Steve was a 21-year-old male college student who complained of pain, nausea with vomiting, and tenderness in the right lower quadrant. The pain was first vague and diffuse, then became more severe in the midepigastric region before localizing in the right lower quadrant. The pain was accentuated by movement, deep respiration, coughing, or sneezing. A mild fever of 102.2° F and a moderate leucocytosis (11,500/cu mm) were present. A marked tenderness was noted over the right lower quadrant at McBurney's point (one-third the distance between the anterior superior iliac spine and the umbilicus). The psoas sign (pain on passive hyperxtension of the thigh) was also present. His vitals were:
| Temperature | 102.2° F |
| Pulse | 96 |
| BP | 140/90 |
| Respiration | 18 b/min and shallow |