Abdomen - Week 9 Flashcards
Your 27 y.o. female presents with a 36-hr h/o RLQ pain that migrates at times to the periumbilical region. Your DDx includes all the following except: (Bates, p. 457)
a. Diverticulosis
b. PID
c. Appendicitis
d. Ectopic pregnancy
*Identify symptom of each except the answer
A
Your 45 y.o. female patient comes in today noting several occasions of seeing bright, red blood on the surface of the toilet paper. The FNP is suspicious of: (Bates, p. 460)
a. Hemorrhoids
b. Colon CA
c. Upper GI bleed
d. Lower GI bleed
*What signs/symptoms might you see with each?
A
Colon CA - hematochezia
Upper GI bleed - melena
Lower GI bleed - >1,00mL blood
You are concerned that your patient has peritonitis based on all of these signs except: (Bates, p. 475)
a. Guarding
b. Rigidity
c. Protuberant abdomen that is tympanic throughout
d. Rebound tenderness
C
The USPSTF recommends colorectal screening beginning at age 40. (Bates, p. 469)
a. True b. False
B
You are concerned your patient may have acute appendicitis based on all findings except: (Bates, p. 486)
a. + Rovsing Sign
b. + Chandelier Sign
c. + Psoas Sign
d. + Obturator Sign
B
Your patient has a sharp increase in RUQ tenderness with inspiratory effort. This is known as: (Bates, p. 486)
a. McBurney’s sign
b. + Splenic Percussion Sign
c. Rigidity
d. + Murphy’s Sign
*Define/describe each
D
Parietal pain occurs when hollow abdominal organs contract unusually forcefully or are distended or stretched (Bates, p. 453)
a. True b. False
B
this is visceral pain
parietal pain - inflammation of the parietal peritoneum. aggravated by coughing or moving, patient’s prefer to lie still
referred pain - pain is felt at more distant sites which are innervated at approximately the same spinal levels as the disordered structures
Kidney pain is an example of what type of pain? (Bates, p. 463)
a. Visceral pain
b. Parietal pain
c. Referred pain
d. Functional pain
A
Your patient is in today c/o stool with red blood. You would describe this as: (Bates, p. 495)
a. Melena
b. Hematochezia
c. Acholic stools
d. Secretory stools
B
The classic initial area of pain in appendicitis begin in the _____. (Bates, p. 486)
a. RLQ
b. RUQ
c. Periumbilicus
d. Epigastrium
C
Localized tenderness anywhere in the RLQ, even the right flank, is suggestive of appendicitis. (Bates, p. 486)
a. True b. False
A
A +Rovsing sign is demonstrated with _____ . (Bates, p. 486)
a. RLQ pain on psoas muscle contraction
b. RLQ pain with obturator muscle contraction
c. RLQ pain with LLQ palpation
d. RLQ with periumbilical palpation
C
You place your hands just above your patient’s right knee & ask her to raise her thigh against your hand with resistance. This is known as ______ sign (Bates, p 486)
a. Obturator
b. Rovsing
c. Appendix
d. Psoas
D
All are considered abnormal abdominal sounds except: (Bates, p. 501)
a. Rushes of high-pitched sounds
b. Clicks & gurgles, up to 34/minute
c. Bruit
d. Friction rub
*Extra consideration: What condition(s) are the abnormal sounds associated with?
B
rushing of high pitched sounds coinciding with an abdominal cramp signal intestinal obstruction
hepatic bruits = liver CA or cirrhosis
arterial bruits = partial occlusion of aorta or larger arteries
bruits in epigastrium - suspicious for renal artery stenosis or reno vascular hypertension
friction rub - indicate inflammation of the peritoneal surface of an organ, as in liver CA, chlamydial or gonococcal perihepatitis, recent liver biopsy, or splenic infarct.
systolic bruit + hepatic friction rub = liver CA
Your patient has a h/o HTN. On exam, you auscultate bruits. You are suspicious of: (Bates, p. 472)
a. Renal artery stenosis
b. Hepatomegaly
c. Splenomegaly
d. Peritonitis
*Extra consideration: What assessment(s) would you use for the other conditions? What signs or symptoms might you see?
A
