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PE midterm > Abdomen > Flashcards

Abdomen Flashcards

1
Q

What is the origin/insertion of the rectus abdominis?

A

origin: pubis, insertion: costal cartilages of ribs 5-7

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2
Q

What nerves innervate the rectus abdominis?

A

Nerve roots T7 - T12

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3
Q

What are the layers of the abdominal wall from most superficial to deep?

A

Skin, Camper’s fascia, Scarpa’s fascia, Rectus abdominis, External Oblique, Internal Oblique, Transverse abdominis, Pyramidalis muscle, Fascia, Pertonium

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4
Q

Does the aorta bifurcate above or below the umbilicus?

A

above

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5
Q

where is the gallbladder palpated anatomically?

A

R MCL

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6
Q

Which renal artery is longer?

A

right

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7
Q

Which kidney is positioned lower than the other?

A

right

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8
Q

What could Costovertebral angle tenderness indicate?

A

pyelonephritis or MSK

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9
Q

Where are bruits in the renal arteries auscultated?

A

on the posterior side of the abdomen

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10
Q

which artery generally bleeds with a stomach ulcer?

A

gastroduodenal

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11
Q

why is the order of inspection (inspection, auscultation, percussion, palpation) important especially on the abdominal exam?

A

you don’t want to cause pain with palpation before inspection of the pt

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12
Q
A

Know these incisions for common surgical procedures

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13
Q

what abdominal finding would be noted in a pt with Cuchings?

A

large abdomen with striae

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14
Q

caput medusae is a sign of?

A

portal HTN, liver failure

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15
Q

What is diastasis recti?

A

not technically a hernia - can become one, due to a weak linae alba

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16
Q

how can you test for diastasis recti?

A

have the pt do a crunch, the abdomen should not bulge

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17
Q

what populations are at risk for developing diastasis recti?

A

pre-mature infants, pregnant women

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18
Q

What “technically” is required before documentation of no bowel sounds?

A

2 minutes of no bowel sounds

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19
Q

what might cause increased bowel sounds?

A

gastroenteritis, hunger, early obstruction

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20
Q

what might cause decreased bowel sounds?

A

peritonitis, adynamic ileus, late obstruction

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21
Q

what can cause adynamic ileus?

A

surgery or anesthesia, gallstones

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22
Q

most of the abdomen should sound tympanic on percussion except…

A

it is over a solid organ, the pt has just eaten, or if the pt is constipated

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23
Q

what is WNL for liver span?

A

6-12cm

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24
Q

how is splenic percussion performed?

A

percuss the lowest ICS, have pt take in a deep breath, percuss over the same area and it shouldn’t change

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25
Q

methods for relaxing a ticklish patient?

A

have the take a deep breath in, bend knees to relax abdominal muscles

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26
Q

where should palpation always be directed last during the exam?

A

the most tender area

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27
Q

what should a normal liver border feel like?

A

smooth and soft/firm

28
Q

what are some abnormal findings on liver palpation?

A

hepatomegaly, hard liver, nodules, oval mass below the liver borders

29
Q

what is a normal aorta diameter?

A

3cm

30
Q

define acute appendicitis

A

poorly localized periumbilical pain followed by RLQ pain that is aggravated by movement/cough

31
Q

what is the peritoneums role in pain sensation with acute appendicitis?

A

once the peritoneum is inflammed, the pt will feel tenderness with any jarring/coughing movement

32
Q

where is the appendix palpated?

A

McBurney’s point

33
Q

if a pt with appendicitis has right-sided rectal tenderness, where is there appendix most likely located?

A

retro-cecal

34
Q

will rebound tenderness be positive or negative with acute appendicitis?

A

positive

35
Q

What is rovsing’s sign?

A

pain in the RLQ during LLQ palpation and LLQ withdrawal (referred rebound tenderness)

36
Q

which leg is the psoas sign performed with and what does a positive test indicate?

A

the right leg, indicates appendicitis

37
Q

if the psoas sign is positive, what might also be noted on exam?

A

pturia since the R ureter is so close to the appendix

38
Q

what is the obturator sign?

A

flex R hip 90 degrees and internally rotate the hip

39
Q

what is murphy’s sign?

A

press firmly under the R costal margin while pt inhales deeply, inspiratory arrest occurs suggesting cholecystitis

40
Q

what is the fluid wave test?

A

2 people required, on person makes a roadblock in the midline of the abdomen while the other pushed back and forth on the abdomen - should feel waves if ascites present

41
Q

what is a normal superficial abdominal reflex?

A

muscle contracts in the direction of the skin stroke

42
Q

when is the superficil abdominal reflex decreased?

A

motor neuron disease, MS, neurogenic bladder

43
Q

what is Kehr’s sign?

A

L shoulder pain with peritonitis due to irritation of the diaphram indicating ruptured spleen

44
Q

Where does pancreatic pain refer to?

A

the back

45
Q

where does uterine pain refer to?

A

the lumbar spine

46
Q

Where does a perforated ulcer refer to?

A

right trapezoid (shoulder)

47
Q

Where does biliary colic refer to?

A

right scapula

48
Q

where can renal colic refer to?

A

over the kidney or either side of lumbar spine

49
Q

where can ureteral pain refer to?

A

the scrotum or labia

50
Q

define hernia

A

translocation of a structure or viscous from its normal position to an abnormal position through a natural boundary

51
Q

what is a hiatal hernia

A

stomach moves through gastro-esophageal junction/esophageal hiatus into the thorax, most are sliding - could also be paraesophageal

52
Q

what is a herniated nucleus pulposus?

A

herniated disc/spine into the annulus fibrosis (could be due to dehydration, wear and tear, age, poor body mechanics )

53
Q

what are ventral hernias?

A

protrusion of a peritoneal-lined sac through some defect in the abdominal wall - could be epigastric, umbilical, incisional

54
Q

what are the 3 types of inguinal hernias?

A

direct, indirect, femoral

55
Q

what causes epigastric hernias

A

defect/weakness/destruction of the linea alba with protrusion of peritoneal contents

56
Q

who is at risk for epigastric hernias?

A

pregnant women, obesity

57
Q

what causes umbilical hernias?

A

fascial defect around the umbilicus

58
Q

when are umbilical hernias repaired?

A

strangulation of contents, in adults

59
Q

what causes incisional hernias?

A

defect/weakness at the site of surgical repair

60
Q

contrast direct/indirect/femoral hernia location

A

direct: right through femoral ring, indirect: peritoneal lined sac, femoral: under inguinal ligament

61
Q

which inguinal hernia is more prone to strangulation?

A

femoral

62
Q

who typically develops inguinal hernias?

A

direct: middle aged and elderly men (smokers, obese, weak abdomen), indirect: anyone, femoral: more common in women

63
Q

which inguinal hernias originate above inguinal ligament?

A

direct/indirect

64
Q

which inguinal hernias involve the scrotum?

A

direct: rare, indirect: common

65
Q

where is the impulse location of the inguinal hernias?

A

direct: side of finger in inguinal canal, indirect: tip of finger in inguinal canal, femoral: not felt in canal

PE midterm (10 decks)

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