NR 509 FINAL EXAM ADVANCED PHYSICAL ASSESSMENT
ACTUAL PAPER SOLVED QUESTIONS
◉ McBurney Point
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
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
,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
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
Answer: RUQ pain
Murphy Sign
,◉ Murphy Sign
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
Answer: Intrapancreatic trypsinogen activation to trypsin and other enzymes, result-ing in
autodigestion and inflammation of the pancreas
◉ Acute Pancreatitis Location
, Answer: Epigastric, may radiate straight to the back or other areas of the abdomen; 20% with severe
sequelae of organ failure
◉ Acute Pancreatitis Quality
Answer: Usually steady
◉ Acute PancreatitisTiming
Answer: Acute onset, persistent pain
◉ Acute Pancreatitis Aggrevating Factors
Answer: Lying supine; dyspnea if pleural effusions from capillary leak syn-drome; selected
medications, high triglycerides may exacerbate
◉ Acute Pancreatitis Relieving factors
Answer: Leaning forward with trunk flexed
ACTUAL PAPER SOLVED QUESTIONS
◉ McBurney Point
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
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
,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
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
Answer: RUQ pain
Murphy Sign
,◉ Murphy Sign
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
Answer: Intrapancreatic trypsinogen activation to trypsin and other enzymes, result-ing in
autodigestion and inflammation of the pancreas
◉ Acute Pancreatitis Location
, Answer: Epigastric, may radiate straight to the back or other areas of the abdomen; 20% with severe
sequelae of organ failure
◉ Acute Pancreatitis Quality
Answer: Usually steady
◉ Acute PancreatitisTiming
Answer: Acute onset, persistent pain
◉ Acute Pancreatitis Aggrevating Factors
Answer: Lying supine; dyspnea if pleural effusions from capillary leak syn-drome; selected
medications, high triglycerides may exacerbate
◉ Acute Pancreatitis Relieving factors
Answer: Leaning forward with trunk flexed
