ROSH Gastrointestinal Practice Exam

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What is a classic manifestation of cholecystitis observed during physical examination?

Rebound tenderness
Guarding
Murphy's sign
Brudzinski's sign

The correct answer is: Murphy's sign

Murphy's sign is a classic physical examination finding associated with acute cholecystitis. This sign is tested by having the patient take a deep breath while the examiner palpates the right upper quadrant of the abdomen. If the patient suddenly stops inhaling due to pain in this area, it indicates inflammation of the gallbladder, supporting a diagnosis of cholecystitis. In contrast, rebound tenderness and guarding are more general signs of abdominal inflammation or irritation that could indicate various conditions, not specific to cholecystitis. Additionally, Brudzinski's sign is a clinical indicator of meningitis and does not relate to gastrointestinal issues or cholecystitis. Thus, Murphy's sign is uniquely characteristic for identifying acute cholecystitis during a physical examination.