Nr 509 final exam with verified
answers
Appendicitis - ✔️✔️correct answer-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, 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 answer-1. McBurney point lies 2 inches from the
anterior superior spinous process of ilium on a line drawn from that process to the
umbilicus
2. Appendicitis is three times more likely if there is McBurney point tenderness.
Rovsing sign - ✔️✔️correct answer-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 answer---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 answer---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 answer-RUQ pain
,Murphy Sign
Murphy Sign - ✔️✔️correct answer-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 answer-Intrapancreatic trypsinogen
activation to trypsin and other enzymes, result-ing in autodigestion and inflammation of
the pancreas
Acute Pancreatitis Location - ✔️✔️correct answer-Epigastric, may radiate straight to
the back or other areas of the abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Quality - ✔️✔️correct answer-Usually steady
Acute PancreatitisTiming - ✔️✔️correct answer-Acute onset, persistent pain
Acute Pancreatitis Aggrevating Factors - ✔️✔️correct answer-Lying supine; dyspnea if
pleural effusions from capillary leak syn-drome; selected medications, high triglycerides
may exacerbate
Acute Pancreatitis Relieving factors - ✔️✔️correct answer-Leaning forward with trunk
flexed
Acute Pancreatitis Associated Symptoms and Setting - ✔️✔️correct answer-Nausea,
vomiting, abdominal dis-tention, fever; often recurrent; 80% with history of alcohol
abuse or gallstones
Peptic Ulcer Disease Process - ✔️✔️correct answer-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 answer-Epigastric, may radiate straight to
the back
Peptic Ulcer Disease Quality - ✔️✔️correct answer-Variable: epigastric gnawing or
burning (dyspepsia); may also be boring, aching, or hungerlike
No symptoms in up to 20%
, Peptic Ulcer Disease Timing - ✔️✔️correct answer-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 answer-Variable
Peptic Ulcer Disease relieving factors - ✔️✔️correct answer-Food and antacids may
bring re-lief (less likely in gastric ulcers)
Peptic Ulcer Disease associated symptoms and setting - ✔️✔️correct answer-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 answer-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 answer-Chest or epigastric
GERD Quality - ✔️✔️correct answer-Heartburn, regurgitation
GERD timing - ✔️✔️correct answer-After meals, especially spicy foods
GERD aggravating factors - ✔️✔️correct answer-Lying down, bending over; physical
activity; diseases such as scleroderma, gastroparesis; drugs like nicotine that relax the
lower esophageal sphincter
GERD : relieving factors - ✔️✔️correct answer-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 answer-Wheezing, chronic
cough, short-ness of breath, hoarseness, choking sensation, dysphagia, regurgitation,
halitosis, sore throat; increases risk of Barrett esophagus and esopha-geal cancer
Diverticulitis process - ✔️✔️correct answer-Acute inflammation of colonic diver-ticula,
outpouchings 5-10 mm in di-ameter, usually in sigmoid or descend-ing colon
Diverticulitis location - ✔️✔️correct answer-Left lower quadrant
Diverticulitis quality - ✔️✔️correct answer-May be cramping at first, then steady
Diverticulitis timing - ✔️✔️correct answer-Often gradual onset
answers
Appendicitis - ✔️✔️correct answer-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, 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 answer-1. McBurney point lies 2 inches from the
anterior superior spinous process of ilium on a line drawn from that process to the
umbilicus
2. Appendicitis is three times more likely if there is McBurney point tenderness.
Rovsing sign - ✔️✔️correct answer-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 answer---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 answer---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 answer-RUQ pain
,Murphy Sign
Murphy Sign - ✔️✔️correct answer-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 answer-Intrapancreatic trypsinogen
activation to trypsin and other enzymes, result-ing in autodigestion and inflammation of
the pancreas
Acute Pancreatitis Location - ✔️✔️correct answer-Epigastric, may radiate straight to
the back or other areas of the abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Quality - ✔️✔️correct answer-Usually steady
Acute PancreatitisTiming - ✔️✔️correct answer-Acute onset, persistent pain
Acute Pancreatitis Aggrevating Factors - ✔️✔️correct answer-Lying supine; dyspnea if
pleural effusions from capillary leak syn-drome; selected medications, high triglycerides
may exacerbate
Acute Pancreatitis Relieving factors - ✔️✔️correct answer-Leaning forward with trunk
flexed
Acute Pancreatitis Associated Symptoms and Setting - ✔️✔️correct answer-Nausea,
vomiting, abdominal dis-tention, fever; often recurrent; 80% with history of alcohol
abuse or gallstones
Peptic Ulcer Disease Process - ✔️✔️correct answer-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 answer-Epigastric, may radiate straight to
the back
Peptic Ulcer Disease Quality - ✔️✔️correct answer-Variable: epigastric gnawing or
burning (dyspepsia); may also be boring, aching, or hungerlike
No symptoms in up to 20%
, Peptic Ulcer Disease Timing - ✔️✔️correct answer-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 answer-Variable
Peptic Ulcer Disease relieving factors - ✔️✔️correct answer-Food and antacids may
bring re-lief (less likely in gastric ulcers)
Peptic Ulcer Disease associated symptoms and setting - ✔️✔️correct answer-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 answer-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 answer-Chest or epigastric
GERD Quality - ✔️✔️correct answer-Heartburn, regurgitation
GERD timing - ✔️✔️correct answer-After meals, especially spicy foods
GERD aggravating factors - ✔️✔️correct answer-Lying down, bending over; physical
activity; diseases such as scleroderma, gastroparesis; drugs like nicotine that relax the
lower esophageal sphincter
GERD : relieving factors - ✔️✔️correct answer-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 answer-Wheezing, chronic
cough, short-ness of breath, hoarseness, choking sensation, dysphagia, regurgitation,
halitosis, sore throat; increases risk of Barrett esophagus and esopha-geal cancer
Diverticulitis process - ✔️✔️correct answer-Acute inflammation of colonic diver-ticula,
outpouchings 5-10 mm in di-ameter, usually in sigmoid or descend-ing colon
Diverticulitis location - ✔️✔️correct answer-Left lower quadrant
Diverticulitis quality - ✔️✔️correct answer-May be cramping at first, then steady
Diverticulitis timing - ✔️✔️correct answer-Often gradual onset
