Abdomen

Question 1

Where is the dome of the diaphragm? (rib wise)

Answer 1

5th anterior intercostal space

Question 2

What are sx of acute cholecystitis?

Answer 2

RUQ pain, fever, nausea, vomiting, tenderness, palpable gallbladder

Question 3

What is a visceral pattern of abdominal pain?

Answer 3

gnawing, burning, cramping aching

distension of organ against capsule

Question 4

What is a parietal pattern of pain?

Answer 4

steady, aching, worse w/ movement

from inflammation of parietal peritoneum, often still, hurts to move

Question 5

What is a referred pattern of pain?

Answer 5

Seems to radiate

felt at same spinal level, duodenal/pancreatic radiates to the back

Question 6

What are sx of dyspepsia?

Answer 6

• chronic/recurrent central upper abdominal pain
• postprandial fullness, early satiety, epigastric burning
• bloating, nausea, heartburn

Question 7

What are sx of GERD?

Answer 7

heartburn + regurgitation > 1 week

• atypical respiratory sx
• pharyngeal sx

Question 8

What are alarm sx that you need to be concerned about?

Answer 8

• dysphagia
• odynophagia
• recurrent vomiting
• melena or bright red blood per rectum
• early satiety
• weight loss
• anemia
• palpable mass
• painless jaundice

Question 9

What will you likely hear in a small/large bowel obstruction?

Answer 9

distension and hyperactive bowel sounds

Question 10

What is a sign of mesenteric ischemia?

Answer 10

loss of lack of appetite, “food fear”

Question 11

What can cause diarrhea?

Answer 11

• medications
• inflammatory bowel conditions
• recent hospitalization (C. Diff)

Question 12

What can cause constipation?

Answer 12

• medications

- Pencil-like stools (sigmoid colon obstruction)

Question 13

What is melena?

Answer 13

• black/tarry stools
  could be due to upper GI bleed, ucler, varices, Mallory-Weiss tear, reflux esophigitis
• will have positive hemoccult

Question 14

What is hematochezia?

Answer 14

• bright red blood

due to: colon cancer, polyps, inflammatory conditions, hemorrhoids, anal fissure

Question 15

What is the order you need to follow when performing the abdominal PE?

Answer 15

• inspect
• auscultate
• palpate
• percuss

Question 16

What does increased, high ptiched, tinkling bowel sounds mean?

Answer 16

early obstruction, diarrhea

Question 17

What kind of bowel sounds will you hear in the ileus?

Answer 17

Hypoactive

Question 18

What type of bowel sounds will you hear in peritonitis?

Answer 18

Absent soudns

Question 19

What does tympany in the abdomen suggest?

Answer 19

gas

Question 20

What does dullness in the bowel suggest?

Answer 20

fluid/feces/solid organ/mass

Question 21

What do you suspect if a pt has CVA tenderness?

Answer 21

• Kidney problem

- pyelonephritis, nephorlithiasis, hydronepherosis

Question 22

Where do you expect to hear dullness and tympany in ascites?

Answer 22

dullness on the flank, tympany is central

Question 23

How do you test shifting dullness?

Answer 23

have the pt roll on one side and the tympany should shift to the top

Question 24

What is the problem with the fluid wave test?

Answer 24

It is not specific and can be positive without ascites and negative with ascites

Question 25

Where is McBurney’s point located?

Answer 25

1/3 between ASIS and umbilicus

Question 26

What is Rovsing sign?

Answer 26

pain in RLQ with LLQ palpation (rebound tenderness, quickly withdraw fingers)

Question 27

What is the psoas sign?

Answer 27

flexion/extension of leg at R hip causes pain

Question 28

What is the obturator sign?

Answer 28

R hypogastric pain w/ pt’s R knee bent and interanlly rotated

Question 29

What are the special tests for appendicitis?

Answer 29

McBurney’s point
Rovsin sign
Psoas sign
Obturator sign