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MBBS IV - Medical and Surgical Demonstration > Abdomen Examination - Medical and Surgical > Flashcards

Abdomen Examination - Medical and Surgical Flashcards

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USMLE® Step 1 flashcards
1
Q

5 stigmata of chronic liver disease on hands

A 
Leukonychia 
Palmar erythema 
Finger clubbing 
Flapping tremor 
Dupuytren's contracture
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2
Q

5 stigmata of chronic liver disease on hands

A 
Leukonychia 
Palmar erythema 
Finger clubbing 
Flapping tremor 
Dupuytren's contracture
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3
Q

2 stigmata of chronic liver disease on face, neck or upper chest

A 
Spider angioma (SVC drainage)
Telangiectasia
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4
Q

Name the condition and d/dx

  • Brown-to-black velvety
    elevations of epidermis
  • Due to confluent papillomas
  • Usually in axillae or neck
A

Acanthosis nigricans

  • GI carcinomas
  • GI lymphoma
  • Endocrinopathies (acromegaly,
    DM, others)
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5
Q

Name the condition and d/dx

  • Slate grey or brown-bronze
    pigmentation
  • Predominance for UV-exposed
    sites eg. face
A

Haemochromatosis

  • Hepatomegaly
  • Signs of chronic liver disease
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6
Q

Name the condition and d/dx

  • Thick skin with tense tethering
  • Calcinosis
  • Raynaud’s phenomenon
  • Sclerodactyly
  • Telangiectasia
A

Scleroderma

  • GERD
  • GI motility disorders
  • Small bowel bacterial overgrowth
    with malabsorption
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7
Q

Name the condition and d/dx

yellow discolouration of sclerae and skin

A

Jaundice: hyperbilirubinaemia

D/dx: prehepatic, hepatic, posthepatic

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8
Q

Name the condition

→ Greenish sclera
→ Xanthelasma
→ Xanthomas
→ Scratch marks

A

obstructive jaundice

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9
Q

Name the condition and d/dx

yellowish plaques in subcutaneous tissues in
periorbital region

A

Xanthelasmata: Indicates hypercholesterolaemia

May occur in cholestasis, esp primary biliary cirrhosis

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10
Q

Name the condition and d/dx

brownish-green rings at periphery of cornea

A

(Kayser-Fleischer rings): Indicates Wilson’s disease

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11
Q

Name the condition and d/dx

yellow keratinized areas on sclera

A

Bitot’s spot:

Indicates vitamin A deficiency

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12
Q

Name the condition and d/dx:

  • sickly sweet smell
  • fishy ammonia smell
  • Putrid smell
A 
- sickly sweet smell
Fetor hepaticus (severe hepatocellular disease) or Ketosis (diabetic ketoacidosis)
  • fishy ammonia smell: uraemia
  • Putrid smell: anaerobic chest infection
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13
Q

Name the condition and d/dx

dark brown discolouration on dorsal surface of tongue

A

Lingua nigra:
posterior extension of filiform papillae with keratin accumulation
→ Completely benign condition

D/dx: bismuth compounds

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14
Q

Name the condition and d/dx

white-coloured thickening of mucosa of tongue and mouth

A

Leukoplakia:premalignant condition

Causes: ‘5S’

  • Sore teeth (poor dental hygiene)
  • Smoking
  • Spirits
  • Sepsis
  • Syphilis
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15
Q

Name the condition and d/dx

smooth tongue surface ± erythema
shallow ulceration in later stages

A

Glossitis:

nutritional deficiencies, eg. Fe, B9, B12

  • Alcoholics (common)
  • Carcinoid syndrome
  • Elderly people
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16
Q

Name the condition and d/dx

Central arteriole from which radiate numerous small vessels
On chest

Confirmation?

