Appendicitis - CORRECT ANSWER 1. McBurney point tenderness
2. Rovsing sign
3. the psoas sign
4. the obturator sign
--Appendicitis is twice as likely
... [Show More] 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
Acute Pancreatitis Aggrevating Factors - CORRECT ANSWER Lying supine; dyspnea if pleural
effusions from capillary leak syn-drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving factors - CORRECT ANSWER Leaning forward with trunk flexed
Acute Pancreatitis Associated Symptoms and Setting - CORRECT ANSWER Nausea, vomiting,
abdominal dis-tention, fever; often recurrent; 80% with history of alcohol abuse or gallstones
Peptic Ulcer Disease Process - CORRECT ANSWER Mucosal ulcer in stomach or duode-num
>5 mm, covered with fibrin, ex-tending through the muscularis mu-cosa; H. pylori infection
present in 90% of peptic ulcers
Peptic Ulcer Disease Location - CORRECT ANSWER Epigastric, may radiate straight to the
back
Peptic Ulcer Disease Quality - CORRECT ANSWER Variable: epigastric gnawing or burning
(dyspepsia); may also be boring, aching, or hungerlike
No symptoms in up to 20%
Peptic Ulcer Disease Timing - CORRECT ANSWER Intermittent; duodenal ulcer is more likely
than gastric ulcer or dyspepsia to cause pain that (1) wakes the patient at night, and (2) occurs
intermittently over a few wks, disappears for months, then recurs [Show Less]