NBME 23 Inspiratory pause on right upper quadrant palpation (NBME Answers)

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NBME 23 Answers

nbme23/Block 2/Question#48 (reveal difficulty score)
A 45-year-old woman is brought to the ...
Inspiratory pause on right upper quadrant palpation 🔍 / 📺 / 🌳 / 📖
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submitted by ∗joonam(31)

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Acute or chronic inflammation of gallbladder. Murphy sign: inspiratory arrest on RUQ palpation due to pain. Pain may radiate to right shoulder (due to irritation of phrenic nerve).􏰁ALP if bile duct becomes involved (eg, ascending cholangitis).

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meningitis To make sure, palpable Gallbladder is more in cholangiocarcinoma and Pancreatic Cancer? And if it were non-tender, could palpable gallbladder mean gallstones? +9

yb_26 @meningitis, it is a Courvoisier sign of pancreatic adenocarcinoma: jaundice + palpable, nontender gallbladder +3

an1 what's the periumbilical ecchymosis? could this be caput medusa? +

an1 and what about tenderness of the epigastrium on palpation? +

fatboyslim @an1 Periumbilical ecchymosis is likely referring to Cullen's sign which is commonly associated with hemorrhagic pancreatitis. Another sign associated with hemorrhagic pancreatitis is Grey Turner sign, which is ecchymosis around the flanks bilaterally. +

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submitted by ∗jboud86(18)

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FA 2019 page 390. This patient is expressing symptoms of biliary colic due to neurohormonal activation by CCK after a fatty meal. The labs will be normal and ultrasound will show cholelithiasis. However, I think this can be confused with acalculous because it also presents with inspiratory arrest on RUQ palpation due to pain. Acalculous cholecystitis is seen in critically ill patients.

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-4 upvote downvote
submitted by ∗thotcandy(131)

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Ugh, I saw Low BP and thought gallstone pancreatitis w/ hemorrhage so I picked ecchymoses/Cullen's sign.

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fatboyslim The BP is 100/60. That's not low, is it? +

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