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5) An 18 year old man presents to the Emergency Department with a 14 hour history of abdominal painwhich has now localized to the right lower quadrant. On physical examination, there is tenderness of deeppalpation in the right lower quadrant, without guarding or rebound. The Rovsing's sign is negative. Whichof the following additional physical findings would be most consistent with a diagnosis of appendicitis if

positive?

Murphy's sign Chvostek's sign

Psoas sign

Carnett's sign

Romberg's sign

Explanation:

Sign Description Typically seen in

Chvostek's signAbnormal reaction of the facial nerve tostimulation

Electrolyte abnormality, mostcommonly hypocalcemia

Carnett's sign

Abdominal wall pain decreases when theabdominal wall musculature is tensed;typically indicating that the source of thepain is the abdominal wall, as opposed to

the abdominal cavity.

Rectus sheath hematomaabdominal wall trauma

Murphy's sign

Pain and tenderness to palpation of theRUQ during inspiration and resulting incessation of inspiration; can be associatedwith physical examination orultrasonography

Acute cholecystitisLiver pathology

Psoas sign

Right lower quadrant pain with passive (oractive) extension of the right lowerextremity. This typically indicates aprocess that is irritating the right psoasmuscle. (Note: the patient is on their sideduring this examination)

Appendicitis (typicallyretrocecal)Psoas muscle abscess orhematoma

Romberg's sign

Tests the body's ability to senseproprioception (positioning) and thusassess function of the dorsal columns ofthe spinal cord.

Any process that causesdysfunction in sensoryperception. This can bemetabolic (ETOH intoxication)or neuroanatomical in etiology.

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