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
An abdominal friction rub is association with all except: (Bates, p. 472)
a. Hepatoma
b. Gonococcal infection around the liver
c. Peritonitis
d. Splenic infarction
C
All of these can cause localized bulges in the abdominal wall except: (Bates, p. 499)
a. Diastasis recti
b. Lipoma
c. Ascites
d. Umbilical hernia
C
You are assessing a newborn. You know _______ is an abnormal abdominal finding. (Bates, p. 838)
a. Umbilical cord with 1 artery & 2 veins
b. Diastasis recti
c. An amniotic portion on the umbilicus cord
d. Pulsations in the epigastrium
A
a single umbilical artery may be associated with congenital anomalies or be an isolated anomaly
You can percuss an infant’s abdomen as you would an adult’s, but you may note greater tympanic sounds. (Bates, p. 839).
a. True b. False
A
You have Juan, a 4-week-old infant, in your office for routine assessment. While the caregiver is feeding Juan with his shirt off, you note visible peristaltic waves pass across the abdomen and then he has projective vomiting. You are most suspicious for: (Bates, p. 840)
a. Peritonitis
b. Pyloric stenosis
c. Intussusception
d. Biliary obstruction
*Describe signs/symptoms of each
B
All are associated with obstructive jaundice except: (Bates, p. 461)
a. Itchy skin
b. Acholic stools
c. Dark urine
d. Steatorrhea
D
Your elderly patient, Hazel, is in today & complaining of food “sticking” in her throat, reporting it “just doesn’t seem to go down right”. You would categorize this symptom as: (Bates, p. 458)
a. Dysphasia
b. Odynophagia
c. Dysphagia
d. Globus
*Define each term
C
dysphasia - difficulty with verbal communication
odynohagia - painful swallowing
dysphagia - difficulty swallowing
globus - a feeling of lump in throat
Your female patient presents today with complaints of acute onset epigastric pain that radiates to her back. The pain is steady. She has N/V, T: 101. Lying supine makes it worse & leaning forward helps. You are most suspicious of: (Bates, 488-489)
a. Acute appendicitis
b. Acute cholecystitis
c. Acute pancreatitis
d. Acute diverticulitis
*Describe signs & symptoms of each disorder
C - acute pancreatitis
acute appendicitis - poorly localized periumbilical pain aggravated by movement or cough
acute cholecystitis - RUQ pain or epigastrium, radiate to right shoulder or inter scapular area, aggravated by jarring/deep breathing
acute diverticulitis - LLQ pain
