Which finding is most suggestive of the likely diagnosis in this patient?

Which finding is most suggestive of the likely diagnosis in this patient?

• A. Leukocytosis
• B. Hematemesis
• C. + psoas sign
• D. Vomiting before the onset of pain

Answer: (C)

The finding shown by a positive psoas sign tests irritation of the iliopsoas muscle from inflammation in the abdomen, most characteristically due to appendicitis with a retrocecal appendix. When the right hip is extended or the patient actively or passively lifts the leg, the stretched psoas muscle irritates inflamed tissue, reproducing pain in the right lower quadrant. This makes it a relatively specific clue for appendicitis among the abdominal pain etiologies listed. Leukocytosis can occur with appendicitis but is nonspecific and can be seen with many infections. Hematemesis points to upper GI bleeding rather than appendiceal disease. Vomiting before pain is not a typical feature of appendicitis and is more aligned with other GI conditions.

The finding shown by a positive psoas sign tests irritation of the iliopsoas muscle from inflammation in the abdomen, most characteristically due to appendicitis with a retrocecal appendix. When the right hip is extended or the patient actively or passively lifts the leg, the stretched psoas muscle irritates inflamed tissue, reproducing pain in the right lower quadrant. This makes it a relatively specific clue for appendicitis among the abdominal pain etiologies listed.

Leukocytosis can occur with appendicitis but is nonspecific and can be seen with many infections. Hematemesis points to upper GI bleeding rather than appendiceal disease. Vomiting before pain is not a typical feature of appendicitis and is more aligned with other GI conditions.