ROSH Gastrointestinal Practice Exam

A patient presents with right upper quadrant pain and a low-grade fever. Which sign would suggest a retrocecal appendix location?

1. Murphy sign

2. Obturator sign

3. Psoas sign

4. Rovsing sign

The correct answer is: Psoas sign

A retrocecal appendix is positioned behind the cecum, which alters the typical presentation of appendicitis. When an appendix is in this location, certain signs of irritation to the surrounding structures can become particularly relevant. The psoas sign indicates the irritation of the iliopsoas muscle due to the presence of an inflamed appendix located retrocecal. This sign is tested by having the patient flex their right hip against resistance or by extending the right leg while lying on their left side. If this movement elicits pain, it suggests that the inflamed appendix is irritating the nearby iliopsoas muscle, which is positioned close to a retrocecal appendix. In contrast, the Murphy sign indicates gallbladder inflammation or irritation, the obturator sign suggests pelvic appendicitis, and Rovsing sign is associated with classic presentations of appendicitis reflected through referred pain in the left lower quadrant when pressure is applied to the right lower quadrant. While each of these signs has its significance in diagnosing appendicitis and other gastrointestinal issues, the discomfort associated with the psoas sign is particularly indicative of an inflamed appendix in a retrocecal position.