ROSH Gastrointestinal Practice Exam

The Murphy's sign is associated with which physical exam finding in patients with right upper quadrant pain?

1. Brudzinski sign

2. Levine sign

3. Murphy sign

4. Psoas sign

The correct answer is: Murphy sign

The Murphy's sign is a key physical examination finding specifically associated with cholecystitis, an inflammation of the gallbladder. When examining a patient with right upper quadrant pain, the clinician will ask the patient to take a deep breath while the examiner applies pressure to the area over the gallbladder. If the patient experiences pain or interrupts their breath due to discomfort during this maneuver, the Murphy's sign is considered positive. This sign directly indicates the involvement of the gallbladder and is particularly useful in diagnosing gallbladder pathology. In the context of right upper quadrant pain, a positive Murphy's sign helps narrow down the differential diagnosis towards conditions like acute cholecystitis, whereas the other signs listed are associated with different clinical conditions. Therefore, recognizing the significance of Murphy's sign is critical in the evaluation of right upper quadrant pain.