Match each classic clinical presentation to its most likely acute surgical diagnosis.
- A 42-year-old female presents with acute right upper quadrant pain, fever, and inspiratory arrest upon deep palpation of the right costal margin.Acute cholecystitis
- A 25-year-old male involved in a motor vehicle collision develops acute left shoulder pain and hypotension.Splenic rupture
- A 55-year-old male with chronic alcohol use disorder presents with severe epigastric pain radiating to the back and bluish discoloration of the flanks.Hemorrhagic pancreatitis
- A 22-year-old male with right lower quadrant pain experiences increased pain in that area when the examiner applies pressure to the left lower quadrant.Acute appendicitis
Answer
The first presentation matches with acute cholecystitis, the second matches with splenic rupture, the third matches with hemorrhagic pancreatitis, and the fourth matches with acute appendicitis.
Each vignette describes a pathognomonic physical examination finding associated with a specific anatomic location. Inspiratory arrest on right upper quadrant palpation is Murphy sign (gallbladder/acute cholecystitis). Referred left shoulder pain in trauma is Kehr sign (diaphragm/splenic rupture). Flank ecchymosis is Grey Turner sign (retroperitoneum/severe hemorrhagic pancreatitis). Right lower quadrant pain upon left lower quadrant palpation is Rovsing sign (peritoneum/acute appendicitis).
Step-by-Step Solution
Key Concept
Classic eponymous physical examination signs in acute abdominal pathology