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PCM II Exam 1 > Abdominal Exam 1 - Arnce > Flashcards

Abdominal Exam 1 - Arnce Flashcards

1
Q

What’s the difference between Visceral Pain and Parietal (Somatic) Pain?

A

Visceral Pain

  • Visceral Pain fibers
  • NOT LOCALIZED
  • Example: Periumbilical pain with early appendicitis

Parietal (Somatic) Pain

  • Somatic pain fibers
  • LOCALIZED
  • Constant/more severe than visceral pain
  • Example: RLQ parietal tenderness is a later finding in acute appendicitis
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2
Q

What is Referred Pain?

A

Originate in abdomen —> felt at distant site innervated at same spinal levels as disordered structure

Example: Duodenal and pancreatic pain —> classically to back.

Biliary tree —> right shoulder

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3
Q

For CC and HPI, which two subsets of OLDCAARTS are “most important?”

A
  1. Location
    - Both initially and currently
  2. Aggravating/Alleviating Factors
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4
Q

Which 3 Systems are considered part of a “Focused ROS” for an Abdominal Examination?

A
  1. Gastrointestinal (GI): nausea, vomiting, diarrhea, black stools, blood in stool, blood in vomit
  2. Genitourinary (GU): dysuria, polyuria, hematuria, flank or CVA pain
  3. Gynecological (GYN): vaginal bleeding, vaginal discharge, LMP, possibility of pregnancy

NOTE: Considered “Associated Symptoms” as well in OLDCAARTS.

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5
Q

What is the correct ABDOMINAL Physical Examination order?

A
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation

Note: Must drape your patient properly.

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6
Q

What are the 4 Inspection Landmarks for Abdominal Examination?

A
  1. Xiphoid process of the sternum
  2. Costal margins
  3. Umbilicus
  4. Anterior Superior Iliac Spine (ASIS)
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7
Q

What is found within each of the 4 quadrants?

A
  1. RUQ
    - Liver, gallbladder, stomach, SB, LB
  2. RLQ
    - Appendix, Ovary, SB, LB
  3. LLQ
    - Sigmoid Colon, ovary, SB, LB
  4. LUQ
    - Spleen, stomach, SB, LB
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8
Q

Which structures are found within the epigastric area?

A

Pancreas, liver, gallbladder, stomach, SB, and LB

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9
Q

What range indicated “Normal” Bowel Sounds?

A

5-34 clicks or gurgles/minute

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10
Q

What are 3 indications for ABSENT bowel sounds?

A
  • Long-lasting intestinal obstruction
  • Intestinal perforation
  • Mesenteric ischemia

NOTE: Absent is none for > 2 min.

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11
Q

What are 2 indications for DECREASED Bowel Sounds?

A
  • Post-surgical ileus
  • Peritonitis

NOTE: No bowel sounds for 1 min.

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12
Q

What are 2 indications for INCREASED Bowel Sounds?

A
  • Diarrhea

- Early Bowel Obstruction

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13
Q

Which percussion sound predominates in the abdomen?

A

TYMPANY - high-pitched, air-filled - because of gas in the GI Tract

Scattered areas of dullness area normal - due to fluid/feces

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14
Q

What are the 4 main types of Percussion sounds?

A

Tympany - high pitched, air filled

Dullness - non-resonating, solid organs/masses

Resonance - hollow abdominal organs (lungs)

Hyper-resonance - air-filled hollow organ (pneumothorax)

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15
Q

When palpating the abdominal area, which part of the hand do you use? Where do you start palpating first?

A

Use the palmar aspect of your hand

Start farthest from the tender area

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16
Q

What are the 4 special tests for Appendicitis?

A
  1. McBurney’s Point Tenderness
  2. Rovsing’s Sign
  3. Psoas Sign
  4. Obturator Sign
17
Q

What is McBurney’s Point Tenderness? What is a positive sign?

A
  1. Line from ASIS to Umbilicus
  2. Palpate 2 inches medial to ASIS on that line

Positive Test = Tenderness

NOTE: Best positive and negative predictor value of the 4 special tests for appendicitis

18
Q

What is Rovsing’s Sign? What is a positive test?

A
  1. Palpate deeply in LLQ

Positive Test = Pain in RLQ

19
Q

What is Psoas Sign? What is a positive test?

A
  1. Place hand above patient’s right knee and patient raises thigh against resistance
  2. Turn patient onto left side and extend right leg at hip

Positive Test = Increased abdominal pain

20
Q

What is Obturator Sign? What is positive test?

A
  1. Flex patient’s right hip with knee bent
  2. Internally rotate hip

Positive Test = Right hypogastric pain

21
Q

What is the special test for Biliary Colic (gallbladder/biliary pain)? What is a positive test?

A

Murphy’s Sign

  1. With RIGHT hand, palpate under patient’s RIGHT costal margin
  2. Ask patient to take deep breath in and palpate deeper

Positive Test = sharp increase in tenderness with sudden STOP in INSPIRATORY effort

22
Q

What is the special test for kidney inflammation/distention? What is a positive test?

A

Lloyd’s Sign (Punch)

  1. Deep percussion in the area of the costovertebral angle

Positive Test = Pain in area of costovertebral angle with deep percussion

IMPLIES: Pyelonephritis or ureterolithiasis

23
Q

What are the 3 signs of Peritoneal Inflammation?

A
  1. Guarding
  2. Rigidity
  3. Rebound Tenderness
24
Q

What is Guarding?

A
  • VOLUNTARY contraction of abdominal wall

- Abdominal musculature guards underlying inflamed organs from palpation pressure

25
Q

What is Rigidity?

A
  • INVOLUNTARY reflex contraction of the abdominal wall
26
Q

What is Rebound Tenderness?

A

-Occurs when you PUSH DOWN deep into the abdomen and let go quickly

Positive = More tenderness when letting go than pushing in

27
Q

What are the 5 steps in “Developing and Working Through a DDX?”

A
  1. Develop Broad DDX
  2. Narrow DDX
  3. Develop Working DDX
  4. Pursue Working DDX
  5. Assessment and Plan (Final Primary and Secondary Diagnoses)
28
Q

In “Developing a Broad Differential Diagnosis”, what does the VINDICATE mnemonic stand for?

A

VINDICATE

Vascular
Infectious/Inflammatory
Neoplasm
Drugs/Degenerative
Iatrogenic/Idiopathic
Congenital
Autoimmune/Allergic/Anatomic
Trauma
Endocrine/Environment

PCM II Exam 1 (2 decks)

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