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NBCE Part 4 > Abdomin Exam > Flashcards

Abdomin Exam Flashcards

1
Q

Distention of the Upper abdomin: Which organs could be affected?

A

Stomach, Liver, GB, Spleen

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2
Q

Distention of the Lower abdomin: Possible diagnosis

A

Bladder, Hernia, Prego

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3
Q

Distention of both lower and upper abdomin is what pathology?

A

Ascities

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4
Q

Purple Striae in the abdomin could indicate?

A

Cushing’s OR Adrenal tumor that produces cortisol

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5
Q

Describe INC/DEC in peristalsis in both early and late bowel obstruction?

A 
INC = Early Obstruction
DEC = Late Obstruction
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6
Q

Pulsations in the abdomin could indicate

A

Abdominal aneurysm

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7
Q

Diastasis Recti (What is it and would you treat?)

A

It is a separation of the abdominal muscles towards the lateral sides caused by heavy lifting/Prego.
Not significant.

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8
Q

Grey Turner’s sign (Located where and what doe sit indicate?)

A 
Blood in Flanks
Indicates Pancreatitis (Rupture has already occurred)
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9
Q

Caput Medusa indicate?

A

Portal Hypertension

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10
Q

Definition of Borborygmi

A

Rumbling sounds heard in abdomin. Bowel sounds.

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11
Q

Tympani indicates?

A

Air

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12
Q

Dullness indicates?

A

Fluid

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13
Q

Liver size parasternal and midclavicular?

A 
Parasternal = 4-8cm
Midclavicular = 6-12cm
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14
Q

Dullness over the spleen indicates?

A

Normal spleen unless enlarged.

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15
Q

How do you palpate the liver?

A

Start at zyphoid and go around coastal margin to posterior axillary line

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16
Q

How do you palpate the KD?

A

Entrapment – Dr Beings pressing medially and with each breath out the dr moves lateral wo bunny hopping. Dr does this over 3 breaths. The other hand is placed underneath the PT. Dr always observes PTs face for pain.

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17
Q

How do you palpate the spleen?

A

Start at Anterior axillary line. Pull w left hand and push with right hand.

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18
Q

Name 3 tests and describe how they are performed for Ascities

A

Shifting dullness = Percuss horizontally across abdomen. If tympany changes to dullness over the center of the abdomen it could indicate air bubble. Have PT side-lying and repeat test. If there is no change in the location of the air then it is most likely gas trapped in the bowel and not from ascities. If it changes location it indicates ascities.
Fluid Wave = PT supine. Dr taps each side of the abdomen and observes for fluid wave indicating ascities.
Puddle Sign =

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19
Q

Name 3 tests and describe how they are performed for Ascities? Which sign is the most sensitive?

A

Shifting dullness = Percuss horizontally across abdomen. If tympany changes to dullness over the center of the abdomen it could indicate air bubble. Have PT side-lying and repeat test. If there is no change in the location of the air then it is most likely gas trapped in the bowel and not from ascities. If it changes location it indicates ascities.
Fluid Wave = PT supine. Dr taps each side of the abdomen and observes for fluid wave indicating ascities.
Puddle Sign = PT standing. Place Stethescope midline above umbilicus. Have PT forward flex. Percuss a few times to each side of the scope.
Puddle sign is the most sensitive test for Ascities.

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20
Q

Which condition is Blumberg’s Test used for and describe the test?

A

Blumberg’s Rebound tenderness for GB.

Palpate each of the 4 quadrants by pressing in slowly and releasing quickly. Go deep.

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21
Q

Describe how to perform Obturator and Psoas sign tests for GB

A

Psoas sign = PT side-lying. Hold PTs leg near knee and extend femur while bracing Hip w other hand. Pain near the GB indicates GB as pain generator bec psoas will irritate the GB.
Obturator sign = PT supine. Flex thigh to 90. To externally rot femur int rot leg.

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22
Q

What is the #1 cause of chest pain

A

Heart Burn

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23
Q

Hiatal hernia cause?

A

Weak Diaphragm

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24
Q

What is Achalasia? What disease causes it?

A

Distal narrowing of the Esophagus.

Cause = Scleroderma

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25
Q

Gastric Vs Duodenal ulcers (Course of pain after eating?)

A

Duodenal pain 2hrs after eating

Gastric pain during meal otherwise unpredictable.

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26
Q

Gastric Vs Duodenal ulcers (Course of pain after eating?)

A

Duodenal pain 2hrs after eating
Gastric pain during meal (Could also be cancer so ask if pain unrelieved by position or medication) otherwise unpredictable.

