NR 509 FINAL EXAM WITH
CORRECT ANSWERS 2025 GRADED
A+
Appendicitis correct answers >> 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 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
2. 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.
GRADED A+
,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
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
GRADED A+
,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
GRADED A+
, 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
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
GRADED A+
CORRECT ANSWERS 2025 GRADED
A+
Appendicitis correct answers >> 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 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
2. 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.
GRADED A+
,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
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
GRADED A+
,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
GRADED A+
, 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
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
GRADED A+
