Abdominal Exam

Question 1

Grey Turner Sign

Answer 1

Flank ecchymosis secondary to hemorrhage

Question 2

Cullen Sign

Answer 2

Ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage

Question 3

normal bowel sounds

Answer 3

5-35 clicks or gurgles per minute

Question 4

tympany

Answer 4

found in the majority of the abdomen, caused by air-filled viscera

Question 5

dullness

Answer 5

flat sound without echoes, heard over solid organs. The liver and spleen, fluid in the peritoneum or feces give a dull note

Question 6

expected liver size

Answer 6

6-12 cm at the mid-clavicular line on the right

Question 7

expected spleen size

Answer 7

from ribs 6-10 at the mid-axillary line on the left

Question 8

abdominal examination order

Answer 8

inspect, auscultation, percussion, palpation

Question 9

rebound tenderness

Answer 9

Pain upon removal of pressure, rather than the application of
pressure to the abdomen. Tests for peritoneal inflammation

Question 10

guarding

Answer 10

Voluntary versus involuntary

Question 11

rigidity

Answer 11

Like it sounds, abdomen is hard, involuntary reflex

Question 12

rovsing’s sign

Answer 12

Pain in the RLQ during left-sided pressure- referred rebound tenderness seen in appendicitis

Question 13

McBurney’s Point

Answer 13

rebound tenderness or pain 1/3 of the distance from the ASIS to the
umbilicus- may suggest appendicitis/peritoneal irritation

Question 14

Murphy sign

Answer 14

Palpate deeply under right costal margin during inspiration, &
observe for pain &/or sudden stop in inspiratory effort. Tests for acute cholecystitis or cholelithiasis

Question 15

Courvoisier’s Sign

Answer 15

Enlarged non-tender gallbladder secondary to pancreatic disease or cancer

Question 16

esophagus sym levels

Answer 16

T2-8

Question 17

stomach sym levels

Answer 17

T5-9

Question 18

liver sym levels

Answer 18

T6-9

Question 19

gallbladder sym levels

Answer 19

T6-9

Question 20

small intestine sym levels

Answer 20

T9-11

Question 21

colon

Answer 21

T10-L2

Question 22

pancreas

Answer 22

T5-11

Question 23

appendix

Answer 23

T12

Question 24

upper portion parasympathetic levels

Answer 24

esophagus thru transverse colon OA, AA (vagus n.)

Question 25

lower portion parasympathetic levels

Answer 25

descending colon, sigmoid, rectum S2-S4 (pelvic splanchnic n.)

Question 26

Iliopsoas mm test

Answer 26

Have the patient flex their hip against your resistance- increased abdominal pain is a positive test. This suggests irritation of the psoas muscle from inflammation of the appendix

Question 27

obturator mm test

Answer 27

Flex the patients right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. Right hypogastric pain is a positive test. This suggests irritation of the obturator muscle from an inflamed appendix

Question 28

lloyd punch/kidney punch/costovertebral angle tenderness

Answer 28

gently tapping the area of the back overlying the kidney (costovertebral angles) produces pain. This suggests an infection around the kidney (perinephric abscess) or pyelonephritis or renal stone

Question 29

heel strike

Answer 29

Patient supine. Doc strikes patient’s heel. Pain upon striking could indicate appendicitis