Rosh Internal Medicine Boost Practice Exam

Which sign or symptom is consistent with a diagnosis of cholecystitis in a patient with right upper quadrant pain?

1. Abdominal distention

2. Jaundice

3. Right scapular pain

4. Shaking chills

The correct answer is: Right scapular pain

In a diagnosis of cholecystitis, a classic symptom often reported is right scapular pain, also known as referred pain. This occurs due to the irritation of the diaphragm or phrenic nerve as a result of inflammation in the gallbladder. The nerve pathways overlap, causing pain to be felt in the right shoulder or scapular area. This phenomenon is particularly relevant in cases of acute cholecystitis, where the inflammation of the gallbladder can lead to significant discomfort that can radiate beyond the abdominal region. While abdominal distention, jaundice, and shaking chills can be associated with various abdominal pathologies, they are not specific indicators of cholecystitis. Abdominal distention might suggest a wider range of gastrointestinal issues, jaundice could indicate bile duct involvement but is not direct evidence for cholecystitis, and shaking chills are more nonspecific indicators of systemic infection. Hence, right scapular pain stands out as a distinctive sign that supports the diagnosis of cholecystitis.