A

Spider naevus (angioma)

Confirmed by pressing on central arteriole
→ Should result in blanching of whole lesion
→ Release → rapid refilling from centre to legs

D/dx
→ Normal variation
→ Cirrhosis (esp if ≥3 or new spider naevus formation)
→ Pregnancy (2nd to 5th month)
→ Hepatitis (may occur transiently in viral hepatitis)
→ Rheumatoid arthritis

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17
Q

Name the condition and d/dx

enlargement of male breasts

A

Gynaecomastia:

D/dx:
→ Healthy adolescence
→ Chronic liver disease
→ Alcoholism
→ Chronic starvation (↓gonadotropin and testosterone production)
→ Oestrogen-secreting testicular tumours
→ Drugs, eg. spironolactone, digoxin, cimetidine

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18
Q

Name the condition and d/dx

Cervical lymphadenopathy
L supraclavicular node ± other cervical nodes

A

□ D/dx: infections (esp TB), malignancies

□ Troisier’s sign: large Lt supraclavicular (Virchow’s) node + CA stomach

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19
Q

Name the condition and d/dx

Scratch marks on arms, legs
generalized marks over body

A

generalized pruritus

may indicate obstructive jaundice, primary biliary cholangitis

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20
Q

Name the condition and d/dx

reddening of palms of the hands, thenar/hypothenar eminence sparing the centre

A

Palmar erythema:

D/dx:
→ Chronic liver diseases
→ Pregnancy
→ Rheumatoid arthritis
→ Thyrotoxicosis
→ Polycythaemia
→ Chronic febrile illness
21
Q

Name the condition and d/dx

visible, palpable thickening and
contraction of palmar fascia causing permanent flexion contracture, affects 4th and 5th tendons of fingers

A

Dupuytren’s contracture:

Causes:
→ Normal, esp in manual workers
→ Cirrhosis, esp alcohol-related
→ DM
→ Systemic fibrosclerosing syndromes (IgG4 disease)

D/dx: G3/4 trigger finger

22
Q

2 leg signs seen in chronic liver disease

A

□ Ankle oedema → hypoalbuminaemia

□ Ankle pigmentation ± leg ulcers
→ Associated with hypersplenism

23
Q

4 abdominal signs seen in chronic liver disease

A

□ Hepatomegaly
□ Splenomegaly → portal hypertension
□ Ascites → portal hypertension
□ Caput medusa → portal hypertension

24
Q

D/dx for abdominal distension

A 
→ Fat: gross obesity
→ Fluid: ascites
→ Foetus: pregnancy
→ Flatus: gaseous distension due to bowel
obstruction
→ Faeces
→ Full-sized tumours
25
Q

Umbilicus:

  • Buried
  • Everted

D/dx?

A

□ Buried indicates obesity
(distension = subcutaneous fat)

□ Bulging/everted indicates ↑intra-abdominal
pressure
→ Ascites: bulging flanks with umbilicus everted or resembling horizontal slit
→ Pelvic mass: umbilicus pointing upwards

26
Q

Dilated veins at abdomen
2 types
D/dx?

A

Determine direction of flow at inferior
abdomen using two fingers
- Downward → portal hypertension
- Upward → IVC obstruction

Caput medusa:
engorged paraumbilical veins
→ Indicates portal hypertension

Dilated thoracoepigastric veins:
→ Indicates IVC obstruction

27
Q

Visible abdominal wall movement
D/dx?
Types of movement?

A

Asymmetrical movement → mass
Lack of movement → peritonitis
Epigastric pulsation due to AAA
Visible peristalsis→ Intestinal obstruction

28
Q

4 peritoneal signs

A

(guarding, rigidity, rebound tenderness, ↓bowel sounds)

29
Q

Define Murphy’s sign

A

RUQ tenderness ± peritoneal sign

30
Q

Increased liver span + nodular surface + hard consistency

D/dx?

A

HCC
Polycystic liver
metastatic cancer in liver

31
Q

Mild Hepatomegaly

D/dx?