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27
Q

Cause of Acute Gastritis?

A

Allergies/Sensitivities

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28
Q

Name one thing to be concerned about in chronic gastritis?

A

B12 deficiency

Low B12 -> Pernicious anemia -> PLS

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29
Q

Gastric Cancer causes which lymh node to become enlarged?

A

Left Virchow

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30
Q

Diseases ass w head of pancreas

A

Pancreatitis, Cancer

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31
Q

Pancreatitis Acute Vs Chronic SS

A 
Acute = Fever, Ridgid Abdomin, Labs
Chronic = Quiet, Normal Labs
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32
Q

SS of Pancreas Cancer (Head of pancreas)

A

Weight loss, jaundice, Pain at T10 straight through and knife like, Bruised flanks, Steatorrhea, Hx of drinking and smoking

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33
Q

If PT has Pain at T10 straight through and knife like think? But ask?

A

Pancreas; Do you have a Hx of drinking or smoking?

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34
Q

Cullen’s Sign (Which Tests to order?)

A

CBC, CT, Amylase, Lipase

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35
Q

Diseases ass w tail of pancreas

A

DM1, DM2, Gestational DM

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36
Q

DM1 and 2 differences (General: Ages, body morphology, Tx)

A 
DM1 = <35yo, thin, INSULIN DEPENDENT
DM2 = ?35yo, obese, Diet controled
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37
Q

SS of DM1 or DM2

A

3Ps: Polydypsia, polyuria, polyphagia

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38
Q

GB (Tests?)

A

CBC w/ Diff, Bilirubin, UA, Cholecystogram, US cystography

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39
Q

Name 2 conditions ass w Gallbladder

A

Cholecystitis (AKA Cholangitis) = infection

Cholelithiasis = Stones

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40
Q

Cholelithiasis and Cholangitis Tx

A

Adjust T5, Diet

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41
Q

Pt has pain in inferior right scapula. What GI organ should you be concerned about?

A

GB

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42
Q

Name 3/5 diseases ass w spleen

A 
Cancer
Leukemia -- Spleen must handle excessive WBC
Hodgkin's -- Splenic Enlargement
Mono -- Splenic Enlargement
Rupture -- From Truama
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43
Q

SS of Spleen disorder

A

Anemia, Frequent infections, Fatigue, Chronic illness

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44
Q

Spleen (Tests)

A

CBC, US, Biopsy (Cancer), CT)

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45
Q

What is the function of the Spleen?

A

Destroy old RBCs, make, store and remove WBCs

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46
Q

Which 4 organs are WBCs made

A

Thymus (T Lymphocyte maturation), Spleen and Lymph nodes (T and B Lympho), Marrow

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47
Q

MC Cause of Hepatitis?

A

Viral

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48
Q

Labs for Viral Hepatits

A

DEC Leukocytes

INC Lymphocytes

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49
Q

Lymphocytes Vs Leukocytes

A

Lymphocytes are a type of Leukocyte with 3 major types: NK cells, T-cells (Thymus cells) and B-cells (Bone cells).
*Leukocytes refer to ALL WBC types.

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50
Q

Hep A

A

Oral; Scratch by butt eat my cookies

51
Q

Viral Hepatitis: Which Ig will be high in Acute Vs Chronic hepatitis?

A

IgM is Acute

IgG is chronic

52
Q

Acute Vs Chronic hepatitis tenderness?

A

Acute the liver is tender. Chronic = NO tenderness

53
Q

Alcoholism causes which 3 liver conditions?

A

Cirrhosis and cancer

54
Q

SS of alcoholic liver?

A

Jaundice, RUQ tenderness, right shoulder pain, varicosities

55
Q

SS of alcoholic liver?

A

Jaundice, RUQ tenderness, right shoulder pain, varicosities (Portal (Liver) and splenic Veins)

56
Q

Palpation for Cirrhosis and Cancer of liver reveals?

A 
Cirrhosis = Nontender, hard and symmetrical enlargement
Cancer = Non-tender, hard and lumpy, not symmetrical
57
Q

Labs for for Cirrhosis and Cancer of liver reveals?

A 
Cancer = Labs variable
Cirrhosis = INC GGT
58
Q

SGOT is?

A

1 of the 2 aminotransferases (SPGT and SPGT).

AST; Aspartate transaminase

59
Q

SPGT is?

A

1 of the 2 aminotransferases (SPGT and SPGT).
ALT; Alanine transaminase
High after heart, pancreatitis, KD, or liver dx

60
Q

GGT is?

A

Gamma-glutamyltransferase
Is a transport molecule that helps body in detox
High in liver cell or bile duct cell damage– when these cells rupture they release GGT.

