Abdominal

Question 1

Order of exam for abdominal

Answer 1

Anatomy
Inspection
Auscultation
Percussion
Palpation

Question 2

Important organs in the four quadrants

Answer 2

Right upper: Liver
Right lower: ascending colon
Left upper: spleen
Left lower: other, descending colon

Question 3

What are you looking for upon inspection of the abdomen

Answer 3

• skin color
• ecchymosis (bruising)
• striae
• lesions and nodules
• scars
• abnormal movements
• contour, symmetry, surface motion

Question 4

Patient movement with appendicitis (or other peritonitis)

Answer 4

• prefer to lie still as movement causes further inflammation and pain

Question 5

Patient movement with kidney stones

Answer 5

• frequently twist on the exam table, unable to find comfortable position

Question 6

Use bell or diaphragm for abdominal ausculation

Answer 6

diaphragm

Question 7

Bowel sounds count

Answer 7

normal: 5-30 sounds/min
absent: none in 2 min
hypoactive: 1-2 sounds in 2 min
hyperactive: more than 30 in 1 min

Question 8

What sounds will you hear when percussing the liver

Answer 8

resonance -> dull -> tympany

Question 9

normal liver span

Answer 9

6-12 cm

Question 10

Light palpation or deep palpation first

Answer 10

light

Question 11

What is rebound tenderness

Answer 11

pt feels pain when palpation pressure released (common in appendicitis)

Question 12

What does light palpation detect

Answer 12

tenderness
muscle spasm
rigidity
use one hand

Question 13

Deep palpation

Answer 13

use two hands

checks organ size and for masses

Question 14

What is Rovsing’s sign

Answer 14

Press on left lower quadrant and quickly release -> will cause pain in right lower quadrant

Question 15

Tests for appendicitis

Answer 15

• rebound tenderness
• McBurney’s sign
• Psoas sign
• Obturator sign

Question 16

McBurney’s sign

Answer 16

Pain elicited with palpation in the LLQ at McBurney’s point (midway between the umbilicus and the anterior superior iliac crest)

Question 17

Psoas sign

Answer 17

Patient attempts to raise knee against examiners hand while supine

Question 18

Obturator sign

Answer 18

Flex patient’s right thigh at hip, knee bent, rotate leg internally, stretching internal obturator

Question 19

Cholecystitis

Answer 19

• Gall stones
• Murphy’s sign.
  Inability to take a deep breath when right subcostal region is palpated without pain.
• May be positive when ultrasound probe is placed at this area.

Question 20

CVA

Answer 20

Costovertebral Angle Tenderness

- Kidney infection

Question 21

Hepato-jugular reflex

Answer 21

• apply pressure to liver
• observe for a rise is JVP
• positive = sustained rise above 4 cm