A

Hepatitis

Biliary obstruction

32
Q

Moderate hepatomegaly

D/dx?

A

Hemochromatosis
Hematological disease
Amyloidosis

33
Q

Severe hepatomegaly

D/dx

A

Malignancy

Alcoholic liver disease, Fatty liver

34
Q

Hepatosplenomegaly

D/dx

A

Chronic liver disease
Haematological diseases
- Infiltrative, eg. amyloidosis
- Infections, eg. infectious mononucleosis, CMV

35
Q

Define Castel method for investigating splenomegaly

A

percuss at Castell’s spot (lowest Lt
ICS along AAL) with pt in full inspiration and expiration
→ Note becomes dull during inspiration if splenomegaly

36
Q

D/dx splenomegaly by size

A

□ Massive: CML, MF
□ Moderate: portal hypertension, haematological malignancy
□ Minimal: haemolytic anaemia (thal intermedia),
autoimmune cytopenia (ITP, AIHA)

37
Q

3 most common causes of splenomegaly

A

→ Haematological malignancy, eg. lymphoma,
leukaemia, MPN
→ Portal hypertension, eg. cirrhosis, splenic v.
obstruction
→ Haemolytic anaemia, eg. thal intermedia, HBH
disease, AIHA, hereditary spherocytosis

38
Q

Differentiating between spleen and Lt kidney?

A

Spleen is anterior to kidney
→ Bimanual (kidney)
vs anterior palpation (spleen)

→ Subcostal gap present for kidney
(kidneys enlarge anteriorly vs spleen enlarges along Gardner’s line)

→ Resonant (kidney) vs dull on percussion (spleen)

39
Q

Complete absence of bowel sounds over 4 mins

cause?

A

Paralytic ileus

40
Q

Bowel sound: louder, higher pitched with a tinkling quality

cause?

A

Bowel obstruction

41
Q

3 locations for auscultation in abdominal exam

A

Liver bruit over a palpable liver
→ HCC
→ Alcoholic hepatitis
→ Compression of aorta

Renal bruit 5cm above umbilicus (at transpyloric plane)
→ Renal artery stenosis

Aortic bruit between umbilicus and xiphisternum

42
Q

Sensitivity of shifting dullness?

A

Can be detected only if there is ≥1L of fluid

43
Q

D/dx palpable gallbladder with jaundice

A

With jaundice:

  • CA head of pancreas
  • CA ampulla of Vater
  • In-situ CBD stone
44
Q

D/dx palpable gallbladder without jaundice

A 
Without jaundice:
- Mucocele/empyema of gallbladder
- CA gallbladder (stony hard,
irregular swelling)
- Acute cholecystitis
45
Q

D/dx palpable kidney unilateral

A
  • Normal – Rt kidney, compensatory hypertrophy of single kidney
  • Vascular – acute renal vein thrombosis
  • Infection – pyelonephritis, renal abscess, pyonephrosis
  • Neoplasm – RCC
  • Congenital – polycystic kidney (with asymmetrical enlargement)
  • Hydronephrosis
46
Q

D/dx Bilateral palpable kidney?

A
  • Unilateral causes occurring bilaterally
  • Endocrine – diabetic nephropathy (common), acromegaly
  • Infiltrative – amyloid, lymphoma
47
Q

Pulsatile mass above or below umbilicus

D/dx?

A

Pulsatile mass below umbilicus > suspect iliac aneurysm

Pulsatile mass above umbilicus > suspect aortic aneurysm

48
Q

Define Courvoisier’s law

1 limitation

A

Differentiate Pancreatic cancer and gallstone obstruction

Gallstone obstruction > gall bladder becomes fibrotic and smaller

Pancreatic cancer mass compressing on bile duct > gall bladder enlarges

Limitation: recurrent progenitor cholangitis > the stones are formed intra-ductally, so the gallbladder can still enlarge

MBBS IV - Medical and Surgical Demonstration (17 decks)

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