61
Q

ALP is?

A

Alkaline Phos

62
Q

Hep A and C Labs values for SPGT and SGOT?

A

Hep A: Very High SPGT and SGOT
Hep C: Mild elevated SPGT and SGOT
*Note: The levels of SPGT and SGOT do not correlate with the exact amount of liver damage. EX: Hep A PTs typically fully recover and Hep C PTs have extensive liver damage

63
Q

Bilirubin: Direct abnormal (Organs affected and then SS)

A

Conjugated; Soluble; Post-hepatic: Liver, GB, Pancreas

SS Jaundice, Pale feces, yellow urine

64
Q

Bilirubin: Indirect abnormal (Organs affected and then SS)

A

Unconjugated; Insoluble; Pre-hepatic: Liver, spleen, blood, rx
SS Jaundice, green urine

65
Q

Name 3/5 spleen diseases

A 
Cancer
Leukemia - Spleen makes excessive WBC
Hodgkins - Spleen enlarged
Mono - Spleen enlarged
Rupture - trauma
66
Q

Name a few SS of spleen diseases?

A

Anemia
Frequent infections
Fatigue
Chronic Illness

67
Q

What is Coomb’s test for?

A

Tests for Antibodies to RBCs (IE Anti-globulin test); 2 Types: Direct and indirect
Indirect tests for blood transfusion compatibility. Done before transfusion. Tests blood SERUM.
Direct tests for autoimmune-hemolytic anemia
Tests RBCs and not serum.

68
Q

Name a few Hemolytic diseases

A
  1. Hereditary Spherocytosis
  2. Hereditary Elliptocytosis
  3. Sickle Cell
  4. G6PD deficiency
  5. Pyruvate kinase deficiency
Autoimmune-hemolytic anemia (IgG attached to RBC which causes the problem):
SLE
RA
IBD
Leukemia
Infectious (IgM agglutination)
69
Q

KD Diseases: Name 3 types:

A

Nephritic KD/Nephritis – Infection
Stones
Nephrotic – Death

70
Q

Name 6 tests for KD (Includes Labs)

A 
IVP - Intravenous pyelogram
Helical CT
UA
Creatinine Clearence
Cystometric
US
71
Q

WHich has RBC casts: Nephritic or Nephrotic disease?

A

Nephritic

72
Q

WHich has RBC casts: Nephritic or Nephrotic disease?

A

Nephritic

73
Q

Nephrotic Syndrome = KD death.

Name 3 SS?

A

HTN
Edema (Lots)
Proteinuria (Positive UA)

*Mnemonic is “HEP HEP HEP Me”

74
Q

Toxemia of Prego will cause: Nephritic or Nephrotic disease?

A

Nephrotic bec KD will get smashed and will result in death of the KD
“Not only eating for 2 but peeing for 2” – Extra stress on KD

75
Q

DID you know that Strep throat first infects the throat Then the KD!, Lastly the heart valves

A

If PT has Fever and LBP ask about “Have you had a sore throat in the last 2 weeks”. Its not the first thing you think when a PT has LBP but fever and LBP could be a strep infection inside the KD!

76
Q

Strep infection: Nephritic or Nephrotic disease?

A

Nephritic

77
Q

Nephritic disease. Name a SS?

A

Fever
Proteinuria (Not always)
Strep MC cause (Dentist or Infection)
RBC Casts

78
Q

Name a few labs for diagnosis of Glomerular nephritis?

A

ASLO = Anti-streptolysin
ANCA = Anti-neutrophil cytoplasmic antibodies – Tests for IgG
Anti-GBM = Glomerular basement mem – Remember thinning of the basement membrane is what occur sin this dx
Complement levels
Anti-nuclear antibodies – Tests for Autoimmune Antibodies

79
Q

Medical name for Bladder infection?

A

Cystitis

80
Q

KD Cancer: Name 2 SS

A

PainLESS bleeding, unexplained weight loss

81
Q

KD Stones: Name 3 SS

A

Painful bleeding
Colicky pain – no position of relief
Writhing Pain = PT cant stop moving or trying to find a position of relief
PT hurts everywhere

82
Q

KD Stones: Age and Gender

A

Male; 20s

83
Q

MC Type of KD stones?

A

Oxalic Acid

84
Q

Stones Tx:

A

INC Fluid
DEC VIT C
DEC Calcium
DEC Green Vegi

85
Q

Cystitis MC bacteria?

