Abdomen and pelvis: retrocaecal appendix: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Abdomen and pelvis: retrocaecal appendix

Sample item

A 24-year-old man with right iliac fossa pain has a positive psoas sign: passive extension of the right hip aggravates the pain. Which anatomical position of the appendix best explains this?

APreileal, lying in front of the terminal ileumBSubhepatic, lying beneath the liverCRetrocaecal, lying on the psoas major muscleDPelvic, lying on the bladder

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Retrocaecal, lying on the psoas major muscle

The commonest position of the appendix is retrocaecal (retrocolic). An inflamed appendix in this position irritates the psoas major, so extension of the hip, which stretches the muscle, causes pain. A pelvic appendix gives a positive obturator sign and urinary or rectal symptoms.

Option by option

A. Preileal, lying in front of the terminal ileum
A preileal appendix lies in front of the terminal ileum, away from the psoas muscle, so the psoas sign is usually negative.
B. Subhepatic, lying beneath the liver
A subhepatic appendix lies near the gallbladder and mimics cholecystitis.
C. Retrocaecal, lying on the psoas major muscle (correct)
Correct. A retrocaecal appendix lies on the psoas and produces the psoas sign.
D. Pelvic, lying on the bladder
A pelvic appendix irritates the obturator internus and produces rectal or bladder symptoms.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is C, Retrocaecal, lying on the psoas major muscle. The commonest position of the appendix is retrocaecal (retrocolic).

Why is "Preileal, lying in front of the terminal ileum" not the answer?

A preileal appendix lies in front of the terminal ileum, away from the psoas muscle, so the psoas sign is usually negative.

Why is "Subhepatic, lying beneath the liver" not the answer?

A subhepatic appendix lies near the gallbladder and mimics cholecystitis.

Why is "Pelvic, lying on the bladder" not the answer?

A pelvic appendix irritates the obturator internus and produces rectal or bladder symptoms.

What concept does this question test?

It tests Abdomen and pelvis: retrocaecal appendix in Anatomy. An inflamed appendix in this position irritates the psoas major, so extension of the hip, which stretches the muscle, causes pain. A pelvic appendix gives a positive obturator sign and urinary or rectal symptoms.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Abdomen and pelvis: retrocaecal appendix?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.