NR 509 Final Exam study guide correct
jng jng jng jng jng jng jng
verified 100% jng
Appendicitisjng-jngcorrectjnganswers-1.jngMcBurneyjngpointjngtendernessjng
2.jngRovsingjngsign
3.jngthejngpsoasjngsign
4.jngthejngobturatorjngsign
--
AppendicitisjngisjngtwicejngasjnglikelyjnginjngthejngpresencejngofjngRLQjngtenderness,jngRovsingjngsign,jngandjngthejngpsoasj
ngsign
--
Thejngpainjngofjngappendicitisjngclassicallyjngbeginsjngnearjngthejngumbilicus,jngthenjngmigratesjngtojngthejngRLQ.jngOlder
jngadultsjngarejnglessjnglikelyjngtojngreportjngthisjngpattern.
--LocalizedjngtendernessjnganywherejnginjngthejngRLQ,jngevenjnginjngthejngrightjngflank,jngsuggestsjngappendicitis.
McBurneyjngPointjng-jngcorrectjnganswers-
1.jngMcBurneyjngpointjngliesjng2jnginchesjngfromjngthejnganteriorjngsuperiorjngspinousjngprocessjngofjngiliumjngonjngajngline
jngdrawnjngfromjngthatjngprocessjngtojngthejngumbilicus
2.jngAppendicitisjngisjngthreejngtimesjngmorejnglikelyjngifjngtherejngisjngMcBurneyjngpointjngtenderness.
Rovsingjngsignjng-jngcorrectjnganswers-
PressjngdeeplyjngandjngevenlyjnginjngthejngLLQ.jngThenjngquicklyjngwithdrawjngyourjngfingers.
PainjnginjngthejngRLQjngduringjngleft-sidedjngpressurejngisjngajngpositivejngRovsingjngsign.
PsoasjngSignjng-jngcorrectjnganswers---
Placejngyourjnghandjngjustjngabovejngthejngpatient'sjngrightjngkneejngandjngaskjngthejngpatientjngtojngraisejngthatjngthighjnga
gainstjngyourjnghand.jngAlternatively,jngaskjngthejngpatientjngtojngturnjngontojngthejngleftjngside.jngThenjngextendjngthejngp
atient'sjngrightjnglegjngatjngthejnghip.jngFlexionjngofjngthejnglegjngatjngthejnghipjngmakesjngthejngpsoasjngmusclejngcontract;jng
extensionjngstretchesjngit.
--Increasedjngabdominaljngpainjngonjngeitherjngmaneuverjngisjngajngpositivejngpsoasjngsign,jngsug-
gestingjngirritationjngofjngthejngpsoasjngmusclejngbyjnganjnginflamedjngappendix.
ObturatorjngSignjng-jngcorrectjnganswers---Lessjnghelpful
--
Flexjngthejngpatient'sjngrightjngthighjngatjngthejnghip,jngwithjngthejngkneejngbent,jngandjngrotatejngthejnglegjnginternallyjngatjn
gthejnghip.jngThisjngmaneuverjngstretchesjngthejnginternaljngobturatorjngmuscle.jng
,--
Rightjnghypogastricjngpainjngisjngajngpositivejngobturatorjngsign,jngfromjngirritationjngofjngthejngobturatorjngmusclejngbyjng
anjnginflamedjngappendix.jngThisjngsignjnghasjngveryjnglowjngsensitivity.
AcutejngCholecystitsjng-jngcorrectjnganswers-RUQjngpain
MurphyjngSign
MurphyjngSignjng-jngcorrectjnganswers-
Hookjngyourjngleftjngthumbjngorjngthejngfingersjngofjngyourjngrightjnghandjngunderjngthejngcostaljngmarginjngatjngthejngpointj
ngwherejngthejnglateraljngborderjngofjngthejngrectusjngmusclejngintersectsjngwithjngthejngcostaljngmargin.jngAlternatively,j
ngpalpatejngthejngRUQjngwithjngthejngfingersjngofjngyourjngrightjnghandjngnearjngthejngcostaljngmargin.jngIfjngthejngliverjngisjng
enlarged,jnghookjngyourjngthumbjngorjngfingersjngunderjngthejngliverjngedgejngatjngajngcomparablejngpoint.jngAskjngthejngp
atientjngtojngtakejngajngdeepjngbreath,jngwhichjngforcesjngthejngliverjngandjnggallbladderjngdownjngtowardjngthejngexamin
ingjngfingers.jngWatchjngthejngpatient'sjngbreathingjngandjngnotejngthejngdegreejngofjngtenderness.
--
AjngsharpjngincreasejnginjngtendernessjngwithjnginspiratoryjngeffortjngisjngajngpositivejngMurphyjngsign.jngWhenjngpositiv
e,jngMurphyjngsignjngtriplesjngthejnglikelihoodjngofjngacutejngcholecystitis.
