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2024 NR 509 FINAL EXAM WITH CORRECT ANSWERS
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2024 NR 509 FINAL EXAM WITH CORRECT ANSWERS
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2024 NR 509 FINAL EXAM WITHCORRECT ANSWERS
Suicide risk and prevention - CORRECT-ANSWERS-Suicide is the 10th leading
cause of death in the U.S.
--Second among 15-24 year olds.
--Highest rate: 45-54 year olds
--Men 4 times more likely than women
-There exist a variety of motives for suicide.
-May be biological and/or "contagious" (the Werther effect)
-Prediction and prevention is difficult, however warning signs are abundant.
Anxiety disorders - CORRECT-ANSWERSexcessive worry persisting over a 6
month period suggests anxiety disorder.
--3 % prevalence
1. Panic disorder
2. OCD
3. PTSD
4. Social anxiety disorder
5. Phobias
Appendicitis - CORRECT-ANSWERS1. 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.
Depression screening - CORRECT-ANSWERSUSPSTF recommendation: B in
primary care setting
two questions
1. Over past 2 weeks, have you felt down, depressed, or hopeless?
2. Over past 2 weeks, have you felt little interest or pleasure in doing things
(anhedonia)?
--Yes to either of these warrants full diagnostic interview
,Schizophrenia - CORRECT-ANSWERS1. Grooming and personal hygiene may
deteriorate
2. flat affect and remoteness
3. Hallucinations and illusions
4. Derailment
5. Neologisms: invented or distorted words
6. Incoherence: speech that is incomprehensible and illogical
7. Blocking: sudden interruption of speech in midsentence or before idea is
complete.
8. Perseveration: persistent repetition of words or ideas
9. Echolalia: repetition of words and phrases of others
10. Clanging: speech with choice of words based on sounds rather than
meaning (rhyming and punning).
Male Tanner staging - CORRECT-ANSWERS1. preadolescent, no pubic hair +
pre-pubertal testes
2. Initial growth of scrotum and testes, skin reddened, thin, wrinkled; few
thin hairs around root of penis
3. Penis longer, testes and scrotum growth, skin of scrotum darker; coarser
curlier hair, still sparse
4. glans develops, penis growth in length and width, scrotum and testes have
grown; darker more coarse curly hair extending to thighs
5. adult size/shape; pubic hair spreads to medial surface of thigh and up
towards umbilicus
bacterial vaginosis - CORRECT-ANSWERS1. Bacterial overgrowth: often
transmitted sexually
2. Gray or white, thin, homogeneous, malodorous discharge
3. Unpleasant fishy or musty genital odor reported after intercourse
4. Vulva and vaginal mucosa appear normal
McBurney Point - CORRECT-ANSWERS1. 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-ANSWERSPress 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-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-ANSWERSRUQ pain
Murphy Sign
Murphy Sign - CORRECT-ANSWERSHook 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-ANSWERSIntrapancreatic trypsinogen
activation to trypsin and other enzymes, result-ing in autodigestion and
inflammation of the pancreas
Acute Pancreatitis Location - CORRECT-ANSWERSEpigastric, may radiate
straight to the back or other areas of the abdomen; 20% with severe
sequelae of organ failure
Acute Pancreatitis Quality - CORRECT-ANSWERSUsually steady
Acute PancreatitisTiming - CORRECT-ANSWERSAcute onset, persistent pain
Acute Pancreatitis Aggrevating Factors - CORRECT-ANSWERSLying supine;
dyspnea if pleural effusions from capillary leak syn-drome; selected
medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving factors - CORRECT-ANSWERSLeaning forward
with trunk flexed
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