ROSH Gastrointestinal Practice Exam

What is the preferred imaging modality for a patient with right upper quadrant pain and a positive Murphy's sign?

1. Abdominal barium meal

2. Abdominal computed tomography scan

3. Abdominal plain film

4. Abdominal ultrasound

The correct answer is: Abdominal ultrasound

The preferred imaging modality for a patient presenting with right upper quadrant pain and a positive Murphy's sign is abdominal ultrasound. This technique is particularly effective for evaluating gallbladder pathology, such as gallstones or cholecystitis, which are common causes of right upper quadrant pain. The Murphy's sign specifically indicates pain upon palpation of the gallbladder, and ultrasound is the most suitable initial imaging examination in this context because it is non-invasive, does not involve ionizing radiation, and can provide real-time imaging of the gallbladder. Additionally, ultrasound can assess for other potential abnormalities such as fluid collections or liver issues. While abdominal computed tomography (CT) scans are also useful for a wide range of abdominal issues, they typically involve more radiation and are generally reserved for cases where ultrasound results are inconclusive or when other complications are suspected. Plain films are less sensitive and specific for gallbladder pathology and are not typically utilized for evaluating this condition. An abdominal barium meal is inappropriate for acute abdominal pain assessments due to its focus on evaluating the gastrointestinal tract rather than the gallbladder or liver.