Fist percussion identifies tenderness over the kidneys, liver, and gallbladder.

• A. Direct percussion
• B. Indirect percussion
• C. Fist percussion
• D. Percussion tapping on surface

Answer: (C)

Percussion techniques in the physical exam are used to detect tenderness and to locate organ borders. Fist percussion uses a clenched fist as the hammer—the examiner places one hand over the area and strikes it with the other fist. This method sends a sharper, deeper impulse that helps reveal tenderness in deep structures like the kidneys and can aid in assessing areas near the liver or gallbladder when inflammation is present. Direct percussion, tapping directly with fingers on the skin, is less focused on eliciting tenderness from deep organs. Indirect percussion involves placing a finger on the body and striking with the other hand’s finger to map borders and density, but it’s not as effective for provoking a focal tender response. Percussion tapping on the surface is essentially a form of direct percussion and doesn’t provide the same targeted sensitivity for deep-organ tenderness.