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Physical Assessment 2 > Abdomen/Rectal/Prostate Exam > Flashcards

Abdomen/Rectal/Prostate Exam Flashcards

1
Q

Organs in the RUQ (6)

A 
liver 
GB 
Pylorus 
Duodenum 
Hepatic flexure of colon 
Head of pancreas
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2
Q

Organs in LUQ (5)

A 
Spleen 
Splenic flexure of colon 
stomach 
body and tail of pancreas 
transverse colon
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3
Q

Organs in LLQ (3)

A

Sigmoid colon
descending colon
left ovary

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4
Q

Organs in the RLQ (4)

A

Cecum
Appendix
Ascending colon
right ovary

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5
Q

are the GB and duodenum generally palpated?

A

no

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6
Q

abdominal aorta is usually palpable in which quadrant?

A

upper quadrants or EIPgastrum

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7
Q

spleen’s position to the stomach

A

later to and behind stomach

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8
Q

upper margin of spleen lies against?

A

diaphragm

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9
Q

a distended bladder may be palpable above the ?

A

symphysis pubis

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10
Q

cramping + colicky pain can suggest?

A

renal stones

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11
Q

sudden, knife like epigastric pain that radiates to the back suggests?

A

pancreatitis

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12
Q

visceral pain in the RUQ suggests?

A

liver distention against its capsule from the various causes of hepatitis,

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13
Q

list the DDs for epigastric pain (3)

A

GERD
Pancreatitis
Perf ulcers

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14
Q

List the DDs for RUQ pain (2)

A

cholecystitis

choleangitis

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15
Q

will asking about severity of pain helpful in IDing the cause?

A

not as helpful

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16
Q

Acute RLQ pain DDs? (3)

A

appendicitis
PID
Ectopic pregnancy

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17
Q

Acute LLQ pain DDs? (3)

A

Diverticulitis
bowel obstruction
peritonitis

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18
Q

List some Dz’s that cause chronic pain

A

IBS

Colon CA

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19
Q

intermittent pain, change in bowel habits and/or change in stool (pellet like) suggests?

A

IBS

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20
Q

Describe physical exam findings for IBS

A
  • intermittent pain,

- change in bowel habits and/or change in stool (pellet like)

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21
Q

change in bowel habits + mass lesion warns of?

A

colon CA

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22
Q

visceral pericumbilical pain suggests?

A

early acute appendicitis

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23
Q

visceral pericumbilical pain that later, pain moves to parietal pain in the RLQ suggests

A

appendicitis

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24
Q

pain disproportionate to PA findings suggests?

A

intestinal mesenteric ischemia

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25
Q

describe visceral pain

A

when hollow organs contract forcefully or distend/stretch
or
solid organs w/ capsule or liver

Difficult to localize:

  • gnawing
  • burning
  • aching
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26
Q

Described as difficult to localize pain

  • gnawing
  • burning
  • aching

which pain?

A

visceral pain

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27
Q

describe parietal pain

A

originates from inflammation of the parietal peritoneum
-easier to localize, pain is usually worse than visceral and worse with movement

steady, aching pain
aggravated by moving or coughing

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28
Q

PT trying to move around–attempting to find a comfortable position suggests?

A

renal stones with peritonitis

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29
Q

ischemia causes which kind of pain

A

visceral pain

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30
Q

descr referred pain

A

felt more in distal sites
caused by which nerve fibers are at the same level of the structures

usually localized

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31
Q

pain of duodenal or pancreatic origin can refer to what areas?

A

back
biliary tree
right scapular region
right posterior thorax

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32
Q

pain from pleurisy or inferior wall MI can refer to?

A

epigastric area

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33
Q

define dyspepsia

A

chronic or recurrent discomfort
or
PAIN in the upper abdomen, characterized by postprandial fullness, early satiety, epigastric pain/burning

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34
Q

Define discomfort

A

subjective
negative feeling that is not painful
-can include symps: bloating, nausea, upper abdominal fullness, heartburn

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35
Q

list two Dz where bloating can ocur

A

lactose intolerance
ovarian CA
aerophagia
IBS

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36
Q

sudden knife like epigasric pain often radiating to the back is typical of?

