NR 509 Final Exam
Study online at https://quizlet.com/_8brio5
1. Appendicitis 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.
2. McBurney Point 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.
3. Rovsing sign 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.
4. Psoas Sign --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.
5. Obturator Sign --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 obtura-
tor muscle by an inflamed appendix. This sign has very low sensitivity.
6. Acute Cholecys- RUQ pain
tits Murphy Sign
, NR 509 Final Exam
Study online at https://quizlet.com/_8brio5
7. Murphy Sign 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.
8. Acute Pancreati- Intrapancreatic trypsinogen activation to trypsin and other enzymes, result-ing in
tis Process autodigestion and inflammation of the pancreas
9. Acute Pancreati- Epigastric, may radiate straight to the back or other areas of the abdomen; 20%
tis Location with severe sequelae of organ failure
10. Acute Pancreati- Usually steady
tis Quality
11. Acute Pancreati- Acute onset, persistent pain
tisTiming
12. Acute Pancreati- Lying supine; dyspnea if pleural effusions from capillary leak syn-drome; selected
tis Aggrevating medications, high triglycerides may exacerbate
Factors
13. Acute Pancreati- Leaning forward with trunk flexed
tis Relieving fac-
tors
14. Acute Pancre- Nausea, vomiting, abdominal dis-tention, fever; often recurrent; 80% with history
atitis Associated of alcohol abuse or gallstones
, NR 509 Final Exam
Study online at https://quizlet.com/_8brio5
Symptoms and
Setting
15. Peptic Ulcer Dis- Mucosal ulcer in stomach or duode-num >5 mm, covered with fibrin, ex-tending
ease Process through the muscularis mu-cosa; H. pylori infection present in 90% of peptic
ulcers
16. Peptic Ulcer Dis- Epigastric, may radiate straight to the back
ease Location
17. Peptic Ulcer Dis- Variable: epigastric gnawing or burning (dyspepsia); may also be boring, aching,
ease Quality or hungerlike
No symptoms in up to 20%
18. Peptic Ulcer Dis- Intermittent; duodenal ulcer is more likely than gastric ulcer or dyspepsia to cause
ease Timing pain that (1) wakes the patient at night, and (2) occurs intermittently over a few
wks, disappears for months, then recurs
19. Peptic Ulcer Dis- Variable
ease aggravating
factors
20. Peptic Ulcer Dis- Food and antacids may bring re-lief (less likely in gastric ulcers)
ease relieving
factors
21. Peptic Ulcer Dis- Nausea, vomiting, belching, bloating; heartburn (more common in duodenal
ease associated ulcer); weight loss (more common in gastric ulcer); dyspepsia is more com-mon
symptoms and in the young (20-29 yrs), gastric ulcer in those over 50 yrs, and duodenal ulcer in
setting those 30-60 yrs
22. GERD Process 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
Study online at https://quizlet.com/_8brio5
1. Appendicitis 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.
2. McBurney Point 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.
3. Rovsing sign 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.
4. Psoas Sign --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.
5. Obturator Sign --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 obtura-
tor muscle by an inflamed appendix. This sign has very low sensitivity.
6. Acute Cholecys- RUQ pain
tits Murphy Sign
, NR 509 Final Exam
Study online at https://quizlet.com/_8brio5
7. Murphy Sign 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.
8. Acute Pancreati- Intrapancreatic trypsinogen activation to trypsin and other enzymes, result-ing in
tis Process autodigestion and inflammation of the pancreas
9. Acute Pancreati- Epigastric, may radiate straight to the back or other areas of the abdomen; 20%
tis Location with severe sequelae of organ failure
10. Acute Pancreati- Usually steady
tis Quality
11. Acute Pancreati- Acute onset, persistent pain
tisTiming
12. Acute Pancreati- Lying supine; dyspnea if pleural effusions from capillary leak syn-drome; selected
tis Aggrevating medications, high triglycerides may exacerbate
Factors
13. Acute Pancreati- Leaning forward with trunk flexed
tis Relieving fac-
tors
14. Acute Pancre- Nausea, vomiting, abdominal dis-tention, fever; often recurrent; 80% with history
atitis Associated of alcohol abuse or gallstones
, NR 509 Final Exam
Study online at https://quizlet.com/_8brio5
Symptoms and
Setting
15. Peptic Ulcer Dis- Mucosal ulcer in stomach or duode-num >5 mm, covered with fibrin, ex-tending
ease Process through the muscularis mu-cosa; H. pylori infection present in 90% of peptic
ulcers
16. Peptic Ulcer Dis- Epigastric, may radiate straight to the back
ease Location
17. Peptic Ulcer Dis- Variable: epigastric gnawing or burning (dyspepsia); may also be boring, aching,
ease Quality or hungerlike
No symptoms in up to 20%
18. Peptic Ulcer Dis- Intermittent; duodenal ulcer is more likely than gastric ulcer or dyspepsia to cause
ease Timing pain that (1) wakes the patient at night, and (2) occurs intermittently over a few
wks, disappears for months, then recurs
19. Peptic Ulcer Dis- Variable
ease aggravating
factors
20. Peptic Ulcer Dis- Food and antacids may bring re-lief (less likely in gastric ulcers)
ease relieving
factors
21. Peptic Ulcer Dis- Nausea, vomiting, belching, bloating; heartburn (more common in duodenal
ease associated ulcer); weight loss (more common in gastric ulcer); dyspepsia is more com-mon
symptoms and in the young (20-29 yrs), gastric ulcer in those over 50 yrs, and duodenal ulcer in
setting those 30-60 yrs
22. GERD Process 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
