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Year 3 - OSCE Abdo > Abdo exam > Flashcards

Abdo exam Flashcards

1
Q

General inspection

A 
Tattoos
Bruising
Total parental nutrition (TPN) 
Jaundice
Pallor 
Abdo distention
Stoma bag
Ask patient to lift head off bed or cough to show hernia
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2
Q

What might bruising indicate?

A

Liver disease - not producing clotting factors

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3
Q

What would you look for in the nails?

A

Koilonychia - IDA due to e.g. malabsorption in Crohn’s disease, GI bleed

Leukonychia - low albumin; chronic liver disease, protein-losing enteropathy (somewhere in gut it’s lost e.g. coeliac or IBD)

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4
Q

What would clubbing of the fingers suggest?

A

IBD
Coeliac disease
Liver cirrhosis
Lymphoma of GI tract

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5
Q

What would you look at in the hand?

A

Dupuytren’s contracture
- in alcohol related chronic liver disease

Palmar erythema
- caused by increased oestrogen levels
as well as in chronic liver disease (normally breaks down oestrogen, therefore seen in excess in liver disease)

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6
Q

What would asterix indicate

A 
Liver failure (hepatic enchephalopathy; build up of anaemia)
Renal failure (urea increase)
Respiratory failure (CO2 renetion)
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7
Q

What else would you inspect on the hands?

A

Temp
Capillary refill
Radial pulse

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8
Q

What is an arteriovenous fistula?

A

surgical connection between artery and vein

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9
Q

What must you never do on the fistula?

A

Never do venepuncture or blood pressure on the side of an AV fistula

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10
Q

What would you look for under the arms?

A

Acanthosis nigricans

  • benign
  • associated with insulin resistance
  • GI malignancy
  • feels velvety to touch
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11
Q

What else are you looking for in the arms?

A 
Bruising/petechiae
Excoriation marks (cholestasis; bile salts deposited in skin causing itchiness) 
Hair loss (IDA)
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12
Q

What do you look for in the neck?

A

JVP

Lymphadenopathy

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13
Q

Which lymph node are you specifically looking for?

A

Virchow’s node

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14
Q

Troisier’s sign

A

Palpable metastatic lymph node in left supraclavicular node

Receives drainage from intraabdominal areas therefore common sign of intraabdominal

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15
Q

What are two signs of high cholesterol in the eyes?

A

Corneal arcus
Xanthelasma

Primary biliary cholangitis (bile ducts are slowly destroyed, therefore bile builds up in liver and is deposited around the body)

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16
Q

What exactly is corneal arcus?

A

Phospholipid deposition around the eye

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17
Q

Jaundice in eye?

A

scleral icterus

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18
Q

Jaundice in eye?

A

Scleral icterus

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19
Q

What are you looking for in the mouth?

A

How hydrated is the mouth?

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20
Q

Fungal infection of the tongue is called?

A

Candidiasis

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21
Q

Candidiasis is commonly seen in patients with?

A

Patients with immunosuppression

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22
Q

Angular stomatitis is commonly caused by?

A

IDA

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23
Q

What do you called inflammation of the tongue?

A

Glossitis

24
Q

Glossitis is caused by

A

B12 deficiency!

25
Q

Ulcers of the gum are called?

A

Aphthous ulcers

26
Q

Aphthous ulcers

A

Crohns
folate deficiency
IDA

27
Q

Telanglectasia

A

Basically spider veins

Can develop GI bleeds

28
Q

Hyperpigmentation

A

Poisiagous syndrome - associated with GI malignancy

29
Q

Hyperpigmentation of lips may indicate?

A

Poisiagous syndrome - associated with GI malignancy

30
Q

What are spider naevi caused by?

A

Increased oestrogen
Pregnancy
Combined oral contraceptive pill
Liver cirrhosis

31
Q

Chest expansion

A

Scars
Spider naevi
Gynaecomastia
Abnormal hair distribution

32
Q

What are you looking for on general inspection

A 
Scars
Distention
Hernias
Caput medusa
Pulsations
Cullen's and Grey Turner's sign
Striae
Stoma
33
Q

What scar do you see with cholecystectomy?

A

Kocher’s scar

right side slanted

34
Q

What scar do you see with liver transplant?

A

Mercedes benz scar

35
Q

Distention may be caused by

A 
6Fs
Fluid
Fat
Flatulence
Faeces 
Fetus 
?
36
Q

Caput medusa is caused by

A

Liver cirrhosis and portal hypertension

tortorous vessels that resemble the hair on medusa’s head!

37
Q

What is cullen’s sign?

A

Rare sign
haemorrhagic pancreatitis
bruising aroudn umbilicis

38
Q

What is grey turner’s sign?

A

Also rare sign

haemorrhagic pancreatitis bruising around flanks (laterally)

39
Q

Abdo striae is caused by

A

Quick distension of abdo:

Cushings
Pregnancy
Ascites

40
Q

Stoma

A

Ileostomy - right

colostomy - left e.g. after rectum has been removed

Urostomy (opening from kidneys, containing urine)

Look for:
Is there a spout?
Contents
Side

41
Q

What is a stoma?

A

Surgical opening of bowel so that the patient

42
Q

What are you looking for on light palpation?

A

Tenderness

43
Q

If rebound tenderness is present, how would you test for this and what can it suggest

A

Perforation of organ

When you quickly remove your hand after light palpation,
it causes pain for the patient

44
Q

Guarding can be split into

A

Voluntary

Involuntary

45
Q

If rebound tenderness and guarding is present, what could this suggest?

A

Peritonitis

46
Q

If there is an abdominal mass, what are you looking for?

A 
Location
Size
Consistency
Mobile
Pulsatile
47
Q

How do you palpate for the liver?

A

Press deeply into right flank region when patient is taking a deep breath IN

48
Q

What are you feeling for besides the spleen?

A

Splenic notch

49
Q

How do you look for the abdominal aorta?

A

Superior to umbilicus

place both hands gently

50
Q

What would lateral expansion of the abdominal aorta indicate?

A

AAA aneurysm

51
Q

If you find an increased mass when balloting the kidneys, what do you have to look out for?

A

Size and consistency
Unilateral - renal tumour
Bilateral - PKD, amyloidosis

52
Q

How would you differentiate between spleen and kidney?

A

Kidney can be knocked between two hands whereas spleen can’t

you also can’t palpate the upper border of a spleen, whereas you can on a kidney

53
Q

If there is hepatomegaly, what do you need to assess?

A 
Size
Surface edge (smooth or regular)
Consistency (soft or hard)
Tenderness
Pulsatility
54
Q

How do you palpate the spleen?

A

Ask patient to take a deep breath in when you palpate left side

55
Q

What would pitting oedema suggest?

A 
Hypoalbuminemiaa
e.g. protein losing enteropathy 
liver cirrhosis
heart failure
renal failure
56
Q

What further examinations could you suggest?

A

Hernial orifices
DRE
External genitalia
Urine dipstick

57
Q

Why would you auscultate the liver?

A

To check for increased blood flow to liver
E.g. in:
Cancer
Alcoholic liver disease

Year 3 - OSCE Abdo (4 decks)

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