Abdominal Exam

Question 1

Borborygmi

Answer 1

Increased hyperactive bowel sounds
low pitch rumbling
hyper-peristalsis

Question 2

Auscultation- where?

Answer 2

Listen before palpation
All 4 quadrants- RLQ d/t cecum best
W/bell L. and R. & midline (between xiphoid and umbilicus) for aortic and renal bruits as well as over femoral a.

Question 3

Percussion- where?

Answer 3

All 4 quadrants and to determine size of the liver

Question 4

Percussion- What should you hear?

Answer 4

Tympany

Dull over the liver- resonant over the lungs

Question 5

Liver- normal size?

Answer 5

less then 10cm

Question 6

Ascites- signs

Answer 6

Fluid Wave or shifting dullness w/ percussion

Question 7

Rovsing’s Sign

Answer 7

Referred Rebound Tenderness: press in the LLQ and release- is positive if there is pain in the RLQ

Question 8

Palpation of the liver-

Answer 8

L. hand under 11th and 12 rib, R. hand in RUQ. Instruct pt to breath deeply as you press gently inward and upward with the right hand

Question 9

Palpation of the liver- hooking technique

Answer 9

While standing at the head- with both hands hook your fingers under the r. costal margin. Instruct pt to breath deeply while gently pulling inward and upward to palpate the liver

Question 10

Palpation of the spleen

Answer 10

Same as live but in the LUQ

Spleen should not be palpable under normal conditions

Question 11

Normal Aorta Size

Answer 11

2.5-3cm

Question 12

Palpation of the kidney’s

Answer 12

Sandwich method

Should not be palpable under normal conditions

Question 13

Percussion of the Kidneys

Answer 13

Check for CVA tenderness- AKA Lloyds sign

Question 14

Positions for a rectal examination

Answer 14

Standing
Modified Lithotomy (on back, legs spread)
Sims’ position (on side)

Question 15

Positive Fecal Occult Blood Test?

Answer 15

evaluate for colorectal cancer- colonoscopy = best choice.

Question 16

Condyloma acuminata (type of anal wart) is indicative of what?

Answer 16

HPV

Question 17

Condyloma lata (anal wart) is indicative of what?

Answer 17

Syphilis

Question 18

Appendicits- etiology

Answer 18

Obstruction of the appendicular lumen

Question 19

Appendicitis - typical hx

Answer 19

pain starts around the belly button and migrates to RLQ
+ N/V
Anorexia
Fever

Question 20

Appendicitis Physical Exam Signs

Answer 20

RLQ pain and rebound tenderness
decreased or absent bowel sounds
+ Rovsing, Psoas, and Obturator sign

Question 21

Psoas Sign

Answer 21

Pain when pt turned on L side with r. leg extended

Question 22

Obturator Sign

Answer 22

Right Leg in a figure 4 position, press on r. knee while holding onto l. iliac crest

Question 23

Appendicitis work up: Bloodwork?

Answer 23

CBC w/ diff: Moderate leukocytosis with a left shift (elevated neutrophils)
BMP: evalute electrolytes and renal function especially if vomiting

Question 24

Appendicitis work up: Imaging?

Answer 24

CT scan is your best bet. X-ray not helpful. US can show an enlarged and thickened appendix

Question 25

Appendicitis: Urine?

Answer 25

Pregnancy test imperative. Will help r/o GU condition.

Question 26

Cholecystitis: Etiology

Answer 26

Obstruction of the cystic duct usually by a gallstone, sometimes neoplasm

Question 27

Cholecystitis: Hx findings

Answer 27

RUQ postprandial (after eating) pain- biliary colic pain
Pain that radiates to R. shoulder
\+ N/V
Anorexia
Obesity
Fever
Female. Fat, Fertile, Fair, Flatulent

Question 28

Acute Cholecystitis: PE findings?

Answer 28

RUQ pain and RUQ rebound tenderness
decreased or absent bowel sounds
abdominal distension
+ Murphy’s Sign (RUQ pain and sudden arrest of inspiration during palpation of the liver and bladder)
Diagnostic triad: RUQ pain, fever, leukocytosis

Question 29

Cholecystitis bloodwork?

Answer 29

CBC: leukocytosis w/ left shift
Serum Bilirubin: can be mildly elevated
AST/ALT: can be elevated

Question 30

Cholecystitis: Imaging?

Answer 30

US: detect stones, thinking of the wall and dilated bile duct and fluid
HIDA Scan: radionucleotide biliary scan
CT Scan