Certified Registered Nurse Anesthetist (CRNA) Practice Exam

Kehr's sign is indicative of which medical condition?

1. Appendicitis

2. Splenic rupture

3. Cholecystitis

4. Pancreatitis

The correct answer is: Splenic rupture

Kehr's sign refers to the presence of referred pain in the left shoulder, which occurs due to irritation of the diaphragm. This phenomenon is often associated with splenic pathology, particularly splenic rupture. When the spleen ruptures, blood can irritate the diaphragm, as both structures share the same nerve supply (the phrenic nerve). This irritation can manifest as pain that radiates to the left shoulder region, a classic presentation known as Kehr's sign. Understanding the anatomical and physiological connections involved is critical to recognizing this sign in clinical practice. For example, if a patient presents with acute abdominal pain and also reports left shoulder pain, the clinician may suspect a splenic rupture or other processes involving the spleen. This is in contrast to the other conditions listed, which do not typically produce referred shoulder pain in this manner.