Question of the Month – June 2019 Written by: Bob Wilder, MD The Mayo Clinic, Rochester, MN A 15-year-old girl developed an acute viral intestinal illness several months ago with nausea, vomiting and diarrhea. These symptoms resolved in 7 – 10 days, but she has had postprandial right upper quadrant abdominal pain since. She notes that she also hurts with exercise. A pediatric gastroenterologist has seen her and has completed a workup consisting of a normal abdominal ultrasound, an EGD that was normal both visually and by pathology. Disaccharidase levels are normal. Gastric emptying studies were also normal. Fructose breath test was normal. Abdominal radiograph shows “non-obstructive pattern with mild to moderate stool in the colon.” She may have increased pain with bearing down to have a bowel movement, but it returns to baseline thereafter. On exam the gastroenterologist states she has a “positive Carnett’s sign” in the right upper quadrant. What is a Carnett’s sign? A) Carnett’s sign is increased abdominal wall tenderness when the abdominal wall muscles are tensed.B) Carnett’s sign is pain in the right lower abdominal quadrant on palpation of the left side of the abdomen.C) Carnett’s sign refers to pain upon removal of pressure rather than application of pressure to the abdomen.D) Carnett’s sign is pain when the patient is asked to cough whilst tensing the psoas muscle.Time is Up!