NR 509 FINAL EXAM NEWEST UPDATE 2025-2026
EXAM WITH ACTUAL QUESTIONS AND CORRECT
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
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
Diverticulitis aggravating factors - CORRECT ANSWER---
Diverticulitis relieving factors - CORRECT ANSWER-Analgesia, bowel rest,
antibiotics
Diverticulitis associated symptoms and setting - CORRECT ANSWER-Fever,
constipation. Also nausea, vomiting, abdominal mass with rebound tenderness
Hepatitis - CORRECT ANSWER--Tenderness over liver (liver inflammation)
--Hep A and B prevention: Vaccination
Hep A: spread through fecal matter and asymptomatic children
Hep B: 1% fatality, 15-25% of chronic infection die from cirrhosis or liver cancer
(usually asymptomatic until onset of advanced liver disease).
Hep C: Mainly percutaneous exposure.
Hepatitis B high risk - CORRECT ANSWER--Sexual contact: w/ partners infected,
more than one parter in prior 6 mos, people seeing eval of treatment for STD,
men with men
-Perc and Mucosal exposure to blod: drugs, household contacts, residents and
staff of facilties of DD, Health care, dialysis
-Others: Travel to endemic areas, chronic liver disease and HIV, people seeking
protection from Hep B.
EXAM WITH ACTUAL QUESTIONS AND CORRECT
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
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
Diverticulitis aggravating factors - CORRECT ANSWER---
Diverticulitis relieving factors - CORRECT ANSWER-Analgesia, bowel rest,
antibiotics
Diverticulitis associated symptoms and setting - CORRECT ANSWER-Fever,
constipation. Also nausea, vomiting, abdominal mass with rebound tenderness
Hepatitis - CORRECT ANSWER--Tenderness over liver (liver inflammation)
--Hep A and B prevention: Vaccination
Hep A: spread through fecal matter and asymptomatic children
Hep B: 1% fatality, 15-25% of chronic infection die from cirrhosis or liver cancer
(usually asymptomatic until onset of advanced liver disease).
Hep C: Mainly percutaneous exposure.
Hepatitis B high risk - CORRECT ANSWER--Sexual contact: w/ partners infected,
more than one parter in prior 6 mos, people seeing eval of treatment for STD,
men with men
-Perc and Mucosal exposure to blod: drugs, household contacts, residents and
staff of facilties of DD, Health care, dialysis
-Others: Travel to endemic areas, chronic liver disease and HIV, people seeking
protection from Hep B.
