Rosving’s, obturator, and psoas signs can help in the diagnosis of acute appendicitis.  Acute appendicitis presents with the following classic features:  periumbilical pain, followed by nausea, migration of pain down to the right lower quadrant, specifically at McBurny’s point, and coupled with very low grade temperature and a very mild leukocytosis.  Unless the appendix has perforated, a temperature of 102 or a leukocytosis of 20,000 would be atypical.  Additionally, Rovsing’s sign may be present (palpation of LLQ causing pain in RLQ), as well as psoas sign (extension of the leg at the hip while patient is laying on L shoulder, or flexing R thigh at 90 degrees against resistance while laying supine) and obturator sign (with patient supine, patient flexes R knee to ninety degrees and examiner grasps ankle with right hand and knee with left, then rotates the ankle out laterally toward examiner while holding knee in place.  This rotates the hip internally and causes irritation at the obturator internus muscle in the setting of inflamed appendix).  Diagnosis can be clinical but the gold standard has now become CT scan of abdomen and pelvis with IV contrast.