Abdominal Exam

Question 1

When is an abdominal exam performed?

Answer 1

Signs and sx of abdominal thoracic, thoracic, or genitourinary disease process

Question 2

What should careful attention be paid to during the abdominal examination?

Answer 2

Patient comfort level or degree of distress

Question 3

What should the status of a patient’s bladder be during the PE?

Answer 3

Empty

Question 4

How should the patient be positioned during the PE?

Answer 4

Supine, arms at the side with a pillow under the head, knee slightly flexed and feet placed flat on exam table

Question 5

What should be exposed during abdominal PE?

Answer 5

Abdomen

Question 6

Which side should you approach the patient during PE?

Answer 6

Right side

Question 7

What does having the patient take a deep breath and hold do to the diaphragm?

Answer 7

Lowers the diaphragm

Question 8

How do you inspect the rectus abdomonis for signs of separation indicative of diastasis recti, hernias or certain masses?

Answer 8

Have patient raise their head off the table which contract the rectus abdominis

Question 9

Visible intestinal peristalsis may indicate what?

Answer 9

Intestinal Obstruction
Males: Abdominal movement
Females: Costal movement

Question 10

What is bluish periumbilical discoloration called and what does it suggest?

Answer 10

Cullen sign, suggests intraabdominal bleeding

Question 11

What is bluish flank discoloration called and what does it suggest?

Answer 11

Gray-turner sign, suggests retroperitoneal or intraabdominal bleeding

Question 12

Purplish striae is indicative of?

Answer 12

Cushing disease

Question 13

Striae of recent origin that are pink or blue but turn silver/white overtime is indicative of?

Answer 13

Cushing disease

Question 14

Excessive corticosteroid use, purplish striae, moon face and buffalo hump are manifestations of what disease?

Answer 14

Cushing Disease

Question 15

Asymmetrical distention of the abdomen seen on inspection is indicative of what?

Answer 15

Hernia, tumors, cysts, bowel obstruction or enlargement of abdominal organs

Question 16

What is the regular range of bowel sounds and how long should you listen?

Answer 16

5-35 per minute, must listen for 5 minutes

Question 17

Where should you auscultate for bowel sounds?

Answer 17

Listen in one place, listen to all 4 quadrants if concerned

Question 18

What are loud prolonged gurgles called?

Answer 18

Borborygmi

Question 19

What could cause increased bowel sounds?

Answer 19

Gastroenteritis, early intestinal obstruction or hunger

Question 20

High pitched tinkling is suggestive of what?

Answer 20

Intestinal fluid, air under pressure

Question 21

What could cause decreased bowel sounds?

Answer 21

Peritonitis and paralytic ileus

Question 22

High pitched sounds with respiration are indicative of?

Answer 22

Friction rubs

Question 23

What are soft low pitched sounds heard in the epigastric region and around the umbilicus?

Answer 23

Venous hums

Question 24

Where should you auscultate for bruits?

Answer 24

Aortic, renal, iliac and femoral arteries

Question 25

Splenic dullness occurs at which ribs?

Answer 25

6-10

Question 26

What is the dullness of a healthy spleen often obscured by?

Answer 26

Tympany of colonic air

Question 27

Gastric bubble is what in pitch compared to tympany of intestine?

Answer 27

Lower

Question 28

What technique is used to assess for floating masses?

Answer 28

Balottement

Question 29

What is a positive Blumberg sign?

Answer 29

Pressing deeply into a region remote from area of discomfort and rapidly withdrawing. Removal of hand causes sharp stabbing pain at the site of peritoneal inflammation

Question 30

What is a positive McBurney’s sign?

Answer 30

Rebound tenderness over McBurney’s point, which is 2 inches from Anterior Superior Iliac Spine (ASIS)

Question 31

Describe Markle (heel jar) test?

Answer 31

Assesses peritoneal irritation by having patient stand with straight knees on toes and having the patient drop to their heels. Positive if abdominal pain occurs

Question 32

Describe Rosving sign

Answer 32

Assessment when concerned for appendicitis. Increased right lower quadrant pain with palpation of left lower quadrant

Question 33

Describe Iliopsoas muscle test

Answer 33

Used if appendicitis is suspected. Lay patient supine and place hand over lower right thigh. Have patient raise right leg while you push down. Abdominal pain with this motion is considered positive

Question 34

Describe obturator muscle test

Answer 34

Used if appendicitis or pelvic abscess is suspected. Lay patient supine and flex patient’s right hip and knee to 90 degrees. Hold leg just above the knee, grasp ankle and rotate the leg laterally and medially. Abdominal pain with this motion is considered positive

Question 35

Describe Murphy’s sign

Answer 35

Assesses for gall bladder irritation or inflammation. Place hands at the inferior coastal margin in the right upper quadrant. Have patient take a deep breath while keeping hands in place. Abrupt cessation of inspiration on palpation of gallbladder is considered positive and suggestive of cholecystitis