Which is an example of non-stigmatizing, person-first language?

A. Pneumothorax is correct because a hyperresonant percussion note occurs when air collects in the pleural space, as in a pneumothorax. The presence of excess air increases the resonance of the chest wall, producing a louder, lower-pitched, and more hollow sound when percussed compared with normal, air-filled lungs. Hyperresonance is a classic finding in conditions where there is trapped air, such as tension or simple pneumothorax, and can also be seen in severe emphysema. Detecting hyperresonance during physical examination helps the clinician identify abnormal air accumulation, which may require urgent intervention depending on the severity of the pneumothorax.

B. Lobar pneumonia is incorrect because consolidation from pneumonia involves alveoli filled with inflammatory exudate and fluid, which decreases the air content of the lung. During percussion, these consolidated areas produce a dull percussion note, which is lower in pitch and less resonant compared with normal lung tissue. Hyperresonance does not occur in pneumonia.

C. Pleural effusion is incorrect because fluid in the pleural space dampens the percussion sound, resulting in a dull or flat percussion note. The increased density from the fluid reduces the resonance compared with normal lung, and hyperresonance is not observed.

D. Empyema is incorrect because empyema involves purulent fluid within the pleural space, which similarly produces a dull or flat percussion note. The presence of fluid and thick pus diminishes resonance, so hyperresonance is not expected in this condition.

A. Pain distant from the site used to check rebound tenderness is incorrect because this describes referred pain or peritoneal irritation, but not the obturator sign specifically. The obturator sign is localized to the hypogastric or pelvic region.

B. Right hypogastric pain with the right hip flexed and the hip internally rotated is correct because the obturator sign is elicited by flexing the patient’s hip and knee at 90° and then internally rotating the hip. Pain in the right hypogastric or pelvic area indicates irritation of the obturator internus muscle, often due to an inflamed appendix in a pelvic position or other pelvic pathology. This is a classic sign in appendicitis when the appendix is located in the pelvis.

C. Pain with extension of the right thigh while the patient is on their left side is incorrect because this describes the psoas sign, which tests for irritation of the iliopsoas muscle and is also used to detect appendicitis, but specifically for a retrocecal appendix.

D. Pain that stops inhalation in the right upper quadrant is incorrect because this describes Murphy’s sign, which is indicative of cholecystitis, not appendiceal or pelvic irritation.