Gallstones Leik (lots of distractor questions with other dx)

Question 1

107. Rovsing’s sign is associated with which of the following?
     A) An acute abdomen, such as during a ruptured appendix
     B) Knee instability
     C) Damage to the meniscus of the knee
     D) Acute cholelithiasis

Answer 1

A) An acute abdomen, such as during a ruptured appendix Rovsing’s sign
identifies an acute abdomen, such as occurs in acute appendicitis. With the patient in the supine position, the examiner palpates deep into the left lower quadrant of the abdomen. The maneuver is positive if pain is referred to the right lower quadrant.

Question 2

13. The nurse practitioner would test the obturator and iliopsoas muscle to evaluate for:
A) Cholecystitis
B) Acute appendicitis
C) Inguinal hernia
D) Gastric ulcer

Answer 2

B) Acute appendicitis Signs and symptoms of an acute abdomen include
involuntary guarding, rebound tenderness, boardlike abdomen, and a positive obturator and psoas sign. A positive obturator sign occurs when pain is elicted by internal rotation of the right hip from 90 degrees hip/knee flexion. The psoas sign is positive when pain occurs with passive extension of the thigh while the patient is lying on his or her side with knees extended, or when pain occurs with active flexion of the thigh at the hip.

Question 3

21. Which of the following is an accurate description of eliciting Murphy’s sign?
    A) On deep inspiration by the patient, palpate firmly in the right upper quadrant of the abdomen below the costovertebral angle
    B) Bend the patient’s hips and knees at 90 degrees, then passively rotate the hip
    externally, and internally
    C) Ask the patient to squat, then place the stethoscope on the apical area
    D) Press into the abdomen deeply, then release it suddenly

Answer 3

A) On deep inspiration by the patient, palpate firmly in the right upper
quadrant of the abdomen below the costovertebral angle Murphy’s sign is tested during an abdominal examination for biliary disorders. As the patient breathes in, the abdominal contents are pushed downward as the diaphragm moves down and the lungs expand. As the patient stops/hold the breath, the gallbladder comes in contact
with the examiner’s fingers and may elicit pain. To be considered positive, the same
maneuver must not elicit pain when performed on the left side. A negative Murphy’s
test in the elderly is not useful for ruling out cholecystitis if history and other tests
suggest the diagnosis.

Question 4

This case is followed by questions and multiple-choice answers specific to the case. A 55-year-old male patient describes an episode of chest tightness in his substernal area that radiated to
his back while he was jogging. It was relieved immediately when he stopped.

88. Which of the following would you recommend to this 55-year-old patient?
    A) Start an exercise program with walking instead of jogging
    B) Consult with a cardiologist for further evaluation
    C) Consult with a gastroenterologist to rule out acute cholecystitis
    D) Take ibuprofen (Advil) 600 mg for pain every 4 to 6 hours as needed

Answer 4

B) Consult with a cardiologist for further evaluation Blood tests that indicate
tissue damage to the heart include troponin and creatine phosphokinase (CPK).
Testing ordered should include EKG, nuclear stress test/stress echocardiogram, and coronary angiography. The patient would need a cardiology consultation for
abnormal and/or invasive tests.

Question 5

379. Extreme tenderness and involuntary guarding at McBurney’s point is a significant finding for possible:
A) Acute cholecystitis
B) Acute appendicitis
C) Acute gastroenteritis
D) Acute diverticulitis

Answer 5

B) Acute appendicitis Symptoms of an acute abdomen, such as appendicitis,
include extreme tenderness and involuntary guarding at McBurney’s point.
McBurney’s point is the name given to the point over the right side of the abdomen
that is one third of the distance (approximately 2 inches) from the anterior superior iliac spine to the umbilicus. This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum. (During pregnancy the location of the appendix changes as the uterus grows)

Question 6

391. A positive obturator sign might signify which of the following conditions?
A) Acute appendicitis
B) Acute pancreatitis
C) Acute cholecystitis
D) Acute hepatitis

Answer 6

A) Acute appendicitis A positive obturator sign may indicate acute appendicitis.
The test is performed with the patient supine. The examiner rotates the hip, using full range of motion. The test is positive if pain is experienced with movement or flexion of the hip.