NORCET 1 - 2020: Murphy's sign is seen in which disorder?

NORCET 1 - 2020

Medical & Surgical Nursing

Easy

Appeared in: NORCET 1 - 2020

Explanation

Murphy's sign is a key diagnostic sign for cholecystitis, which is the inflammation of the gallbladder.
It is elicited by palpating the right upper quadrant of the abdomen while the patient takes a deep breath.
A positive sign is characterized by sharp pain and an abrupt cessation of inspiration (inspiratory arrest) as the inflamed gallbladder descends and makes contact with the examiner's hand.

Option A: Appendicitis is associated with McBurney's sign, which is tenderness in the right lower quadrant, not the right upper quadrant where Murphy's sign is elicited.
Option B: Cystitis, or bladder inflammation, causes suprapubic tenderness in the lower central abdomen and urinary symptoms, which is anatomically and symptomatically distinct from Murphy's sign.
Option D: Renal stones are characterized by costovertebral angle (CVA) tenderness, which is assessed on the patient's back over the kidneys, and typically cause flank pain radiating to the groin.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of abdominal pathologies as background academic context rather than a clinical decision trigger.
Nurses must be proficient in abdominal assessment to identify signs like Murphy's, which can indicate a serious condition like cholecystitis requiring urgent medical evaluation and potential surgical intervention.
Accurate documentation of the location, type, and intensity of abdominal pain, along with the results of specific maneuvers like Murphy's sign, is crucial for the diagnostic process and for monitoring the patient's condition.
What if? If the patient is elderly or has a high pain tolerance, a classic Murphy's sign might be absent or less pronounced even with cholecystitis. In such cases, other signs like low-grade fever, elevated white blood cell count, and ultrasound findings become more critical for diagnosis.

How to Approach the Question

First, identify the core term in the question: "Murphy's sign".
Recognize this as a factual recall question that tests your knowledge of clinical signs associated with common abdominal disorders.
Access your memory to link "Murphy's sign" to its corresponding organ and condition. The sign is elicited in the right upper quadrant, which is the location of the gallbladder.
Systematically evaluate the given options based on their associated pathologies and anatomical locations.
Eliminate Appendicitis (right lower quadrant), Cystitis (suprapubic region), and Renal stone (flank/back).
Conclude that Cholecystitis is the correct answer as it affects the gallbladder, located in the right upper quadrant where Murphy's sign is positive.

Concept Tested & Keywords

QvP9RlZax2nUDXrtWy4b-x

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

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

E6 Anatomy BDChaurasia V2 10e Part 2 p. 67-69