Murphy's sign is positive in?

Appeared in: NIA - 29 January 2023

Explanation

Murphy's sign is a specific physical examination finding used to diagnose Acute Cholecystitis (inflammation of the gallbladder).
The test is performed by palpating the right subcostal area while the patient takes a deep breath.
A positive sign occurs when the patient experiences sharp pain and abruptly stops inspiration as the inflamed gallbladder descends and touches the examiner's hand.
This inspiratory arrest due to pain is the hallmark of a positive Murphy's sign.

Option B: Appendicitis is the inflammation of the appendix. Its diagnosis is associated with other specific signs.
Option C: Diverticulitis is the inflammation of diverticula, most commonly in the sigmoid colon. The associated pain is typically in the left lower quadrant (LLQ).
Option D: Nephritis refers to inflammation of the kidneys. The characteristic sign is tenderness over the back.

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 conditions as background academic context rather than a clinical decision trigger.
Differentiating the cause of abdominal pain is a critical nursing skill. Recognizing Murphy's sign helps distinguish cholecystitis from other conditions like pancreatitis, peptic ulcer disease, or appendicitis, guiding appropriate and timely intervention.
A positive Murphy's sign, along with other symptoms like fever, nausea, and RUQ tenderness, strongly suggests the need for further diagnostic workup, such as an abdominal ultrasound, and surgical consultation.
What if the patient is elderly and has a blunted pain response? In this case, Murphy's sign may be absent or less pronounced despite the presence of acute cholecystitis. Nurses should maintain a high index of suspicion based on other signs like fever, leukocytosis, and changes in mental status.

How to Approach the Question

First, identify the core concept of the question, which is 'Murphy's sign'.
Recall the definition and clinical significance of this specific diagnostic sign from your medical-surgical nursing knowledge.
Associate Murphy's sign with the specific organ and condition it helps diagnose. Remember that it involves the gallbladder.
Evaluate the given options: Cholecystitis (gallbladder inflammation), Appendicitis (appendix inflammation), Diverticulitis (colon inflammation), and Nephritis (kidney inflammation).
Select the option that directly corresponds to the condition indicated by a positive Murphy's sign.

Concept Tested & Keywords

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

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

Practise the full NIA - 29 January 2023

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