What is the characteristic sign seen on exam that indicates a ruptured appendicitis?

Right lower quadrant tenderness is the characteristic sign associated with ruptured appendicitis. This tenderness often arises due to inflammation of the appendix, which irritates the surrounding peritoneal cavity. When the appendix ruptures, it can lead to peritoneal irritation and subsequent pain localized in the right lower quadrant. Upon physical examination, this area will typically elicit significant tenderness, which can be assessed through palpation.

Other signs, while potentially present in cases of appendicitis or related conditions, do not specifically indicate a rupture. For instance, decreased abdominal sounds can suggest various gastrointestinal issues but are not specific to ruptured appendicitis. An increased heart rate might occur as a response to pain or infection but is not unique to ruptured appendicitis. Abdominal distension can occur in multiple conditions affecting the abdomen but does not directly point to ruptured appendicitis either. Therefore, right lower quadrant tenderness stands out as the key indicator of a ruptured appendix during examination.