106.A 73-year-old man is seen in the ED for abdominal pain, nausea, and
vomiting. His symptoms have progressively worsened over the past 2 to 3 days.
The pain is diffuse and comes in waves. He denies fever or chills, but has a his-
tory of constipation. He reports no flatus for 24 hours. Physical examination is
notable for diffuse tenderness and voluntary guarding. There is no rebound
tenderness. An abdominal radiograph is seen below. Which of the following is
the most likely diagnosis?
96 Emergency Medicine
a. Constipation
b. SBO
c. Cholelithiasis
d. Large bowel obstruction
e. Inflammatory bowel disease
107.A 25-year-old man presents to the ED complaining of dull periumbil-
ical pain that migrated to his RLQ over the last hour. He states that he has
no appetite and vomited twice. His BP is 125/75 mm Hg, HR is 87 beats per
minute, temperature is 100.6°F, and RR is 16 breaths per minute. Labora-
tory results reveal WBC 11,000/μL, hematocrit 48%, platelets 170/μL. On
physical examination, the patient complains of pain when you flex his knee
with internal rotation at his hip. What is the name of this sign?
a. Obturator
b. Psoas
c. Rovsing
d. McBurney
e. Murphy