ROSH Gastrointestinal Practice Exam

The presence of epigastric pain along with a positive Murphy sign is strongly indicative of cholecystitis. The Murphy sign is used specifically to evaluate for gallbladder inflammation, which occurs in cholecystitis. When a doctor performs the Murphy test by asking the patient to take a deep breath while palpating the right upper quadrant, pain or the cessation of breath due to pain suggests irritation of the gallbladder. This is a classic clinical finding associated with acute cholecystitis, which often results from gallstones blocking the cystic duct, leading to inflammation and potential infection.

Other conditions listed, such as cholangitis, duodenal ulcer, and pancreatitis, may present with epigastric pain, but they would not typically produce a positive Murphy sign. Cholangitis involves infection of the bile duct, which may cause jaundice and fever. A duodenal ulcer would generally cause a different pattern of pain and is not associated with the Murphy sign. Pancreatitis could cause severe abdominal pain, but again, it does not elicit a Murphy sign. Therefore, the combination of specific symptoms presented confirms that cholecystitis is the most likely diagnosis in this scenario.