5)An18yearoldmanpresentstotheEmergencyDepartmentwitha14hourhistoryofabdominalpain

whichhasnowlocalizedtotherightlowerquadrant.Onphysicalexamination,thereistendernessofdeep
palpationintherightlowerquadrant,withoutguardingorrebound.TheRovsing'ssignisnegative.Which
ofthefollowingadditionalphysicalfindingswouldbemostconsistentwithadiagnosisofappendicitisif
positive?

Murphy'ssign

Chvostek'ssign

Psoassign

Carnett'ssign

Romberg'ssign

Explanation:
Sign
Chvostek'ssign

Carnett'ssign

Murphy'ssign

Psoassign

Romberg'ssign

Description
Typicallyseenin
Abnormalreactionofthefacialnerveto Electrolyteabnormality,most
stimulation
commonlyhypocalcemia
Abdominalwallpaindecreaseswhenthe
abdominalwallmusculatureistensed;
Rectussheathhematoma
typicallyindicatingthatthesourceofthe
abdominalwalltrauma
painistheabdominalwall,asopposedto
theabdominalcavity.
Painandtendernesstopalpationofthe
RUQduringinspirationandresultingin
Acutecholecystitis
cessationofinspiration;canbeassociated
Liverpathology
withphysicalexaminationor
ultrasonography
Rightlowerquadrantpainwithpassive(or
active)extensionoftherightlower
Appendicitis(typically
extremity.Thistypicallyindicatesa
retrocecal)
processthatisirritatingtherightpsoas
Psoasmuscleabscessor
muscle.(Note:thepatientisontheirside hematoma
duringthisexamination)
Anyprocessthatcauses
Teststhebody'sabilitytosense
dysfunctioninsensory
proprioception(positioning)andthus
perception.Thiscanbe
assessfunctionofthedorsalcolumnsof
metabolic(ETOHintoxication)
thespinalcord.
orneuroanatomicalinetiology.