregnancy assessment

Management

NPO, analgesia, antiemetic and fluid
Early surgical consultation
Antibiotics per appendicitis pathway
Urgent operation for perforation/peritonitis/deterioration
Gynecology involvement if indicated

Communication behaviours

Ask sensitive questions nonjudgmentally
Offer chaperone for intimate examination
Do not withhold analgesia

Critical safety actions

Pregnancy testing is essential
Recognize peritonism
Do not discharge an uncertain deteriorating patient

Model closing summary

This 24-year-old woman has migratory periumbilical-to-RLQ pain, anorexia, nausea, fever and focal peritonism, making appendicitis most likely. Ectopic pregnancy and torsion must be excluded. I would keep her NPO, provide analgesia/fluids/antiemetic, obtain an urgent pregnancy test and relevant blood/urine tests, arrange appropriate imaging and consult surgery early.

Common pitfalls

Missing ectopic pregnancy
Repeated maximal palpation
Delaying analgesia
CT before pregnancy status

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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