Which sign of appendicitis occurs when palpation of the left lower quadrant causes pain in the right lower quadrant?

• A. Rectal exam
• B. Rovsing's sign
• C. Psoas sign
• D. Rebound tenderness

Answer: (B)

This question tests a sign of peritoneal irritation where pain is referred from one area to another. In acute appendicitis, the lining of the abdomen (the peritoneum) becomes irritated by the inflamed appendix. When the clinician presses on the left lower quadrant, the increased intra-abdominal pressure and peritoneal irritation can transfer sensation to the right lower quadrant, where the appendix sits. A positive sign occurs when LLQ palpation elicits pain in the RLQ, indicating Rovsing’s sign.

This is different from rebound tenderness, which is pain felt upon releasing pressure in any area and reflects generalized peritoneal irritation. It’s also different from the psoas sign, which indicates irritation of the iliopsoas muscle typically due to a retrocecal appendix and is elicited by extending the hip. Rectal exam is a separate part of the abdominal examination that can provoke pain through other mechanisms but does not describe this specific cross-hemisphere referral.