Murphy's sign is an important sign associated with?

Appeared in: TMC Staff Nurse - 2019

Explanation

Murphy's sign is the hallmark clinical sign for acute cholecystitis (inflammation of the gallbladder).
The sign is elicited by asking the patient to inspire deeply while the examiner palpates the right subcostal area.
A positive sign is characterized by a sudden cessation of inspiration (inspiratory arrest) due to sharp pain as the inflamed gallbladder descends and meets the examiner's hand.
This specific response helps differentiate cholecystitis from other causes of abdominal pain.

Option A: Appendicitis is inflammation of the appendix. It is not associated with Murphy's sign.
Option B: Pancreatitis is inflammation of the pancreas. While it causes upper abdominal pain, it is not associated with Murphy's sign.
Option C: Cholelithiasis refers to the presence of gallstones. The stones themselves do not cause a positive Murphy's sign unless they lead to inflammation of the gallbladder (cholecystitis).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical assessment signs for abdominal pathologies as background academic context rather than a clinical decision trigger.
Accurate physical assessment is a critical nursing skill for differentiating between various causes of abdominal pain, guiding further diagnostic tests, and prioritizing care.
A positive Murphy's sign is a strong indicator for acute cholecystitis, prompting a nurse to anticipate orders for an abdominal ultrasound, lab tests (CBC, LFTs), and potential surgical consultation.
What if? If a patient presents with right upper quadrant pain but has a negative Murphy's sign, the nurse should consider other diagnoses like hepatitis, peptic ulcer disease, or referred pain from a right lower lobe pneumonia, and assess for other relevant signs and symptoms.

How to Approach the Question

First, identify the core concept of the question, which is 'Murphy's sign'. This is a specific clinical term.
Recall the definition and clinical significance of Murphy's sign. This is a knowledge-based question requiring you to link a sign to a specific medical condition.
Evaluate each option provided:
Appendicitis: Recall its classic signs (McBurney's point, Rovsing's sign). This is incorrect.
Pancreatitis: Recall its signs (epigastric pain radiating to the back, Cullen's/Grey-Turner's signs). This is incorrect.
Cholelithiasis: Understand this means gallstones, which can be asymptomatic or cause biliary colic, but doesn't inherently mean inflammation. This is less likely.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 p. 636-638

E6 Anatomy Workbook BDChaurasia V2 10e p. 106-108

Practise the full TMC Staff Nurse - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.