A

pancreatitis

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37
Q

define aerophagia

A

swallowing air– can lead to bloating

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38
Q

Functional Dyspepsia define

A

3 MO hx of non-specific upper GI discomfort or nausea not attributable to structural abnormalities or PUD

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39
Q

diagnostic criteria for GERD

A

patient reporting heartburn and regurgitation TOGETHER for over 1 week….. 90% likely its gerd

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40
Q

Heartburn define

A

rising retrosternal burning pain/discomfort occurring weekly or more

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41
Q

heartburn can be a sign of?

A

Myocardial ischemia

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42
Q

non-GI signs
hoarseness
coughing
wheezing

A

GERD

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43
Q

dysphagia define

A

difficulty swallowing from impaired passage of solid foods or liquids from mouth to stomach

“i feel that food is getting stuck when i swallow”

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44
Q

dysphagia to solid food– list DZs

A

structural causes like stricture, webbing or neoplasm

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45
Q

Dysphagia to liquids list causes

A

motility disorder such as achalasia

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46
Q

Define globus sensation

A

FB/lump sensation in throat

unrelated to swallowing

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47
Q

Define odynophagia and list causes

A

pain with swallowing

causes: esophageal ulceration

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48
Q

list alarming symptoms that can present with odynophagia

A

wt loss
GI bleeding
palpable mass

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49
Q

difference b/w retching and vomiting

A

retching: involuntary spasm of stomach, dia and esophagus that LEADS to vomiting
vomiting: forceful expulsion of gastric contents out of the mouth

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50
Q

regurgitation define

A

raise of esophageal/gastric conents w/o nausea/retching

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51
Q

hematemesis define

*causes

A

coffee ground emesis or red blood

causes: esophageal/gastric varices, Mallory-Weise tears or PUD

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52
Q

anorexia define

A

loss of appetite

  • fear of abdominal discomfort “food fear”
  • self-image/body distortions or appendicitis
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53
Q

timing for acute diarrhea

A

can last up to 2 weeks

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54
Q

timing for chronic diarrhea

*causes

A

4 weeks or longer

*non-infectious like CD or UC

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55
Q

high volume and frequent watery stools likely coming from what part of colon

A

small intestine

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56
Q

steatorrhea

causes

A

fatty diarrheal stools from malabsoprtion

  • oily residue + frothy + floating
  • celiacl sprue, pancreatic insufficiency
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57
Q

tenesmus define

A

constant urge to defecate accompanied by pain, cramping, and involuntary straining

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58
Q

small volume stools + tenesmus =?

A

rectcal inflammatory conditions

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59
Q

pus/mucous/blood in stool occur in?

A

rectal inflammatory conditions

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60
Q

causes of tenesmus

A

recent use of ABX
recent hospitalization
recent travel
new diet

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61
Q

timing for constipation

A

3 months
with symptoms onset at least 6 months prior to diagnosis PLUS 2 of the following:
1. fewer than 3 BM/week
2. 25% or more BM associated with straining/sensation of incomplete evacuation/hard stool
3. manual facilitation

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62
Q

melena vs hematochezia

A

melena–upper GI bleed, black and tarry

hematochezia–lower GI bleed (rectal, colon anus), bright red stool

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63
Q

blood on surface or toilet paper points to

A

hemorrhoids

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64
Q

primary vs secondary contipation

A

primary: normal transit, slow transit, impaired expulsion
secondary: pregnancy, adv age, medications, underlying med condition

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65
Q

define obstipation

A

no passage of either feces or gas

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66
Q

cause of obstipation

A

intestinal obstruction

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67
Q

jaundice can signify issues with what organs

A

liver
GB
pancreas

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68
Q

acholic stool
MC w/?
other causes

A

stool without bile–>gray, light colored stoools
MC in obstrcutive jaundice

causes: ETOH, hep A, Hep B, Hep C, liver damage secondary to medications

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69
Q

what are caput medusae and what is the cause

A

dilated veins

*from portal HTN from cirrhosis

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70
Q

asymmetry on exam can suggest

A

hernia
enlarged organ
mass

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71
Q

do you asucultate before or after percuss/palpate

A

AUSCULTATE BEFORE

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72
Q

vascular sounds like heart murmur

A

bruits

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73
Q

grating sound corresponding to respirations

A

friction rub

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74
Q

continuous soft humming noise

A

venous hum

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75
Q

incr bowel sounds suggest

A

diarrhea

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76
Q

decr bowel sounds suggest

A

ileus

peritonitis

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77
Q

bruit in epigastric/renal artery suggests?

