Kehr's sign refers to pain in which location, suggestive of splenic injury?

• A. Hypotension with fever
• B. Pain in left shoulder
• C. Pain in right shoulder
• D. Nausea with vomiting

Answer: (B)

Kehr sign is left shoulder pain caused by irritation of the diaphragmatic peritoneum from intra-abdominal bleeding, most classically from splenic injury. When blood or fluid irritates the underside of the left hemidiaphragm, the phrenic nerve (originating from C3-C5) transmits pain that is referred to the shoulder region. This neural referral explains why pain is felt at the left shoulder tip even though the injury is in the spleen. In a trauma setting, new left shoulder pain raises suspicion for splenic rupture with peritoneal bleeding. The other options describe more general or unrelated symptoms and do not specifically indicate diaphragmatic irritation from splenic injury.