Which of the following physical signs is associated with the correct definition suggestive of acute appendicitis?a. Rovsing sign: pain in the RLQ on palpation of the left lower quadrant
Appendicitis usually starts with periumbilical pain that migrates to the RLQ. Patients often have associated gastrointestinal symptoms such as anorexia, nausea, and vomiting. On physical examination, patients often prefer to remain lying supine and often guard due to peritoneal irritation. Rebound tenderness is when the examiner presses on the RLQ and the patient experiences a sudden pain upon removal of the hand. Rovsing sign is RLQ pain that is induced by palpation of the left lower quadrant and is highly suggestive of a RLQ inflammatory process. Dunphy sign elicits pain with coughing and is related to inflammation of the peritoneum. The obturator sign occurs with internal rotation of the right hip. Lastly, the iliopsoas sign is pain with extension of the right hip, attributed to a retrocecal appendix.