A

htn caused by renal artery stenosis

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78
Q

friction rubs are present in?

A

Hepatoma
Gonococcal infection around liver
splenic infarction
pancreatic CA

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79
Q

venous hum is heard in PTs with?

A

hepatic cirrhosis

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80
Q

tympany vs dull

A

tympany: hollow drum sound—AIR FILLED (GI tract, gas

Dull: heard over solid structures, or if fluid is beneath

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81
Q

what is castell’s sign

A

splenic percussion sign—lowest interspace on the left anterior axillary line
**should be tympanic

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82
Q

is castell’s sign tympanic or dull

A

tympanic

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83
Q

why do we palpate abdomen

A

to check for tenderness, guarding or masses

84
Q

guarding can decrease if patient inhales or exhales

A

exhales—– bc the muscles are relaxed

85
Q

signs of peritonitits– (4)

A
  1. coughing causes pain
  2. guarding
  3. rigidity
  4. rebound tenderness
86
Q

with rebound tenderness, what hurts more.. pushing down or letting go?

A

letting go

87
Q

define guarding

A

VOLNTARY contractions of abdominal wall

88
Q

define rigidity

A

INVOL contraction of abdominal wall that persists over a few exams

89
Q

why does liver go down when PT takes a deep breath

A

bc liver is attached to the underside of dia—

90
Q

STEPS TO PALPATE LIVER:

  1. place ___(R/L) hand ____ (above/below) patient and press ____ (down/upward)
  2. ___(R/L) hand on abdomen ___(below/above) border of ____(dullness/tympany)
  3. gently push ___ (up/down) and in with the ___(R/L) hand as patient takes deep breath (in/out)
A
  1. place left hand under patient (11th and 12th rib) and press upward
  2. Right hand on abdomen below lower border of dullness
  3. gently push up and in with the right hand as patients takes a deep breath in
91
Q

when do we use the hooking technique?

A

to palpate the liver in obese PT

92
Q

at what age do we palpate the aorta

A

> 50

93
Q

normal width of aorta

A

no more than 3 cm wide

94
Q

list the special techniques

A

CVA tenderness
Test for ascites
Appendicitis test
Cholecystitis test

95
Q

+CVA tenderness?

A

pylonephritis

96
Q

testing for ascites– what will a + exam result look like

A

WILL BE a shift in dullness (move to dependent side) and tympany shifts to top

97
Q

McBurney Point

A

junction of the middle and outer thirds of the line joining the umbilicus to the anterior superior illiac spine

98
Q

Appendicitis is __times more likely when what is tender?

A

there is McBurney point tenderness

99
Q

List the appendicitis tests

A

ROvsing sign
Psoas sign
Obturator sign

100
Q

Rovsing sign

A

worsening RLQ pain with palpation to LLQ
AND
can check if referred rebound tenderness in the LLQ

101
Q

Psoas Sign

A

worsening abdominal pain with right left extension at hip when patient is lying on their side
OR
place hand above the PT’s right knee, ask PT to raise thigh against hand
PAIN= + test

102
Q

Obturator sign

A

RLQ pain on internal rotation of flexed right hip

  • lower leg swings outward
  • ***not as reliable
103
Q

test for cholecytitis?

A

Murphy test

104
Q

typical patient demographic for cholecystitis

A

Fat
Female
Forty
Fertile

105
Q

non-tender RUQ pain perform what test

A

murphy test to chest GB

106
Q

how to perform Murphy test

A
  • deeply palpate the RUQ at location of pain
  • ask PT to take deep breath in (forces GB and liver down toward fingers)
  • sharp halting in inspiratory effort due to pain from palpation of the GB on exam—-POSITIVE MURPHY SIGN
107
Q

+ murphy sign _____ likelihood of ____

A

triples likelihood for acute cholecystitis

108
Q

prostate gland location

A

anterior rectal wall
below bladder
infront of rectum

109
Q

normal length of prostate

A

2.5 cm

110
Q

pencil thin stools?