A

E-Coli

86
Q

Cystitis: Age and Gender

A

Younger Female

Older Male esp w prostate problems

87
Q

Cystitis Name 2 SS

A

Urinary Urgency

Burning

88
Q

SI VS LI issue: Endoscopy or Colonoscopy

A

LI = Colonoscopy

89
Q

Colon Cancer SS

A

Painless Bleeding

90
Q

TX for all Colon issues?

A

Fiber

91
Q

Crohns Disease marked by lesions where?

A

Skip Lesions

MC in Distal ileum

92
Q

String Sign AKA

A

Skip Lesions

93
Q

Crohns Disease invovles narrowing of the lumen forming strictures called Skip lesions
Name 2 SS

A

Rectal bleeding - Red streaks

INC WBC

94
Q

Ulcerative Colitis (UC) is marked by?

A

Local Megacolon

95
Q

How does Megacolon occur in UC?

A

Sacral Plexus becomes damaged so GI cant contract and the colon spreads out. Can also be caused by repetitive straining or holding of stool – IE waiting 30min to finish a move.

96
Q

How does Megacolon occur in UC?

A

Sacral Plexus becomes damaged so GI cant contract and the colon spreads out.

97
Q

Name MC location of UC

A

Descending Colon

98
Q

Name 3 SS of UC? (BAI)

A

Bloody Diarrhea
Arthritis (Large Joints)
Iritis/Uveitis

99
Q

HLA-B27 Suggests?

A

UC or Crohns

100
Q

Crohns Tx:

A

Restrict Raw foods and high calorie foods
Adjust
Fecal Transplant – Taking Stool from healthy person and implanting it into Crohns PT to restore GI microbiota – For C. difficile colitis

101
Q

UC Tx:

A

Electrolytes bec diarrhea
Avoid Milk
Adjust
Fecal Transplant

102
Q

IBS AKA?

A

Spastic Colon

Mucous Colitis

103
Q

IBS is defined by what SS?

A

Alternating Diarrhea and constipation

104
Q

Diverticulosis cause:

A

Repetitive straining or holding of stool – IE waiting 30min to finish a move. This weakens the lumen and allows out-pouching

105
Q

Outpouching occurs MC where?

A

Distal Colon

106
Q

Outpouching is a SS of?

A

Diverticulosis

107
Q

Diverticulosis Tx:

A

Avoid Nuts and seeds and popcorn

INC Water intake

108
Q

Diarrhea lasting 2-4 hrs indicates?

A

Staph food poisoning

109
Q

Diarrhea lasting a full day indicates?

A

Salmonella Food poisoning

110
Q

What is an IVP

A

Intravenous pyelogram
Used to look for KD Stones
Uses Radiography and a dye

111
Q

Describe Cystometric test?

A

Pumps water into the bladder. The device then measures the amount of fluid present in the bladder when you first feel the need to urinate, when you are able to sense fullness, and when your bladder is completely full.
The time required to begin voiding and the size, force, and continuity of the urinary stream is recorded. The amount of urine, how long the voiding took, and the presence of straining, hesitancy, and dribbling are also recorded.

112
Q

What is the Cystometric test for?

A

Urinary Incontinence

113
Q

UA is used as a KD screen

A

Looks for Proteinuria

114
Q

Creatinine Clearance

A

For End stage Renal disease
PT will be very Swollen
Used to determine if PT needs dialysis that day and if they need a KD transplant

115
Q

UCRAPE B27

AKA
U CRAPe B27

A 
Ulcerative Collitis
Crohn's
Reiter's
AS
Psoriatic
Enteropathic
116
Q

HLA - B27

*Neg sign means its Seroneg

A

Seroneg arthritis:

117
Q

Which are the Seroneg arthritis?

A

RAPE from UCRAPE
Reiters, AS, Psoriatic, Enteropathic
**These are the arthritides that attack the spine and make SYNDESMOPHYTES

118
Q

Which conditions Make Syndesmophytes?

A

RAPE

Reiter’s
AS
Psoriatic
Enteropathic

119
Q

Which conditions Make Syndesmophytes?

A

RAPE

Reiter’s
AS
Psoriatic
Enteropathic

120
Q

What are Syndesmophytes?

A

Calcified ligs of the spine

121
Q

Name 2 SS of enteropathic arthritis?

A

Back Ache and Bloody Diarrhea

122
Q

Calcification of the Lig around the spine indicate what radiological finding?

A

Osteophytes unless Reiter’s, AS, Psoriatic, or Enteropathic

Then Syndesmophytes

123
Q

What tissue does RA and OA target?

A

RA – Synovium of joints (Cartilage)

OA – Targets end plates and Joints

NBCE Part 4 (5 decks)

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