Abdominal Exam Flashcards
A patient with liver disease presents with lesions on the upper chest that appears to have a central arteriole with numerous small vessels radiating from the central point. Which one of the following signs fits this description?
a. Pruritis
b. Spider naevi
c. Psoriasis
d. Ecchymosis
*b. Spider naevi
On colonoscopy, a patient is found to have haemorrhage from his left colon. Which of the following terms would be used to describe the type of stool that the patient may present with?
a. Melaena
b. Steatorrhoea
c. Coffee grounds stool
d. Hematochezia
*d. Hematochezia
Hematochezia is the passage of fresh blood per anus, usually in or with stools.
Melaena - the production of dark sticky faeces containing partly digested blood, as a result of internal bleeding or the swallowing of blood
A patient with advanced liver disease is brought in by his family. They complain that he is lethargic, does not know what day it is and behaves inappropriately at home. At what grade of hepatic encephalopathy would you diagnose him?
a. Grade 1
b. Grade 2
c. Grade 3
d. Grade 4
*b. Grade 2
Grade 0 - Minimal hepatic encephalopathy (also known as CHE [27] and previously known subclinical hepatic encephalopathy); lack of detectable changes in personality or behavior; minimal changes in memory, concentration, intellectual function, and coordination; asterixis is absent.
Grade 1 - Trivial lack of awareness; shortened attention span; impaired addition or subtraction; hypersomnia, insomnia, or inversion of sleep pattern; euphoria, depression, or irritability; mild confusion; slowing of ability to perform mental tasks
Grade 2 - Lethargy or apathy; disorientation; inappropriate behavior; slurred speech; obvious asterixis; drowsiness, lethargy, gross deficits in ability to perform mental tasks, obvious personality changes, inappropriate behavior, and intermittent disorientation, usually regarding time
Grade 3 - Somnolent but can be aroused; unable to perform mental tasks; disorientation about time and place; marked confusion; amnesia; occasional fits of rage; present but incomprehensible speech
Grade 4 - Coma with or without response to painful stimuli
On general examination of a patient with diabetes mellitus, you notice brown velvety elevations of the epidermis. Which one of the following skin lesions is best described in this way?
a. Porphyria cutanea tarda
b. Hereditary haemorrahagic telangiectasia
c. Peutz-Jehers syndrome
d. Acanthosus Nigricans
*d. Acanthosus Nigricans
Peutz–Jeghers syndrome (often abbreviated PJS) is an autosomal dominant genetic disorder characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa
A patient complains of poorly formed stools that are black and tarry in appearance and have an offensive smell. Which term describes this type of stool?
a. Haematochezia
b. Melaena
c. Rice-water stools
d. Steatorrhea
*b. Melaena
Melaena - the production of dark sticky faeces containing partly digested blood, as a result of internal bleeding or the swallowing of blood
A patient with symptoms of small bowel obstruction presents in Casualty. How would this patient describe his vomit?
a. Vomits brown offensive liquid
b. Vomits material that looks like ground coffee
c. Vomits yellow-green liquid
d. Vomits ingested food in a projectile manner
*a. Vomits brown offensive liquid
While taking a patient’s history, you realize that the patient is describing steatorrhoea. Which description is most characteristic of steatorrhoea?
a. Dark stools that look like ground coffee
b. Pale, smelly stools that are difficult to flush away
c. This. Watery stools that resemble rice-water
d. Small hard stools flecked with blood
*b. Pale, smelly stools that are difficult to flush away
A patient presents with dysphagia and odynophagia. Which of the following conditions is the MOST LIKELY cause of this patient’s symptoms?
a. Herpes simplex esophagitis
b. Goitre with retrosternal extention
c. Achalasia
d. Carcinoma of the pharynx
*a. Herpes simplex esophagitis
Odynophagia is a disorder in which swallowing feels painful. A person may feel pain in the throat, mouth, or food pipe (esophagus) when swallowing food, liquid, or saliva. Painful swallowing is a symptom of many medical conditions. The location and intensity of pain depend on the cause.
Achalasia is a serious condition that affects your esophagus. The lower esophageal sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. If you have achalasia, your LES fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your esophagus.
A patient presents with pigmented lesions in the mouth. Which of the following conditions is the MOST LIKELY cause?
a. Leukemia
b. Medication use, such as phenytoin
c. Addison’s disease
d. Sarcoidosis
*c. Addison’s disease
Addison’s disease, also called adrenal insufficiency, is an uncommon disorder that occurs when your body doesn’t produce enough of certain hormones. In Addison’s disease, your adrenal glands, located just above your kidneys, produce too little cortisol and, often, too little aldosterone.