A

colon CA

111
Q

pain on defication, itching, bleeding/discharge from infection or rectcal abscess suggests?

A

proctitis

112
Q

rectal intching in peds suggest?

A

pinworms

113
Q

difficulty starting/stopping urine stream
and/or
frequency at night

A

benign prostate hypertrophy (BPH)
or
prostate CA
ESP >70 male

114
Q

men: sudden onset of UTI symptoms with perineal and low back pain, malaise and fever chills

A

acute prostatitis

115
Q

when is the DRE performed?

A
  • when dz is suspected or already IDed

* screening when there is no suspicion or expectation of DZ

116
Q

patient positioning for rectal exam

A

PT laying on L side with knee/hip flexed

*ask PT to beardown and then insert as the sphincter relaxes

117
Q

tender purulent reddened mass with fever

A

anal abscess

118
Q

abscesses that funnel from anus/rectum to surface of skin may form?

A

fistula

119
Q

ooze blood, pus or feculent mucus can suggest?

A

fistula

120
Q

laxity in sphincter tone could suggest?

A

neurologic dz (S2-S4 cord lesions)

121
Q

normal prostate feels?

A

rubbery and non-tender

122
Q

rotate fingers in what direction (towards PTs __ side) and then in what direction after?

A

FIRST rotate clockwise (PTs right) and then counterclockqise (to their left)

123
Q

small tuft of hair surrounded by halo of erythema ?

A

Pilonidal cyst

124
Q

list some abnormalities of rectum

A

external hemorrhoid
internal hem
prolapse of rectum

125
Q

Abdomen is protuberant with active bowel sounds. It is soft and nontender; no palpable masses or hepatosplenomegaly. Liver span is 7 cm in the right midclavicular line; edge is smooth and palpable 1 cm below the right costal margin. Spleen and kidneys not felt. No costovertebral angle (CVA) tenderness.”

**what is this?

A

normal

126
Q

Abdomen is flat. No bowel sounds heard. It is firm and board like, with increased tenderness, guarding, and rebound in the right mid-quadrant. Liver percusses to 7 cm in the midclavicular line; edge not felt. Spleen and kidneys not felt. No palpable masses. No CVA tenderness

**what is this suggestive of?

A

appendicitis poss peritonitis

127
Q

No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Prostate smooth and nontender with palpable median sulcus. (Or if female, uterine cervix nontender.) Stool brown; no fecal blood

*what is this?

A

normal

128
Q

Perirectal area inflamed; no ulcerations, warts, or discharge. Unable to examine external sphincter, rectal vault, or prostate because of spasm of external sphincter and marked inflammation and tenderness of anal canal

A

prostitis

129
Q

No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Left lateral prostate lobe with 1 × 1 cm firm, hard nodule; right lateral lobe smooth; median sulcus obscured. Stool brown; no fecal blood

A

prostate CA

130
Q

how is hep a transmitted

A 
fecal-oral 
poor handwashing 
international travel 
sick contacts 
MSM 
homelessness 
illicit drug use 
shellfish
131
Q

how is hep c transmitted

A

percutaneous exposures–needle sticks, IV drug users, blood transfusions b4 1992

132
Q

how is hep B transmitted

A

sexual contacts, percutaneous, parenteral and perinatal

133
Q

how to reduce tranmission for hep A

A

advice hand washing

clean surfaces with diluted bleach

134
Q

when does CDC reccommend Hep A vaccination? (7)

A

> 1
indv with chronic liver disease
groups at incrs risk–travelers, MSM, IV drug users, ppl who work with non human primates, ppl with clotting disorder

135
Q

a healthy PT is exposed to Hep A.. what is the next step

A
  1. Hep A vaccine
    OR
  2. single dose of immune globulin (>40) within 2 weeks of exposure
136
Q

