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NBME 17 Answers

nbme17/Block 4/Question#27 (4.0 difficulty score)
A 20-year-old man with suspected appendicitis ...

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submitted by cassdawg(546),

T10 is the dermatome level for the umbilicus, hence the periumbilical discomfort (Landmark dermatomes FA2020 p510)

In appendicitis, the first pain is generalized referred pain and comes from stimulation of visceral afferents (which is why it is poorly localized). Pain eventually localizes as irritation to the parietal peritoneum occurs (FA2020 p383)

waitingonprometric  T10 for bellybutTEN dermatome. +3  
baja_blast  FA 2019 p. 498 for dermatomes and p. 377 for appendicitis +