Which sign would lead a physician to suspect a diagnosis of cholecystitis during a physical examination?

Murphy's sign is a clinical maneuver that is specifically associated with cholecystitis. This sign is elicited when a physician palpates the right upper quadrant of the abdomen while the patient is asked to take a deep breath. If the patient experiences pain and stops inhaling due to discomfort during this maneuver, it is considered a positive Murphy's sign. This reaction indicates inflammation of the gallbladder, typically due to obstruction, usually by gallstones, leading to cholecystitis. Therefore, the presence of Murphy's sign during the examination strongly suggests this diagnosis and is commonly used in clinical practice to differentiate cholecystitis from other abdominal conditions.

In contrast, jaundice may suggest a more concerning process affecting the liver or bile ducts, such as choledocholithiasis or hepatitis. Costovertebral angle tenderness is more indicative of renal pathology, such as pyelonephritis. Guarding can indicate irritation of the peritoneum, which is nonspecific and can occur in a variety of abdominal conditions, including appendicitis or perforation. None of these signs are as specific to cholecystitis as Murphy's sign.