Immunocomp PT or Chronic liver Dz PT exposed to Hep A.. what to do next

A

HAV AND HAV immunoglobulin within 2 weeks of exposure

137
Q

who is at risk for getting Hep B (6)

A
  • born in countries with high endemic HBV infections
  • person with HIV
  • IV drug user
  • MSM
  • household contacts or sexual partners have HBV
  • any kind of HC worker
138
Q

which PT population ALWAYS gets Hep B screening

A

Pregnant–first tri

139
Q

CDC reccomendations for Hep B vaccination (5)

A
  1. having sex with someone who has HBV, or person with many sexual partners
  2. ppl with percutanoues or mucosal exposure to blood
  3. travelers to endemic regions
  4. chornic liver dz
  5. HIV, correctional facilities,
140
Q

Hep B scheduling for babies

A

birth
1-2 MO
6-18MO

141
Q

Hep B scheduling for an adult w.o prior Hep B vaccine

A

3 doses total: 0, 1, 6 MO

142
Q

Hep C becomes chronic illness in ___% of patients

A

75%

143
Q

is there a vaccine for Hep C?

A

NO

144
Q

prevention against Hep C?

A

avoic percutaneous exposures, blood exposures

145
Q

who screening for Hep C?

A

high risk groups
all pregnant women (1st tri)
screen all adults 18-79 for chronic HCV infection

146
Q

major RF for Hep C (3)

A

cirrhosis
hepatic CA
liver failure

147
Q

RLQ pain or pain that migrates from the periumbilical region + abdominal wall rigidity on palpation
MC suggests?
-what also could it be suggestive of in a woman PT

A

appendicitis

WOMAN: PID, ruptured ovarian cyst, ectopic preg

148
Q

cramping pain radiating to the right or LLQ or groin

A

renal stone

149
Q

LLQ pain

+palpable mass

A

diverticulitis

150
Q

diffuse abdominal pain with abdominal distention, hyperactive high pitched bowel sounds and tenderness on palpation

A

small or large bowel obstruction

151
Q

pain with absent bowel sounds, rigidity, percussion tenderness and guarding

A

peritonitis

152
Q 
intermittent pain for 12 weeks
with relief from defecation 
change in frequency of BMs 
or 
change in form of stool (loose, watery, pellet)
A

IBS

153
Q

Regurgitation occurs with? (3)

A

GERD
esophageal stricture
esophageal CA

154
Q

vomiting + pain can indicate?

A

SBO

155
Q

fecal odor occurs with?

A

SBO and gastrocolic fistula

156
Q

Hematemesis can occur with (3)

A

esophageal or gastric varices, Mallory-Weiss tears or PUD

157
Q

abdominal pain, slight distended soft nontender abdomen and a fear of eating food bc it will hurt?

A

hallmark of mesenteric ischemia

158
Q

fullness or early satiety (5)

A 
diabetic gastroparesis
antichoinergic meds 
gastric outlet obstruction 
gastric CA 
hepatits
159
Q

drooling, nasopharyngeal regurgitation, cough from aspiration are indicators of?

A

oropharyngeal dysphagia

160
Q

gurgling or regurgitation of undisgested food occurs in? (3)

A

GERD
motility disrodres
structural disroders (Zenkers diverticulum and esoph stricture)

161
Q

PT points to where dysphagia occurs: below the sternoclavicular notch suggets?

A

Esophageal dysphagia

162
Q

if solid food dysphagia consider?

A

structural causes: esoph stricutre, webing or Schatzki ring, neoplasm

163
Q

if dysphagia to solid and liquid consider?

A

motility disorder like achalasia

164
Q

flatus
causes?
define?

A

excessive gas

  • aerophagia
  • legumes
  • intestinal lactase deficiency
  • IBS
165
Q

acute diarrhea MCC?

A

infectious

166
Q

high volume, frequent and watery stools are coming from where in the colon?

A

small intestine

167
Q

small volume stools with tenesmus
or
diarrhea with mucus pus or blood occur in?

A

rectal inflammatory conditions

168
Q

diarrhea is comon with which drugs (4)

A

PNCs
macrolides
magnesium antacids
metformin

169
Q

patient recently hospitalized + diarrhea.. consider what?

