NR 509 FINAL EXAM 88 CONCEPT REVIEW
GUIDE 2026 NORMAL AND ABNORMAL
PHYSICAL EXAM FINDINGS
◉ Peptic Ulcer Disease Process.
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.
Answer: Epigastric, may radiate straight to the back
◉ Peptic Ulcer Disease Quality.
Answer: Variable: epigastric gnawing or burning (dyspepsia); may
also be boring, aching, or hungerlike
No symptoms in up to 20%
◉ Peptic Ulcer Disease Timing.
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.
Answer: Variable
◉ Peptic Ulcer Disease relieving factors.
Answer: Food and antacids may bring re-lief (less likely in gastric
ulcers)
◉ Peptic Ulcer Disease associated symptoms and setting.
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.
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.
Answer: Chest or epigastric
◉ GERD Quality.
Answer: Heartburn, regurgitation
,◉ GERD timing.
Answer: After meals, especially spicy foods
◉ GERD aggravating factors.
Answer: Lying down, bending over; physical activity; diseases such
as scleroderma, gastroparesis; drugs like nicotine that relax the
lower esophageal sphincter
◉ GERD : relieving factors.
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.
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.
Answer: Acute inflammation of colonic diver-ticula, outpouchings 5-
10 mm in di-ameter, usually in sigmoid or descend-ing colon
◉ Diverticulitis location.
, Answer: Left lower quadrant
◉ Diverticulitis quality.
Answer: May be cramping at first, then steady
◉ Diverticulitis timing.
Answer: Often gradual onset
◉ Diverticulitis aggravating factors.
Answer: --
◉ Diverticulitis relieving factors.
Answer: Analgesia, bowel rest, antibiotics
◉ Diverticulitis associated symptoms and setting.
Answer: Fever, constipation. Also nausea, vomiting, abdominal mass
with rebound tenderness
◉ Hepatitis.
Answer: -Tenderness over liver (liver inflammation)
--Hep A and B prevention: Vaccination
Hep A: spread through fecal matter and asymptomatic children
GUIDE 2026 NORMAL AND ABNORMAL
PHYSICAL EXAM FINDINGS
◉ Peptic Ulcer Disease Process.
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.
Answer: Epigastric, may radiate straight to the back
◉ Peptic Ulcer Disease Quality.
Answer: Variable: epigastric gnawing or burning (dyspepsia); may
also be boring, aching, or hungerlike
No symptoms in up to 20%
◉ Peptic Ulcer Disease Timing.
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.
Answer: Variable
◉ Peptic Ulcer Disease relieving factors.
Answer: Food and antacids may bring re-lief (less likely in gastric
ulcers)
◉ Peptic Ulcer Disease associated symptoms and setting.
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.
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.
Answer: Chest or epigastric
◉ GERD Quality.
Answer: Heartburn, regurgitation
,◉ GERD timing.
Answer: After meals, especially spicy foods
◉ GERD aggravating factors.
Answer: Lying down, bending over; physical activity; diseases such
as scleroderma, gastroparesis; drugs like nicotine that relax the
lower esophageal sphincter
◉ GERD : relieving factors.
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.
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.
Answer: Acute inflammation of colonic diver-ticula, outpouchings 5-
10 mm in di-ameter, usually in sigmoid or descend-ing colon
◉ Diverticulitis location.
, Answer: Left lower quadrant
◉ Diverticulitis quality.
Answer: May be cramping at first, then steady
◉ Diverticulitis timing.
Answer: Often gradual onset
◉ Diverticulitis aggravating factors.
Answer: --
◉ Diverticulitis relieving factors.
Answer: Analgesia, bowel rest, antibiotics
◉ Diverticulitis associated symptoms and setting.
Answer: Fever, constipation. Also nausea, vomiting, abdominal mass
with rebound tenderness
◉ Hepatitis.
Answer: -Tenderness over liver (liver inflammation)
--Hep A and B prevention: Vaccination
Hep A: spread through fecal matter and asymptomatic children
