Which combination of clinical findings is most characteristic of acute appendicitis in a patient with a retrocaecal appendix?

• A Tenderness exactly at McBurney's point with early localised guarding
• B Suprapubic tenderness with urinary frequency and urgency
• C Positive psoas stretch test with minimal anterior abdominal wall rigidity ✓
• D Right hypochondrial tenderness mimicking acute cholecystitis with a positive Murphy's sign

Explanation

C retrocaecal appendix lies against the psoas muscle, so hip extension reproduces pain (positive psoas sign) and the inflamed organ is shielded by caecum and ilium, producing little anterior rigidity despite significant disease. Suprapubic tenderness with urinary frequency points to a pelvic appendix, where rectal examination is more revealing than abdominal examination. Subhepatic (high lying) appendix causes right hypochondrial pain but Murphy's sign relates to gallbladder inflammation.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.