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 hallmark physical examination finding for acute cholecystitis (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 a sudden, sharp pain that causes the patient to abruptly stop inhaling (inspiratory arrest).
This pain occurs because the inflamed gallbladder descends during inspiration and makes contact with the examiner's hand.

Option A: Appendicitis is inflammation of the appendix, located in the right lower quadrant (RLQ). The pain and tenderness are typically localized there.
Option B: Cystitis is inflammation of the urinary bladder. It causes symptoms like urinary frequency, urgency, and pain in the suprapubic area (lower central abdomen).
Option D: Renal stones (nephrolithiasis) cause pain that originates in the flank (costovertebral angle) and often radiates to the groin. The characteristic sign is CVA tenderness.

Visual 1: Diagram: An illustration showing the correct hand placement in the right upper quadrant to elicit Murphy's sign.
Visual 2: Anatomical Chart: A map of the abdominal quadrants highlighting the location of Murphy's point (RUQ), McBurney's point (RLQ), and the area for CVA tenderness (posteriorly) to help differentiate the conditions.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Association of specific clinical signs with abdominal disorders as background academic context rather than a clinical decision trigger.
Accurately identifying clinical signs like Murphy's sign is a critical nursing assessment skill for differentiating causes of acute abdominal pain, enabling prompt and appropriate intervention.
A positive Murphy's sign should lead the nurse to suspect cholecystitis, monitor for complications like fever and signs of sepsis, and anticipate orders for an abdominal ultrasound and potential surgical consultation.
What if? If a patient has right upper quadrant pain but a negative Murphy's sign, the nurse should consider other diagnoses like hepatitis, peptic ulcer disease, or pancreatitis, and broaden the assessment to include questions about alcohol use, medication history, and stool color.

How to Approach the Question

This is a factual recall question that tests your knowledge of specific clinical signs.
Identify the key term in the question stem: 'Murphy's sign'.
Access your knowledge base to recall the definition of this sign and the pathological condition it indicates.
Evaluate each option by associating it with its own characteristic signs: Appendicitis with McBurney's sign, Cystitis with suprapubic tenderness, and Renal stone with CVA tenderness.
By elimination and direct recall, conclude that Cholecystitis is the only condition listed that is correctly associated with Murphy's sign.

Concept Tested & Keywords

Concept Tested: Association of specific clinical signs with abdominal disorders.
Stem keywords: Murphy's sign, disorder
Lead-in keywords: seen in which
Negative lead-in flag: false

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