During the evaluation of patients presenting to the emergency department with acute abdominal pain, specific physical examination findings are critical for establishing a differential diagnosis. Match each described physical examination maneuver or finding with the clinical condition it most strongly indicates.
- Inspiratory pause elicited during deep palpation of the right upper quadrantAcute cholecystitis
- Right lower quadrant pain that occurs during deep palpation of the left lower quadrantAcute appendicitis
- Right lower quadrant pain exacerbated by passive extension of the right hipRetrocecal appendicitis
- Referred pain to the left shoulder that worsens when the patient is placed in a supine positionSplenic rupture
Answer
Inspiratory pause during RUQ palpation matches Acute cholecystitis; RLQ pain on LLQ palpation matches Acute appendicitis; RLQ pain on passive hip extension matches Retrocecal appendicitis; and referred left shoulder pain matches Splenic rupture.
The correct matches require distinguishing the pathophysiological mechanisms behind eponymous physical examination signs. Murphy sign represents focal gallbladder inflammation. Rovsing sign relies on general peritoneal irritation localizing to the right lower quadrant. Psoas sign relies on the anatomic relationship of the appendix to the retroperitoneum. Kehr sign relies on the referred pain pathway of the phrenic nerve.
Step-by-Step Solution
Key Concept
Correlation of eponymous abdominal physical examination signs with their underlying pathophysiologic mechanisms and associated acute abdominal emergencies.
Estimated Time:1m 30s