Abdo

Question 1

What should you look at in the inspection aspect of abdo exam?

Answer 1

Distention
Pallor
Jaundice
Hyperpigmentation - bronzing of skin associated with haemochromatosis
Oedema
Cachexia - muscle loss not associated with nutritional supplementation
Hernias

Question 2

What is myoclonus of the hands?

Answer 2

Stretch patients hands out and bend wrists back to 90 degrees with finger splayed out and observe for 20 secs. If a tremor occurs it may indicate possible co2 retention.

Question 3

What are all of the head and neck lymph nodes?

Answer 3

Preauricular (in front of ears)
Posteriorauricular (behind ears)
Parotid (underneath pre auricular)
Tonsillar (behindnext to mandible)
Submental (under chin)
Submandibular (under mandible)
Occipital (back of head on neck)
Deep and posterior cervical ( on neck middle on the sides)
Supraclavicular

Question 4

Where does the left supraclavicular node receive drainage from?

Answer 4

The abdominal cavity

Question 5

Where does the right supraclavicular node receive drainage from?

Answer 5

The thorax

Question 6

What is Cullens sign?

Answer 6

Bruising around belly button. sign of haemorrhage pancreatitis

Question 7

What is grey turners sign?

Answer 7

Bruising in the flanks associated with hemorrhagic pancreatitis

Question 8

Auscultation landmarks for abdomen?

Answer 8

Aorta - Midline a few cm above umbilicus

Renal (Left and Right) - a few cm lateral to the aorta

Iliac (Left and Right) - a few cm inferior to umbilicus

Femoral (Left and right) - On inguinal lines

Question 9

Where should a dull/thud sound be in abdo percussion?

Answer 9

Dense areas

Liver
Spleen

Question 10

Where would a flat/stony/dull

Answer 10

Over bone

Question 11

How much bowel sounds would you here per minute?

Answer 11

5-30 per min

Question 12

Where would you hear hollow higher pitched sounds?

Answer 12

Over the stomach

Question 13

How long is the liver?

Answer 13

6-12cm

Question 14

Landmark for liver percussion

Answer 14

Right midclavicular

Start at 3rd intercostal space

The sound will change from resonant (over lungs) to dull when you reach the liver (around 5th intercostal space)

Then begin percussing upwards from below the right costal margin (around umbilicus)

Question 15

Where should you percuss the spleen?

Answer 15

8th/9th intercostalspace in the anterior axillary line left side

Ask pt to take deep breath then percuss

If dull then splenomegaly

Question 16

What is the pinch test and what does it test for?

Answer 16

Pinch abdo skin over pts right hip.

The release quickly, if it hurts then positive for peritonitis

Question 17

Where is Murphys sign and what does it test for?

Answer 17

Right midclavicular costal margin

Tests for cholecystitis

Question 18

Where do you test for ballot test and what does it test for?

Answer 18

• Left hand on patient’s back
  (flank area) under the 12th rib,
  pushing upwards
• Right hand pushing down just
  below the (anterior) costal
  margin.
• Ask the patient to take a deep
  breath to help descend the
  kidney and ‘trap it’ between your
  two hands.
• Easily palpable and/or tender
  kidney is abnormal =
  (hydronephrosis or
  pyelonephritis)

Question 19

Where is CVA tenderness test?

Answer 19

• Find the CVA by assessing for
  posterior 12th rib and the spine…just
  below the 12th rib in between the
  spine is the angle.
• Lay non-dominate hand flat over the
  angle.
• Make fist with dominate hand and
  firmly thump the fist onto flat non-
  dominate hand.
• Ask the patient if they felt
  tenderness or pain = if yes likely
  pyelonephritis

Question 20

What is rovsing sign?

Answer 20

RLQ pain of palpation of LLQ

Question 21

What is psoas sign?

Answer 21

RLQ pain with extension of right hip with resistance

Question 22

What is Mallory-Weiss Tear?

Answer 22

Tear/laceration of the mucous membrane, most commonly at the point where the oesophagus and the stomach meet

Question 23

What is steatorrhoea?

Answer 23

The presence of excess fat in the faeces causing them to appear pale and difficult to flush

Question 24

What is mesenteric adenitis?

Answer 24

Inflammation of the lymph nodes in the mesentery.

It typically affects the lymph nodes in the LRQ, near appendix.

Question 25

What is cholecystitis the inflammation of?

Answer 25

Gallbladder

Question 26

What is volvulus?

Answer 26

When the intestine twists on itself and causes an obstruction leading to necrosis

Question 27

What is intussusception?

Answer 27

A portion of the intestine telescopes into an adjacent segment, creating a blockage.

Question 28

What is indicated for AAA?

Answer 28

TXA