Questions and Answers
What could a pulsatile mass indicate during a physical exam?
Tachycardia or hypotension may suggest dehydration.
False
What is a poor predictor of acute appendicitis in older patients?
Fever
Which of the following signs should be checked during a physical exam for appendicitis?
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What does a positive Rovsing's sign indicate?
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What does Carnett's sign indicate during an abdominal examination?
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The psoas sign can be positive with sources of retroperitoneal irritation.
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What maneuver is performed to elicit the psoas sign?
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What is the clinical sign indicating localized peritonitis due to acute appendicitis called?
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What should be observed during a physical exam related to domestic violence?
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Study Notes
Physical Exam: Signs to Look for in Abdominal Pain
- Check for pulsatile mass to indicate abdominal aortic aneurysm.
- Tachycardia or hypotension could signal ruptured aortic aneurysm, septic shock, GI hemorrhage, or volume depletion.
- Absence of fever in elderly patients does not rule out serious illness.
- Look for signs of domestic violence in "bathing suit" areas (breasts, body, buttocks, genitals).
Appendicitis Signs & Symptoms
- Key symptoms include anorexia and periumbilical pain, often followed by nausea and vomiting, present in 50% of cases.
- Fever is a poor predictor of acute appendicitis in older individuals.
Appendicitis Physical Exam Techniques
- Murphy's sign assesses for gallbladder disease (cholecystitis).
- Obturator sign checks for appendicitis-related irritation.
- Psoas sign evaluates for abdominal irritation.
- Rovsing's sign tests rebound tenderness or pain referral.
Obturator Sign
- Indicates irritation of the obturator internus muscle.
- Detected by flexion and internal rotation of the hip with the knee and ankle held in a specific position.
- Pain during this maneuver suggests inflammation of the appendix.
Psoas Sign
- Indicates irritation to the iliopsoas group of hip flexors, suggesting a retrocaecal appendix orientation.
- Elicited by passive thigh extension or active thigh flexion from the hip.
- Positive sign denotes possible appendicitis or other retroperitoneal irritation.
Rovsing's Sign
- Presence of pain in the right lower quadrant upon palpation of the left lower quadrant indicates appendicitis.
- Positive when palpating the left iliac fossa increases pain in the right iliac fossa.
Heel Jar (Markle) Test
- Elicits pain in the right lower quadrant when a patient drops from standing on toes to heels.
- Sign of localized peritonitis, such as from acute appendicitis.
- Abdominal pain during walking/running serves as an equivalent indicator.
Carnett's Sign
- Positive sign occurs when abdominal pain remains unchanged or worsens upon tensing the abdominal wall.
- Tested by having the patient lift head/shoulders or raise straight legs.
- A positive result suggests abdominal wall source of pain; a negative result points to an intra-abdominal cause.
Murphy's Sign
- Tested during abdominal exam, indicating gallbladder disease (cholecystitis).
- Patient is asked to breathe out while the examiner palpates the area.
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Description
Test your knowledge on the physical exam techniques and signs associated with abdominal pain, including appendicitis and other serious conditions. This quiz covers key indicators such as Murphy's sign, tachycardia, and the obturator sign, as well as special considerations for elderly patients.