AcutejngPancreatitisjngProcessjng-jngcorrectjnganswers-
Intrapancreaticjngtrypsinogenjngactivationjngtojngtrypsinjngandjngotherjngenzymes,jngresult-
ingjnginjngautodigestionjngandjnginflammationjngofjngthejngpancreas
AcutejngPancreatitisjngLocationjng-jngcorrectjnganswers-
Epigastric,jngmayjngradiatejngstraightjngtojngthejngbackjngorjngotherjngareasjngofjngthejngabdomen;jng20%jngwithjngseverejn
gsequelaejngofjngorganjngfailure
AcutejngPancreatitisjngQualityjng-jngcorrectjnganswers-Usuallyjngsteady
AcutejngPancreatitisTimingjng-jngcorrectjnganswers-Acutejngonset,jngpersistentjngpain
AcutejngPancreatitisjngAggrevatingjngFactorsjng-jngcorrectjnganswers-
Lyingjngsupine;jngdyspneajngifjngpleuraljngeffusionsjngfromjngcapillaryjngleakjngsyn-
drome;jngselectedjngmedications,jnghighjngtriglyceridesjngmayjngexacerbate
AcutejngPancreatitisjngRelievingjngfactorsjng-jngcorrectjnganswers-Leaningjngforwardjngwithjngtrunkjngflexed
AcutejngPancreatitisjngAssociatedjngSymptomsjngandjngSettingjng-jngcorrectjnganswers-
Nausea,jngvomiting,jngabdominaljngdis-
tention,jngfever;jngoftenjngrecurrent;jng80%jngwithjnghistoryjngofjngalcoholjngabusejngorjnggallstones
PepticjngUlcerjngDiseasejngProcessjng-jngcorrectjnganswers-Mucosaljngulcerjnginjngstomachjngorjngduode-
numjng>5jngmm,jngcoveredjngwithjngfibrin,jngex-tendingjngthroughjngthejngmuscularisjngmu-
cosa;jngH.jngpylorijnginfectionjngpresentjnginjng90%jngofjngpepticjngulcers
PepticjngUlcerjngDiseasejngLocationjng-jngcorrectjnganswers-Epigastric,jngmayjngradiatejngstraightjngtojngthejngback
PepticjngUlcerjngDiseasejngQualityjng-jngcorrectjnganswers-
Variable:jngepigastricjnggnawingjngorjngburningjng(dyspepsia);jngmayjngalsojngbejngboring,jngaching,jngorjnghungerlike
, Nojngsymptomsjnginjngupjngtojng20%
PepticjngUlcerjngDiseasejngTimingjng-jngcorrectjnganswers-
Intermittent;jngduodenaljngulcerjngisjngmorejnglikelyjngthanjnggastricjngulcerjngorjngdyspepsiajngtojngcausejngpainjngthatjng
(1)jngwakesjngthejngpatientjngatjngnight,jngandjng(2)jngoccursjngintermittentlyjngoverjngajngfewjngwks,jngdisappearsjngforjng
months,jngthenjngrecurs
PepticjngUlcerjngDiseasejngaggravatingjngfactorsjng-jngcorrectjnganswers-Variable
PepticjngUlcerjngDiseasejngrelievingjngfactorsjng-jngcorrectjnganswers-Foodjngandjngantacidsjngmayjngbringjngre-
liefjng(lessjnglikelyjnginjnggastricjngulcers)
PepticjngUlcerjngDiseasejngassociatedjngsymptomsjngandjngsettingjng-jngcorrectjnganswers-
Nausea,jngvomiting,jngbelching,jngbloating;jngheartburnjng(morejngcommonjnginjngduodenaljngulcer);jngweightjnglossjn
g(morejngcommonjnginjnggastricjngulcer);jngdyspepsiajngisjngmorejngcom-monjnginjngthejngyoungjng(20-
29jngyrs),jnggastricjngulcerjnginjngthosejngoverjng50jngyrs,jngandjngduodenaljngulcerjnginjngthosejng30-60jngyrs
GERDjngProcessjng-jngcorrectjnganswers-
Prolongedjngexposurejngofjngesophagusjngtojnggastricjngacidjngduejngtojngimpairedjngesopha-
gealjngmotilityjngorjngexcessjngrelaxationsjngofjngthejnglowerjngesophagealjngsphincter;jngHelico-
bacterjngpylorijngmayjngbejngpresent
GERDjngLocationjng-jngcorrectjnganswers-Chestjngorjngepigastric
GERDjngQualityjng-jngcorrectjnganswers-Heartburn,jngregurgitation
GERDjngtimingjng-jngcorrectjnganswers-Afterjngmeals,jngespeciallyjngspicyjngfoods
GERDjngaggravatingjngfactorsjng-jngcorrectjnganswers-
Lyingjngdown,jngbendingjngover;jngphysicaljngactivity;jngdiseasesjngsuchjngasjngscleroderma,jnggastroparesis;jngdrugsjng
likejngnicotinejngthatjngrelaxjngthejnglowerjngesophagealjngsphincter
GERDjng:jngrelievingjngfactorsjng-jngcorrectjnganswers-Antacids,jngprotonjngpumpjnginhibi-
tors;jngavoidingjngalcohol,jngsmoking,jngfattyjngmeals,jngchocolate,jngselectedjngdrugsjngsuchjngasjngtheophylline,jngcal
-ciumjngchanneljngblockers
GERDjngassociatedjngsymptomsjngandjngsettingjng-jngcorrectjnganswers-Wheezing,jngchronicjngcough,jngshort-
nessjngofjngbreath,jnghoarseness,jngchokingjngsensation,jngdysphagia,jngregurgitation,jnghalitosis,jngsorejngthroat;jngi
ncreasesjngriskjngofjngBarrettjngesophagusjngandjngesopha-gealjngcancer
Diverticulitisjngprocessjng-jngcorrectjnganswers-Acutejnginflammationjngofjngcolonicjngdiver-
ticula,jngoutpouchingsjng5-10jngmmjnginjngdi-ameter,jngusuallyjnginjngsigmoidjngorjngdescend-ingjngcolon
Diverticulitisjnglocationjng-jngcorrectjnganswers-Leftjnglowerjngquadrant
Diverticulitisjngqualityjng-jngcorrectjnganswers-Mayjngbejngcrampingjngatjngfirst,jngthenjngsteady
Diverticulitisjngtimingjng-jngcorrectjnganswers-Oftenjnggradualjngonset
Diverticulitisjngaggravatingjngfactorsjng-jngcorrectjnganswers---
Diverticulitisjngrelievingjngfactorsjng-jngcorrectjnganswers-Analgesia,jngboweljngrest,jngantibiotics
