ROSH Gastrointestinal Practice Exam

Which physical exam finding is most suggestive of appendicitis?

1. Kehr's sign

2. Murphy's sign

3. Rovsing's sign

4. Scarf sign

The correct answer is: Rovsing's sign

Rovsing's sign is a physical exam finding that is considered most suggestive of appendicitis. It refers to the pain that is felt in the right lower quadrant when pressure is applied to the left lower quadrant of the abdomen. This phenomenon occurs because of the shared nerve pathways in the abdominal cavity. The irritation or inflammation associated with appendicitis can cause referred pain, so the eliciting of pain in the right lower quadrant upon palpation of the left is an important indicator for the diagnosis of appendicitis. In contrast, the other signs listed have different clinical implications. Kehr's sign, which is characterized by referred pain to the left shoulder due to irritation of the diaphragm (often associated with splenic issues), does not specifically indicate appendicitis. Murphy's sign, indicating gallbladder disease, involves pain upon deep palpation during inspiration, which is not relevant for appendicitis. The Scarf sign is primarily associated with hypermobility and is not relevant to acute abdominal issues like appendicitis. Thus, the presentation of Rovsing's sign aligns closely with the pathophysiology of appendicitis, making it the most suggestive physical exam finding in this context.