A

C Diff

170
Q

list secondary caues of constipation (3)

A

amyloidosis
DM
CNS disorders

171
Q

drugs tht cause constipation (4)

dz that cause it? (6)

A

anticholinergics
ccb
iron
opiates

dm 
hypothyroidism 
hypercalciemia 
MS
PD
systemic sclerosis
172
Q

ostipation signifies?

A

obstruction

173
Q

drugs that cause cholestasis (3)

A

OCPs
methyl testosterone
chlorpromazine

174
Q

dark urine indicates?

A

impaired excretion of bilirubin into the GI tract

175
Q

painless jaundice

A

malignant obstruction of bile ducts

176
Q

painful jaundice

A

infectious in origin–hepatitis A and cholangitis

177
Q

acholic stools

A

viral hep

obstrucitve jaundice***

178
Q

pink tinged urine

A

myoglobin from rhabdo

179
Q

protuberant abdomen that is tympanic thorughout suggests?

A

intestinal obstruction or paralytic ilius

180
Q

dull areas on abdomen characterize?

A

pregnant uterus
ovarian tumor
distended bladder
large liver or spleen

181
Q

dullness in both flanks suggests

A

ascities

182
Q

air bubble on the right… liver dullness on left suggests?

A

sinus inversus

183
Q

liver dullness is displaced downward by the low diaphragm if PT has what dz

A

COPD

*span stays normal

184
Q

what can falsely increase liver size

A

dullness from a right pleural eff or consolidated lung if adjacent to the liver

185
Q

what is a positive splenic percussion sign

A

change in percussion note from tympany to dullness on inspiration

186
Q

causes of splenomegaly

A

portal HTN
hematologic malignancies
HIV
infiltrative dz–amyloidosis, splenic infarct or hematoma

187
Q

enlarged left flank mass can be?

A

splenomegaly or an enlarged left kidney

188
Q

palpating spleen area: palpable notch on medial border, the edge extends beyond the midline, percussion is dull and fingers can probe deep to the medial and lateral borders but not between the left flank mass and costal margin

A

splenomegaly

189
Q

tympany in the LUQ + probe fingers b/w the mass and costal margin suggest

A

enlarged kidney

190
Q

RF for AAA

A

> 65
smoking
male
first degree relative with hx of AAA

191
Q

RUQ pain

-sharp increase in tenderness with inspiratory effort is a + ______ sign?

A

+ murphys sign

192
Q

timing of GERD?
agrivating factors?
location of discomfrt

A

after meals esp spicy food
-lying down, bending over, exercise,
chest or epigastric

193
Q

pain is whre for PUD

+radiation to?

A

epigastric

can radiatie to the baack

194
Q

which ulcer is more likely to wake the PT in the night?

A

duodenal ulcer

195
Q

which ulcer is more liley to occur intermittently over a few weeks and then disappers for months and then reappears

A

duodenal

196
Q

persistent abdominal pain–slowly progressive–

A

Gastric carcinoma

197
Q

pain in gastric carcinoma or PUD is shorter

A

gastric carcinoma

198
Q

if pain subsides temporarily with acute appendiits.. what do you want to suspect?

A

perforation

199
Q

where is the pain for small bowel obstruction vs large bowel obstruc

A

SBOO: periumbilical or upper abdom
LBO: lower abdmoinal or generlzed

200
Q

time for acute diarrhea

A

<14 days

201
Q

chronic diarrhea time

A

> 30 days

202
Q

dz that cause melena (3)

A

BLACK TARRY STOOL

  • GERD
  • gastritis
  • PUD
203
Q

dz that cause hematochezia

A

BRIGHT RED BLOOD

  • colon CA
  • hyperplasia or adenomatous polyps
  • diverticula of colon
  • UC
  • CD
  • infectious diarr
  • proctitis
  • ischemic colitits
  • hemorrhoids
  • anal fissure
204
Q

MCC of protuberant abdomen

A

fat

205
Q

bulging flanks?

A

ascities

206
Q

venous hum has both?

A

diastolic and systolic components

207
Q

venous hum indicates

A

hepatic cirrhosis

Physical Assessment 2 (6 decks)

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