Abdominal

Question 1

Clinical signs of note on general inspection

Answer 1

Age (young = IBD, old = chronic liver disease, malignancy)
Abdominal distension
Scars
Pallor
Jaundice
Hyperpigmentation
Oedema
Cachexia
Hernias

Question 2

Objects/equipment of note on general inspection

Answer 2

Stoma + bag
Surgical drains/feeding tubes/medical equipment
Mobility aids

Question 3

Palm clinical signs

Answer 3

Pallor - anaemia
Palmar erythema - chronic liver disease
Dupuytren’s contracture

Question 4

Nail clinical signs

Answer 4

Koilonychia (spoon-shaped) = iron def anaemia
Leukonychia (whitening of nail bed) = hypoalbuminaemia

Question 5

Abdominal causes of clubbing

Answer 5

IBD, coeliac disease
Liver cirrhosis
GI tract lymphoma

Question 6

Asterixis causes

Answer 6

Hepatic encephalopathy
Uraemia secondary to renal failure
(resp = CO2 retention)

Question 7

Clinical signs on arms

Answer 7

Bruising (clotting abnormalities due to liver disease)
Excoriations (pruritus = cholestasis)
Needle track marks (IVDU = viral hep)

Question 8

Clinical signs in axillae

Answer 8

Acanthosis nigricans
Hair loss (IDA, malnutrition)

Question 9

Clinical signs in eyes

Answer 9

Conjunctival pallor, jaundice, corneal arcus (normal >50, <50 = hypercholesterolaemia), xanthelasma, Kayser-Fleischer rings, inflammation of conjunctiva adjacent to iris (anterior uveitis = IBD)

Question 10

Clinical signs in mouth

Answer 10

Angular stomatitis (IDA)
Glossitis
Oral candidiasis
Aphthous ulceration (benign but can be iron/B12/folate def, Crohn’s)
Hyperpigmented macules (Peutz-Jegher syndrome)

Question 11

Clinical signs on chest

Answer 11

Spider naevi
Gynaecomastia
Hair loss

Question 12

Clinical signs on abdomen inspection

Answer 12

Scars, striae
Caput medusae
Abdominal distension
Hernias
Cullen’s sign
Grey-Turner’s sign

Question 13

Cullen’s and Grey-Turner’s signs

Answer 13

Cullen’s - bruising of tissue around umbilicus (late haemorrhagic pancreatitis sign)
Grey-Turner’s - bruising in the flanks (late haemorrhagic pancreatitis sign)

Question 14

Stoma characteristics to mention (types are on passmed)

Answer 14

Location
Contents (stool or urine)
Consistency of stool (liquid = ileostomy, solid = colostomy)
Spout (colostomy = flush, ileostomy/urostomy = spouted)

Question 15

Clinical signs on light palpation of abdomen

Answer 15

Tenderness (location + severity)
Rebound tenderness
Voluntary guarding
Involuntary guarding/rigidity
Rovsing’s sign
Masses

Question 16

Features of masses to assess on deep palpation

Answer 16

Location
Size + shape
Consistency
Mobility
Pulsatility

Question 17

Causes of hepatomegaly

Answer 17

H - hepatitis, hepatocellular carcinoma, hepatic metastases
Iron + copper - haemochromatosis, Wilson’s
Cancer - leukaemia, myeloma
Others - glandular fever, primary biliary cirrhosis, tricuspid regurgitation, haemolytic anaemia

Question 18

Murphy’s sign?

Answer 18

Right costal margin mid-clavicular line, press down then ask pt to take deep breath
If stops mid-breath due to pain = CHOLECYSTITIS

Question 19

Causes of splenomegaly

Answer 19

Portal hypertension secondary to liver cirrhosis, haemolytic anaemia, congestive heart failure, splenic mets, glandular fever (hepatosplenomegaly)

Question 20

Causes of enlarged kidneys

Answer 20

BILATERAL = polycystic kidney disease, amyloidosis
Unilateral = renal tumour

Question 21

Bowel sounds implications

Answer 21

Normal = gurgling
Tinkling = obstruction
Absent = ileus