Family Nurse Practitioner Exam

Which finding during palpation of the right upper quadrant is indicative of acute cholecystitis?

1. Severe sharp pain upon deep inspiration

2. Fever and vomiting

3. Borborygmi and cramping

4. Localized tenderness with rebound pain

The correct answer is: Severe sharp pain upon deep inspiration

The correct answer is the finding of severe sharp pain upon deep inspiration, commonly referred to as Murphy's sign. This is a classic indicator of acute cholecystitis. When the gallbladder becomes inflamed, palpation of the right upper quadrant can elicit significant discomfort, particularly when the patient takes a deep breath in. This reaction occurs because the inflamed gallbladder comes into contact with the abdominal wall during deep inspiration, producing a sharp, localized pain that causes the individual to halt their breath—a response indicative of gallbladder irritation. While fever and vomiting can accompany acute cholecystitis, they are more general symptoms that may not be specific to this condition. Borborygmi and cramping pertain to gastrointestinal disturbances but do not diagnose acute cholecystitis directly. Localized tenderness with rebound pain might indicate peritoneal irritation, but it is less definitive than the sharp pain experienced during inhalation when assessing for cholecystitis. Thus, when considering the specificity of palpation findings in diagnosing acute cholecystitis, severe sharp pain during deep inspiration is a significant hallmark characteristic.