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Review
of Clinical Signs

Murphy’s Sign of Cholecystitis

Series Editor and Author: Frank L. Urbano, MD

1. Which of the following statements best characterizes cholecystitis?
  1. It has no association with diet
  2. It is characterized by right upper quadrant pain
  3. It is often accompanied by nausea, vomiting, and leukopenia
  4. It most commonly occurs in persons younger than 30 years
  5. Its incidence is greater in men than in women
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2. Which one of the following statements regarding Murphy’s sign is correct?

  1. Because of its accuracy, Murphy’s sign can be used alone to diagnose cholecystitis
  2. Few patients with a positive hepatobiliary scan will show a positive Murphy’s sign
  3. It is considered positive when full expiration causes pain in the right subcostal area upon palpation
  4. It is highly specific but not very sensitive
  5. It is positive in cholecystitis because the inflamed gallbladder descends towards the examiner’s fingers, irritating the peritoneum and causing pain
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  3. Which one of the following statements regarding the sonographic Murphy’s sign is correct?
  1. It is more useful than color Doppler imaging in the diagnosis of cholecystitis
  2. It is equal in accuracy to the traditional Murphy’s sign
  3. It is more useful than the presence of gallbladder wall thickening or pericholecystic fluid in the diagnosis of cholecystitis
  4. Palpation of the right upper quadrant with the ultrasound transducer elicits a positive response
  5. The test is generally less sensitive than it is specific
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