4/4/25, 5:48 NR 509 Final Exam |
PM
NR 509 FINAL EXAM QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED LATEST UPDATE GRADED A++
Terms in this set (162)
1. McBurney point tenderness
2.Rovsing sign
3.the psoas sign
4. the obturator sign
--Appendicitis is twice as likely in the presence of RLQ tenderness, Rovsing sign,
Appendicitis
and the psoas sign
--The pain of appendicitis classically begins near the umbilicus, then migrates to
the RLQ. Older adults are less likely to report this pattern.
--Localized tenderness anywhere in the RLQ, even in the right flank, suggests
appendicitis.
1. McBurney point lies 2 inches from the anterior superior spinous process of
McBurney Point ilium on a line drawn from that process to the umbilicus
2. Appendicitis is three times more likely if there is McBurney point tenderness.
Press deeply and evenly in the LLQ. Then quickly withdraw your fingers.
Rovsing sign
Pain in the RLQ during left-sided pressure is a positive Rovsing sign.
--Place your hand just above the patient's right knee and ask the patient to raise
that thigh against your hand. Alternatively, ask the patient to turn onto the left
side. Then extend the patient's right leg at the hip. Flexion of the leg at the hip
Psoas Sign
makes the psoas muscle contract; extension stretches it.
--Increased abdominal pain on either maneuver is a positive psoas sign, sug-
gesting irritation of the psoas muscle by an inflamed appendix.
--Less helpful
--Flex the patient's right thigh at the hip, with the knee bent, and rotate the leg
Obturator Sign internally at the hip. This maneuver stretches the internal obturator muscle.
--Right hypogastric pain is a positive obturator sign, from irritation of the
obturator muscle by an inflamed appendix. This sign has very low sensitivity.
RUQ pain
Acute Cholecystits
Murphy Sign
1/11
, 4/4/25, 5:48 NR 509 Final Exam |
PM
Hook your left thumb or the fingers of your right hand under the costal margin at
the point where the lateral border of the rectus muscle intersects with the costal
margin. Alternatively, palpate the RUQ with the fingers of your right hand near
the costal margin. If the liver is enlarged, hook your thumb or fingers under the
Murphy Sign liver edge at a comparable point. Ask the patient to take a deep breath,
which forces the liver and gallbladder down toward the examining fingers. Watch
the patient's breathing and note the degree of tenderness.
--A sharp increase in tenderness with inspiratory effort is a positive Murphy sign.
When positive, Murphy sign triples the likelihood of acute cholecystitis.
Intrapancreatic trypsinogen activation to trypsin and other enzymes, result-ing in
Acute Pancreatitis Process
autodigestion and inflammation of the pancreas
Epigastric, may radiate straight to the back or other areas of the abdomen; 20%
Acute Pancreatitis Location
with severe sequelae of organ failure
Acute Pancreatitis Quality Usually steady
Acute PancreatitisTiming Acute onset, persistent pain
Lying supine; dyspnea if pleural effusions from capillary leak syn-drome; selected
Acute Pancreatitis Aggrevating Factors
medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving factors Leaning forward with trunk flexed
Acute Pancreatitis Associated Symptoms Nausea, vomiting, abdominal dis-tention, fever; often recurrent; 80% with history of
and Setting alcohol abuse or gallstones
Mucosal ulcer in stomach or duode-num >5 mm, covered with fibrin, ex-tending
Peptic Ulcer Disease Process through the muscularis mu-cosa; H. pylori infection present in 90% of peptic
ulcers
Peptic Ulcer Disease Location Epigastric, may radiate straight to the back
Variable: epigastric gnawing or burning (dyspepsia); may also be boring, aching,
Peptic Ulcer Disease Quality or hungerlike
No symptoms in up to 20%
Intermittent; duodenal ulcer is more likely than gastric ulcer or dyspepsia to
Peptic Ulcer Disease Timing cause pain that (1) wakes the patient at night, and (2) occurs intermittently over
a few wks, disappears for months, then recurs
Peptic Ulcer Disease aggravating factors Variable
Peptic Ulcer Disease relieving factors Food and antacids may bring re-lief (less likely in gastric ulcers)
Nausea, vomiting, belching, bloating; heartburn (more common in duodenal
Peptic Ulcer Disease associated ulcer); weight loss (more common in gastric ulcer); dyspepsia is more com-mon in
symptoms and setting the young (20-29 yrs), gastric ulcer in those over 50 yrs, and duodenal ulcer in
those 30-60 yrs
Prolonged exposure of esophagus to gastric acid due to impaired esopha-geal
GERD Process motility or excess relaxations of the lower esophageal sphincter; Helico-bacter
pylori may be present
GERD Location Chest or epigastric
GERD Quality Heartburn, regurgitation
GERD timing After meals, especially spicy foods
Lying down, bending over; physical activity; diseases such as scleroderma,
GERD aggravating factors
gastroparesis; drugs like nicotine that relax the lower esophageal sphincter
Antacids, proton pump inhibi-tors; avoiding alcohol, smoking, fatty meals,
GERD : relieving factors
chocolate, selected drugs such as theophylline, cal-cium channel blockers
Wheezing, chronic cough, short-ness of breath, hoarseness, choking sensation,
GERD associated symptoms and setting dysphagia, regurgitation, halitosis, sore throat; increases risk of Barrett esophagus
and esopha-geal cancer
2/11
PM
NR 509 FINAL EXAM QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED LATEST UPDATE GRADED A++
Terms in this set (162)
1. McBurney point tenderness
2.Rovsing sign
3.the psoas sign
4. the obturator sign
--Appendicitis is twice as likely in the presence of RLQ tenderness, Rovsing sign,
Appendicitis
and the psoas sign
--The pain of appendicitis classically begins near the umbilicus, then migrates to
the RLQ. Older adults are less likely to report this pattern.
