Which sign indicates appendicitis when there is pain on internal rotation of the flexed right thigh?

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Pain on internal rotation of the flexed right thigh signals the obturator sign. When the appendix is inflamed and lies near the obturator nerve as it passes through the obturator internus, rotating the thigh inward while the hip is flexed irritates the nerve and produces pain in the right lower quadrant. This sign is especially associated with a pelvis-located appendix.

For contrast, a positive psoas sign arises from irritation of the psoas muscle and is elicited by hip extension or resisted hip flexion, suggesting retrocecal appendicitis. Rovsing's sign is pain in the right lower quadrant with palpation of the left lower quadrant, reflecting peritoneal irritation, and Murphy's sign is inspiratory arrest with right upper quadrant palpation, typical of gallbladder inflammation.