Abdominal Exam

Question 1

General Inspection

Answer 1

Body habitus, well/ unwell, pain, fever, jaundice

Question 2

Nails

Answer 2

Clubbing
Leuconychia
Koilonychia (spooning)

Question 3

Clubbing

Answer 3

Inflammatory bowel disease

Cirrhosis

Question 4

Leuconychia

Answer 4

Whitening of the nail beds due to albumin
Malnutrition
Malabsorption chronic liver disease
Nephrotic syndrome

Question 5

Koilonychia

Answer 5

Spooning of the nails

Iron deficiency anaemia

Question 6

Hands

Answer 6

Xanthomata- raised yellow lesions on tendons
Dupuytren’s contracture- thickening and contracture of palmar fascia
Palmar erythema- blotchy reddening of the palms

Question 7

Xanthomata

Answer 7

Hyperlipidaemia through primary biliary cirrhosis

Question 8

Dupuytren’s contracture

Answer 8

Alcoholic liver disease
Manual work
Familial

Question 9

Palmar Erythema

Answer 9

Chronic liver disease

Question 10

Wrist and Arms

Answer 10

Pulse
Flapping tremor 
Bruising
Scratch marks
Track marks and tattoos

Question 11

Flapping Tremor

Answer 11

Encephalopathy due to liver failure

Question 12

Bruising

Answer 12

Chronic liver disease may affect clotting

Question 13

Scratch Marks

Answer 13

Raised urea

Question 14

Track Marks and Tattoos

Answer 14

Hepatitis risk

Question 15

Eyes

Answer 15

Yellowing of sclera
Conjunctival pallor
Corneal arcus
Xanthelasma

Question 16

Yellowing of the sclera

Answer 16

Jaundice

Question 17

Conjunctival pallor

Answer 17

Anaemia

Question 18

Corneal Arcus and Xanthelasma

Answer 18

Yellow ring overlying the iris (only significant in <50s)
Yellow raised lesions around the eyes
Hyperlipidaemia

Question 19

Mouth

Answer 19

Angular stomatis and Glossitis
Ulcers
Foector hepaticus

Question 20

Angular Stomatitis and Glossitis

Answer 20

Reddening and inflammation at the sides of the mouth and erythematous swelling of the tongue
Iron, folate, B12 deficiencies

Question 21

Ulcers

Answer 21

Coeliac
Inflammatory bowel disease
Iron deficiency

Question 22

Foector Hepaticus

Answer 22

Musty sweet breath

Liver failure

Question 23

Chest

Answer 23

Virchow’s node
Gynaecomastia
>5 spider naevi

Question 24

Virchow’s Node

Answer 24

Left supraclavicular node

Gastric cancer

Question 25

Gynaecomastia

Answer 25

Alcohol liver disease

Drugs: DISCO- digoxin, isoniazid, spironolactone, cimetidine, oestrogens

Question 26

> 5 Spider Naevi

Answer 26

Chronic liver disease

Excess oestrogen

Question 27

Abdominal Inspection

Answer 27

Distention 
Everted umbilicus (with distention)
Distended abdominal veins 
Hernias 
Scars and stomas

Question 28

Distention

Answer 28

6F’s: fat, fluid, flatus, faeces, foetus, f’ing big mass

Question 29

Everted umbilicus (with distention)

Answer 29

?ascites

Question 30

Distended abdominal veins

Answer 30

Portal hypertension

Question 31

Light palpation

Answer 31

Rebound tenderness

Guarding

Question 32

Rebound Tenderness

Answer 32

Pain on release

Peritonitis

Question 33

Guarding

Answer 33

Involuntary tensing of abdominal muscles

Question 34

Deep palpation

Answer 34

Masses or structural abnormalities

Describe: location, size, shape, surface, constancy, mobility, movement (with respiration), tenderness, pulsatile

Question 35

Hepatomegaly

Answer 35

Infective, neoplastic, cirrhotic, metabolic, toxins

Question 36

Splenomegaly

Answer 36

Infective, neoplastic, cirrhotic, metabolic, toxins

Question 37

Gall Bladder

Answer 37

Murphy’s sign

?Cholecystitis

Question 38

Abdominal aortic aneurysm

Answer 38

Pulsatile mass above umbilicus

Question 39

Bladder

Answer 39

Bladder = dull

Distended bowel = resonant

Question 40

Bowel sounds

Answer 40

Low pitched intermittent gurgling = normal
Tinkling/ high pitched = partial or total obstruction
Loud low pitched = diarrhoeal or abnormal peristalsis
Absent = paralytic ileus, peritonitis