--Localized tenderness anywhere in the RLQ, even in the right flank, suggests
appendicitis.
1. McBurney point lies 2 inches from the anterior superior spinous process of
McBurney Point ilium on a line drawn from that process to the umbilicus
2. Appendicitis is three times more likely if there is McBurney point tenderness.
Press deeply and evenly in the LLQ. Then quickly withdraw your fingers.
Rovsing sign
Pain in the RLQ during left-sided pressure is a positive Rovsing sign.
--Place your hand just above the patient's right knee and ask the patient to raise
that thigh against your hand. Alternatively, ask the patient to turn onto the left
side. Then extend the patient's right leg at the hip. Flexion of the leg at the hip
Psoas Sign
makes the psoas muscle contract; extension stretches it.
--Increased abdominal pain on either maneuver is a positive psoas sign, sug-
gesting irritation of the psoas muscle by an inflamed appendix.
--Less helpful
--Flex the patient's right thigh at the hip, with the knee bent, and rotate the leg
Obturator Sign internally at the hip. This maneuver stretches the internal obturator muscle.
--Right hypogastric pain is a positive obturator sign, from irritation of the
obturator muscle by an inflamed appendix. This sign has very low sensitivity.
RUQ pain
Acute Cholecystits
Murphy Sign
1/11
, 4/4/25, 5:48 NR 509 Final Exam |
PM
Hook your left thumb or the fingers of your right hand under the costal margin at
the point where the lateral border of the rectus muscle intersects with the costal
margin. Alternatively, palpate the RUQ with the fingers of your right hand near
the costal margin. If the liver is enlarged, hook your thumb or fingers under the
Murphy Sign liver edge at a comparable point. Ask the patient to take a deep breath,
which forces the liver and gallbladder down toward the examining fingers. Watch
the patient's breathing and note the degree of tenderness.
--A sharp increase in tenderness with inspiratory effort is a positive Murphy sign.
When positive, Murphy sign triples the likelihood of acute cholecystitis.
Intrapancreatic trypsinogen activation to trypsin and other enzymes, result-ing in
Acute Pancreatitis Process
autodigestion and inflammation of the pancreas
Epigastric, may radiate straight to the back or other areas of the abdomen; 20%
Acute Pancreatitis Location
with severe sequelae of organ failure
Acute Pancreatitis Quality Usually steady
Acute PancreatitisTiming Acute onset, persistent pain
Lying supine; dyspnea if pleural effusions from capillary leak syn-drome; selected
Acute Pancreatitis Aggrevating Factors
medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving factors Leaning forward with trunk flexed
Acute Pancreatitis Associated Symptoms Nausea, vomiting, abdominal dis-tention, fever; often recurrent; 80% with history of
and Setting alcohol abuse or gallstones
Mucosal ulcer in stomach or duode-num >5 mm, covered with fibrin, ex-tending
Peptic Ulcer Disease Process through the muscularis mu-cosa; H. pylori infection present in 90% of peptic
ulcers
Peptic Ulcer Disease Location Epigastric, may radiate straight to the back
Variable: epigastric gnawing or burning (dyspepsia); may also be boring, aching,
Peptic Ulcer Disease Quality or hungerlike
No symptoms in up to 20%
Intermittent; duodenal ulcer is more likely than gastric ulcer or dyspepsia to
Peptic Ulcer Disease Timing cause pain that (1) wakes the patient at night, and (2) occurs intermittently over
a few wks, disappears for months, then recurs
Peptic Ulcer Disease aggravating factors Variable
Peptic Ulcer Disease relieving factors Food and antacids may bring re-lief (less likely in gastric ulcers)
Nausea, vomiting, belching, bloating; heartburn (more common in duodenal
Peptic Ulcer Disease associated ulcer); weight loss (more common in gastric ulcer); dyspepsia is more com-mon in
symptoms and setting the young (20-29 yrs), gastric ulcer in those over 50 yrs, and duodenal ulcer in
those 30-60 yrs
Prolonged exposure of esophagus to gastric acid due to impaired esopha-geal
GERD Process motility or excess relaxations of the lower esophageal sphincter; Helico-bacter
pylori may be present
GERD Location Chest or epigastric
GERD Quality Heartburn, regurgitation
GERD timing After meals, especially spicy foods
Lying down, bending over; physical activity; diseases such as scleroderma,
GERD aggravating factors
gastroparesis; drugs like nicotine that relax the lower esophageal sphincter
Antacids, proton pump inhibi-tors; avoiding alcohol, smoking, fatty meals,
GERD : relieving factors
chocolate, selected drugs such as theophylline, cal-cium channel blockers
Wheezing, chronic cough, short-ness of breath, hoarseness, choking sensation,
GERD associated symptoms and setting dysphagia, regurgitation, halitosis, sore throat; increases risk of Barrett esophagus
and esopha-geal cancer
2/11
