NR 509 Final Exam 162 Questions with Correct

NR 509 Final Exam 162 Questions with Correct Answers 100% Verified Appendicitis - Correct Answers 1. McBurney point tenderness

• Rovsing sign
• the psoas sign
• the obturator sign

--Appendicitis is twice as likely in the presence of RLQ 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.McBurney Point - Correct Answers 1. McBurney point lies 2 inches from the anterior superior spinous process of ilium on a line drawn from that process to the umbilicus

• Appendicitis is three times more likely if there is McBurney point tenderness.

Rovsing sign - Correct Answers Press deeply and evenly in the LLQ. Then quickly withdraw your fingers.Pain in the RLQ during left-sided pressure is a positive Rovsing sign.Psoas Sign - Correct Answers --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 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.Obturator Sign - Correct Answers --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 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.Acute Cholecystits - Correct Answers RUQ pain Murphy Sign 1 / 3

Murphy Sign - Correct Answers 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 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.Acute Pancreatitis Process - Correct Answers Intrapancreatic trypsinogen activation to trypsin and other enzymes, result-ing in autodigestion and inflammation of the pancreas Acute Pancreatitis Location - Correct Answers Epigastric, may radiate straight to the back or other areas of the abdomen; 20% with severe sequelae of organ failure Acute Pancreatitis Quality - Correct Answers Usually steady Acute PancreatitisTiming - Correct Answers Acute onset, persistent pain Acute Pancreatitis Aggrevating Factors - Correct Answers Lying supine; dyspnea if pleural effusions from capillary leak syn-drome; selected medications, high triglycerides may exacerbate Acute Pancreatitis Relieving factors - Correct Answers Leaning forward with trunk flexed Acute Pancreatitis Associated Symptoms and Setting - Correct Answers Nausea, vomiting, abdominal dis-tention, fever; often recurrent; 80% with history of alcohol abuse or gallstones Peptic Ulcer Disease Process - Correct Answers Mucosal ulcer in stomach or duode-num >5 mm, covered with fibrin, ex-tending through the muscularis mu-cosa; H. pylori infection present in 90% of peptic ulcers Peptic Ulcer Disease Location - Correct Answers Epigastric, may radiate straight to the back Peptic Ulcer Disease Quality - Correct Answers Variable: epigastric gnawing or burning (dyspepsia); may also be boring, aching, or hungerlike 2 / 3

No symptoms in up to 20% Peptic Ulcer Disease Timing - Correct Answers Intermittent; duodenal ulcer is more likely than gastric ulcer or dyspepsia to 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 - Correct Answers Variable Peptic Ulcer Disease relieving factors - Correct Answers Food and antacids may bring re-lief (less likely in gastric ulcers) Peptic Ulcer Disease associated symptoms and setting - Correct Answers Nausea, vomiting, belching, bloating; heartburn (more common in duodenal ulcer); weight loss (more common in gastric ulcer); dyspepsia is more com-mon in the young (20-29 yrs), gastric ulcer in those over 50 yrs, and duodenal ulcer in those 30-60 yrs GERD Process - Correct Answers Prolonged exposure of esophagus to gastric acid due to impaired esopha-geal motility or excess relaxations of the lower esophageal sphincter; Helico-bacter pylori may be present GERD Location - Correct Answers Chest or epigastric GERD Quality - Correct Answers Heartburn, regurgitation GERD timing - Correct Answers After meals, especially spicy foods GERD aggravating factors - Correct Answers Lying down, bending over; physical activity; diseases such as scleroderma, gastroparesis; drugs like nicotine that relax the lower esophageal sphincter GERD : relieving factors - Correct Answers Antacids, proton pump inhibi-tors; avoiding alcohol, smoking, fatty meals, chocolate, selected drugs such as theophylline, cal-cium channel blockers GERD associated symptoms and setting - Correct Answers Wheezing, chronic cough, short-ness of breath, hoarseness, choking sensation, dysphagia, regurgitation, halitosis, sore throat; increases risk of Barrett esophagus and esopha-geal cancer

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