Surgery MCQs Q43

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SURGERY • CLINICAL SIGNS

A patient presents with suspected acute appendicitis. On examination, pain is elicited when the hip is extended while the patient lies on their side.

Which hip movement is most likely to produce pain in retrocecal appendicitis?

A Extension

B Flexion

C Medial rotation

D Lateral rotation

E Abduction

The correct answer is Extension.

Decoding the Stem

1

CLUE "Retrocecal appendix"

TRANSLATION Lies directly over psoas major → Stretching psoas causes pain (Psoas Sign).

Detailed Explanation

✅ Correct Option (Extension): The Psoas Sign is elicited by extending the right hip while the patient lies on their left side. This maneuver stretches the psoas major muscle. If an inflamed appendix is in the retrocecal position (lying directly on the psoas), the stretch causes friction and pain, suggesting appendicitis.

❌ Why other options are incorrect:

→ Flexion: Flexing the hip actually relaxes the psoas muscle and often relieves the pain associated with a psoas sign.

→ Medial/Lateral Rotation: These movements are more relevant to the Obturator Sign (pain on internal rotation of a flexed hip), which indicates a pelvic appendix position rather than retrocecal.

→ Abduction: Abduction does not specifically stretch the muscles associated with the typical appendical positions (psoas or obturator internus).

🧠 High-Yield Pearls

✔ Psoas Sign = Pain on Hip Extension = Retrocecal Appendix.

✔ Obturator Sign = Pain on Internal Rotation (with flexed hip) = Pelvic Appendix.

✔ Rovsing's Sign = Palpation of LLQ causes pain in RLQ.

Integrated Clinical Questions

1. What is Psoas sign?

→ Pain on hip extension (or resisted flexion).

2. What is Obturator sign?

→ Pain on internal rotation of the flexed hip.

3. Most common position of appendix?

→ Retrocecal.

4. Why pain initially periumbilical?

→ Visceral pain (midgut origin).

5. Why shifts to RIF later?

→ Parietal peritoneum involvement.

⚡ Exam Pearls

• • Retrocecal → Psoas → Extension pain.
• • Pelvic → Obturator sign (Internal rotation).
• • Always link the Anatomy to the Physical Sign for exams.
• • Tip position determines the clinical sign; base is constant.

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