Science Medicine Surgery
NR 509 Final Exam
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NR509 Final Exam NR 509 - Final Exam Bate's Interacti... Prophecy medical su
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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
Appendicitis tenderness, Rovsing sign, 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 ilium on a line drawn from that process to the
McBurney Point 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 makes the psoas
Psoas Sign
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 internally at the hip. This maneuver stretches the
Obturator Sign 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
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 liver edge at a comparable point. Ask the patient to take a
Murphy Sign
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
Acute Pancreatitis Process enzymes, result-ing in autodigestion and inflammation of the
pancreas
Epigastric, may radiate straight to the back or other areas of the
Acute Pancreatitis Location
abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Quality Usually steady
Acute PancreatitisTiming Acute onset, persistent pain
Acute Pancreatitis Aggrevating Lying supine; dyspnea if pleural effusions from capillary leak syn-
Factors drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving Leaning forward with trunk flexed
factors
Acute Pancreatitis Associated Nausea, vomiting, abdominal dis-tention, fever; often recurrent;
Symptoms and Setting 80% with history of alcohol abuse or gallstones
Mucosal ulcer in stomach or duode-num >5 mm, covered with
Peptic Ulcer Disease Process fibrin, ex-tending 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
Peptic Ulcer Disease Quality boring, aching, or hungerlike
No symptoms in up to 20%
Intermittent; duodenal ulcer is more likely than gastric ulcer or
dyspepsia to cause pain that (1) wakes the patient at night, and
Peptic Ulcer Disease Timing
(2) occurs intermittently over a few wks, disappears for months,
then recurs
Peptic Ulcer Disease Variable
aggravating factors
Peptic Ulcer Disease relieving Food and antacids may bring re-lief (less likely in gastric ulcers)
factors
NR 509 Final Exam
Save
Students also studied
Flashcard sets Study guides
NR509 Final Exam NR 509 - Final Exam Bate's Interacti... Prophecy medical su
88 terms 100 terms Teacher 60 terms
brit_oldland Preview jaci_buteau Preview Jacklyne_Chege
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
Appendicitis tenderness, Rovsing sign, 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 ilium on a line drawn from that process to the
McBurney Point 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 makes the psoas
Psoas Sign
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 internally at the hip. This maneuver stretches the
Obturator Sign 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
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 liver edge at a comparable point. Ask the patient to take a
Murphy Sign
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
Acute Pancreatitis Process enzymes, result-ing in autodigestion and inflammation of the
pancreas
Epigastric, may radiate straight to the back or other areas of the
Acute Pancreatitis Location
abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Quality Usually steady
Acute PancreatitisTiming Acute onset, persistent pain
Acute Pancreatitis Aggrevating Lying supine; dyspnea if pleural effusions from capillary leak syn-
Factors drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving Leaning forward with trunk flexed
factors
Acute Pancreatitis Associated Nausea, vomiting, abdominal dis-tention, fever; often recurrent;
Symptoms and Setting 80% with history of alcohol abuse or gallstones
Mucosal ulcer in stomach or duode-num >5 mm, covered with
Peptic Ulcer Disease Process fibrin, ex-tending 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
Peptic Ulcer Disease Quality boring, aching, or hungerlike
No symptoms in up to 20%
Intermittent; duodenal ulcer is more likely than gastric ulcer or
dyspepsia to cause pain that (1) wakes the patient at night, and
Peptic Ulcer Disease Timing
(2) occurs intermittently over a few wks, disappears for months,
then recurs
Peptic Ulcer Disease Variable
aggravating factors
Peptic Ulcer Disease relieving Food and antacids may bring re-lief (less likely in gastric ulcers)
factors
