ROSH Gastrointestinal Practice Exam

In assessing right upper quadrant pain, the presence of which finding is least likely in cholecystitis?

1. Murphy sign

2. Tenderness in the right upper quadrant

3. Fever

4. Constant pain

The correct answer is: Fever

In the context of assessing right upper quadrant pain, the correct finding that is least likely associated with cholecystitis is the presence of fever. Acute cholecystitis is typically characterized by persistent and severe abdominal pain, particularly in the right upper quadrant, and a positive Murphy sign, which indicates gallbladder inflammation or irritation. Tenderness in the right upper quadrant is also a common finding during physical examination, as these patients often experience significant discomfort when that area is palpated. While fever can occur in many cases of cholecystitis due to underlying infection, it is not present in every case and can sometimes be absent even if other classical signs and symptoms are evident. This makes fever the least reliable or least expected finding in all patients with cholecystitis, impacting its overall diagnostic value in this specific condition. Therefore, in a clinical scenario, while one might frequently expect to find Murphy’s sign, tenderness, and constant pain in patients with cholecystitis, the absence of fever in certain cases indicates a broader variability in presentation.