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Acute Appendicitis Exam Questions with Latest Update
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Acute Appendicitis Exam Questions with Latest Update
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Acute Appendicitis Exam Questions withLatest Update
Physical Exam: Signs to Look out for in Abdominal Pain - Answer-Check for pulsatile
mass at it may indicate abdominal aortic aneurysm
Tachycardia or hypotension may be signs of ruptured aortic aneurysm, septic shock, GI
hemorrhage, and volume depletion.
Absence of fever in the elderly does not exclude serious illness
Examine for signs of domestic violence in the "bathing suit" areas primarily involving
breasts, body, buttocks, and genitals
Appendicitis Signs & Symptoms - Answer-Anorexia
Periumbilical pain followed by nausea and vomiting occurs in only 50% of cases.
Fever alone is a poor predictor of acute appendicitis in older patients.
Appendicitis PE techniques - Answer-Check for Murphy's sign (Cholecystitis)
Check of Obturator sign
Check of Psoas sign
Check of Rovsing sign or rebound tenderness
Obturator sign: Appendicitis - Answer-The obturator sign is an indicator of irritation to
the obturator internus muscle.
The technique for detecting the obturator sign, called the obturator test, is carried out on
each leg in succession. The patient lies on her/his back with the hip and knee both
flexed at ninety degrees. The examiner holds the patient's ankle with one hand and
knee with the other hand. The examiner internally rotates the hip by moving the patient's
ankle away from the patient's body while allowing the knee to move only inward. This is
flexion and internal rotation of the hip.
In the clinical context, it is performed when acute appendicitis is suspected. In this
condition, the appendix becomes inflamed and enlarged. The appendix may come into
physical contact with the obturator internus muscle, which will be stretched when this
maneuver is performed on the right leg. This causes pain and is evidence in support of
an inflamed appendix
Psoas sign: Appendicitis - Answer-The psoas sign is a medical sign that indicates
irritation to the iliopsoas group of hip flexors in the abdomen and consequently indicates
that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is
retroperitoneal).
It is elicited by performing the psoas test by passively extending the thigh of a patient
lying on his side with knees extended, or asking the patient to actively flex his thigh at
the hip. If abdominal pain results, it is a "positive psoas sign".
, The pain results because the psoas borders the peritoneal cavity, so stretching (by
hyperextension at the hip) or contraction (by flexion of the hip) of the muscles causes
friction against nearby inflamed tissues. In particular, the right iliopsoas muscle lies
under the appendix when the patient is supine, so a positive psoas sign on the right
may suggest appendicitis. A positive psoas sign may also be present in a patient with a
psoas abscess. It may also be positive with other sources of retroperitoneal irritation,
e.g. as caused by hemorrhage of an iliac vessel.
Rovsing: Appendicitis - Answer-Rovsing's sign is a sign of appendicitis. If palpation of
the left lower quadrant of a person's abdomen increases the pain felt in the right lower
quadrant, the patient is said to have a positive Rovsing's sign and may have
appendicitis.
In acute appendicitis, palpation in the left iliac fossa may produce pain in the right iliac
fossa.
Heel Jar (Markle) test - Answer-Clinical sign in which pain in the right lower quadrant of
the abdomen is elicited by dropping from standing on the toes to the heels with a jarring
landing. It is found in patients with localized peritonitis due to acute appendicitis. It is
similar to rebound tenderness, but may be easier to elicit when the patient has firm
abdominal wall muscles. Abdominal pain on walking or running is an equivalent sign.
Carnett's sign: - Answer-Carnett's sign is a finding on clinical examination in which
(acute) abdominal pain remains unchanged or increases when the muscles of the
abdominal wall are tensed. For this part of the abdominal examination, the patient can
be asked to lift the head and shoulders from the examination table to tense the
abdominal muscles. An alternative is to ask the patient to raise both legs with straight
knees.
A positive test increases the likelihood that the abdominal wall and not the abdominal
cavity is the source of the pain (for example, due to rectus sheath hematoma instead of
appendicitis).
A negative Carnett's sign is said to occur when the abdominal pain decreases when the
patient is asked to lift the head; this points to an intra-abdominal cause of the pain.
Murphy's sign: Cholecystitis - Answer-Murphy's sign is tested for during an abdominal
examination; it is performed by asking the patient to breathe out and then gently placing
the hand below the costal margin on the right side at the mid-clavicular line (the
approximate location of the gallbladder). The patient is then instructed to inspire
(breathe in). Normally, during inspiration, the abdominal contents are pushed downward
as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as
the gallbladder is tender and, in moving downward, comes in contact with the
examiner's fingers) and winces with a 'catch' in breath, the test is considered positive. In
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