In which one of the following conditions are you UNLIKELY to find gynecomastia on examination?
a. Thyrotoxicosis
b. Starvation
c. Bronchial carcinoma
d. Cushing syndrome
*d. Cushing syndrome
Cushing’s syndrome is a disorder that occurs when your body makes too much of the hormone cortisol over a long period of time. Cortisol is sometimes called the “stress hormone” because it helps your body respond to stress. Cortisol also helps. maintain blood pressure. regulate blood glucose, also called blood sugar.
A patient presents with a history of chronic diarrhoea which abates when he avoids eating food. Which of the following is MOST likely the cause of his diarrhoea?
a. Lactose intolerance
b. Irritable bowel syndrome
c. Inflammatory bowel disease
d. Carcinoid syndrome
*a. Lactose intolerance
On examining a patient who is presents with obstructive jaundice, you find that the patient’s gallbladder is enlarged. Which of the following is the MOST likely cause of his presentation?
a. Carcinoma of the pancreas
b. Carcinoma of the gall bladder
c. Acute cholesistitis
d. Gallstones in the gallbladder
*a. Carcinoma of the pancreas
In which of the following conditions would the patient have a yellow skin, but normal conjunctivae?
a. Carotenaemia
b. Hemolytic anemia
c. Bile obstruction
d. Hepatocellular failure
*a. Carotenaemia
Carotenaemia is the term used for excessive carotenoids in the blood. The terms xanthoderma (yellow skin) and carotenosis are also used. Carotenaemia is usually harmless.
Which one of the following is the most likely cause of a bruit heard in the epigastrium?
a. Renal artery stenosis
b. Acute alcoholic hepatitis
c. Hepatocellular carcinoma
d. Mesenteric arterial stenosis
*d. Mesenteric arterial stenosis
Which one of the following conditions is LEAST likely to be associated with proteinuria?
a. Severe hypertension
b. Acute alcohol abuse
c. Inflammatory bowel disease
d. Burns
*c. Inflammatory bowel disease
A patient presents with a history of vomiting that is delayed for more than an hour after a meal. Which one of the following conditions is most likely to present in this manner?
a. Pregnancy
b. Gastric outlet obstruction
c. Renal colic
d. Peptic ulcer disease
*b. Gastric outlet obstruction
On auscultation of the abdomen there is noted to be a complete absence of bowel sounds over a 4-minute period. Which one of the following conditions would most likely present with this sign?
a. Diarrhoeal disease
b. Paralytic ileus
c. Bowel obstruction
d. Hepatocellular carcinoma
*b. Paralytic ileus
Which one of the following conditions is most likely to cause secretory diahorrea?
a. E.coli infection
b. Irritable bowel syndrome
c. Inflammatory bowel disease
d. Colon cancer
*a. E.coli infection
Which one of the following conditions may present with leucoplakia?
a. Scurvy
b. Sepsis
c. Vit B2 deficiency
d. Candidiasis
*b. Sepsis
Leukoplakia is a condition in which thick, white or grayish patches form usually inside your mouth. Smoking is the most common cause. But other irritants can cause this condition as well. Mild leukoplakia is usually harmless and often goes away on its own.
A patient complains of abdominal pain which is steady, radiates to his back and is relieved by sitting up and leaning forward. Which finding is likely to be present?
a. Renal colic
b. Biliary colic
c. Pancreatic pain
d. Pain of peptic ulcer disease.
*c. Pancreatic pain
On examining a patient with abdominal distension, you inspect the umbilicus for clues as to the cause of the distension. An umbilicus that is shallow or everted and points downwards suggests
a. The patient eats too much
b. The patient has ascites or fluid in the abdomen
c. The patient is pregnant
d. The patient has an ovarian cyst
*b. The patient has ascites or fluid in the abdomen
A patient presents in emergency with a Mallory - Weiss tear. Which one of the following risk factors is the most likely cause?
a. Drug abuse
b. Smoking
c. Alcohol abuse
d. Obesity
*c. Alcohol abuse
A Mallory-Weiss tear is a tear of the tissue of your lower esophagus. It is most often caused by violent coughing or vomiting. A Mallory-Weiss tear can be diagnosed and treated during an endoscopic procedure. If the tear is not treated, it can lead to anemia, fatigue, shortness of breath, and even shock.
A patient presents with alcoholic liver disease. Which of the following signs are you unlikely to find on examination of the hands?
a. Palmar erythema
b. Dupuytren’s contracture
c. Hepatic flap
d. Increased palmer crease pigmentation
*d. Increased palmer crease pigmentation
Which of the following signs would be an UNLIKELY finding in a patient suspected of having advanced cirrhosis of the liver secondary to alcohol?
a. Pectoral muscle wasting
b. Fever
c. Tender hepatomegaly
d. Palmar erythema
*c. Tender hepatomegaly
