The advanced abdominal examination integrates specific provocative maneuvers with systematic assessment to localize pathology and guide differential diagnosis. Murphy sign (inspiratory arrest during palpation of the right upper quadrant as the inflamed gallbladder descends to meet the examiner's hand) has a positive likelihood ratio of approximately 2.8 for acute cholecystitis; the sonographic Murphy sign (focal tenderness directly over the gallbladder during ultrasound) is more specific. McBurney point tenderness (located one-third the distance from the right anterior superior iliac spine to the umbilicus) is the classic finding in acute appendicitis, representing the base of the appendix. Rovsing sign (right lower quadrant pain elicited by palpation of the left lower quadrant) indicates peritoneal irritation from appendiceal inflammation -- the transmitted pressure wave stimulates the inflamed peritoneum on the right. Additional peritoneal signs include rebound tenderness (pain that worsens upon release of pressure, more specific when performed with gentle percussion rather than deep palpation-release), psoas sign (right lower quadrant pain with passive extension or active flexion of the right hip, indicating retrocecal appendicitis irritating the psoas muscle), and obturator sign (right lower quadrant...