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CPA Exam > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

Abdominal exam flashcards

1
Q

You are performing an abdominal examination, on palpation the patient has a hard rigid abdomen, which does not move with respiration across all 9 regions of the abdomen.

Which of the following is the most likely cause?

Cholecystitis
Gastrointestinal perforation
Peptic ulcer disease
Pyelonephritis
Voluntary guarding due to nerves
A

Gastrointestinal perforation

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2
Q

You are performing an abdominal examination, on palpation the patient has pain in the right iliac fossa. The patient describes pain which originated in the umbilicus before migrating to the right iliac fossa.

Which of the following is the most likely cause?

Appendicitis
Cholelithiasis
Diverticulitis
Pancreatitis

A

Appendicitis

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3
Q

You are performing an abdominal examination, on palpation you feel a pulsatile and expansile mass in the umbilical region.

Which of the following is the most likely cause?

Abdominal aortic aneurysm
Ascities
Hepatomegaly
Splenomegaly

A

Abdominal aortic aneurysm

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4
Q

If a patient was suffering from severe liver cirrhosis, which of the following signs would you be the least likely to see on examination?

Enlarged kidneys
Guarding
Hepatomegaly on palpation and percussion
Jaundice on inspection
Shifting dullness to percussion
A

Enlarged kidneys

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5
Q

A patient presents with severe loin pain, haematuria and on palpation the patient has pain in the flank region on palpation of the left kidney.

You think the patient has a urinary tract stone, which of the following locations is NOT a location where urinary tract stones sit?

Across the sacroiliac joint
In the bladder
The pelvi-ureteric junction
Vesicoureteric junction

A

In the bladder

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6
Q

Why is the head of the patient raised slightly by adjusting the headrest of the couch or by adding a pillow under the head in the abdominal examination?

A

This will help to relax the abdominal musculature.

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7
Q

How much of the abdomen is exposed in the abdominal examination?

A

The entire abdomen is exposed from the xiphisternal joint to the pubic symphysis.

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8
Q

Why do on the abdominal examination, some physicians tend to do the auscultation before any palpation or percussion?

A

To prevent the bowel sounds being disturbed by deep palpation.

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9
Q

What should you look out for in visual inspection of the abdomen? [6]

A

Visually inspect the shape of the abdomen, skin abnormalities, surgical scars, masses, hernias, movements of the abdominal wall with respiration, and for any asymmetry
.

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10
Q

Appearance of the normal abdomen

A

The normal abdomen is usually flat and symmetrical.

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11
Q

Movement of the abdomen during inspiration

A

During inspiration the abdominal wall moves out and the liver, spleen and the kidneys move downwards.

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12
Q

What is respiration at rest mainly?

A

Diaphragmatic

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13
Q

Normal appearance of umbilicus

A

The umbilicus is usually inverted

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14
Q

Appearance of umbilicus in obesity

A

In obesity the umbilicus is usually sunken.

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15
Q

Indications of a distended and everted umbilicus

A

Umbilical hernia

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16
Q

What do abnormally enlarged veins on the anterior abdominal wall indicate?

A

Portal hypertension or an obstructed inferior vena cava

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17
Q

Causes of diffuse abdominal swelling? [2]

A

Ascites (fluid collection in peritoneal cavity) or intestinal obstruction

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18
Q

Causes of abdominal wall asymmetry

A

A localised mass

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19
Q

Tenderness with minimal pressure over a wider area of the abdomen may be due to:

A

Peritonitis or in some cases is due to anxiety of the patient.

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20
Q

When does the abdominal wall tend to contract voluntarily?

A

When palpation causes pain

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21
Q

What is this called “the abdominal wall tends to contract voluntarily when palpation causes pain”?

A

Voluntary guarding

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22
Q

When there is inflammation of the parietal peritoneum, the abdominal wall muscles undergo a:

A

Reflex contraction

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23
Q

What is this called “When there is inflammation of the parietal peritoneum, the abdominal wall muscles undergo a reflex contraction.”?

A

Involuntary guarding

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24
Q

What is the appearance of the abdominal wall in involuntary guarding?

A

The abdominal wall may not show any movements with respiration, and may show a board like rigidity.

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25
Q

What is this called “If the abdominal wall is compressed slowly, and then released suddenly they will experience a sharp stabbing pain.”?

A

Rebound tenderness

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26
Q

Which type of patients may exhibit rebound tenderness?

A

Patients with generalised or localised peritonitis

27
Q

Which types of patients may exhibit rigidity of the abdomen?

A

Patients with inflammation of the parietal peritoneum

28
Q

How does the liver, affected by disease, enlarge?

A

It usually enlarges inferiorly from the right costal margin towards the right iliac fossa.

29
Q

Can you feel the liver edge in a healthy adult person?

A

Not usually

30
Q

If you ever feel the liver’s edge you should be able to describe whether: [4]

A

Its surface is smooth or irregular, soft or hard, or there is any tenderness and pulsations.

31
Q

What are the start and end position of palpation of the liver?

A

Start position - right iliac fossa

End position - right costal margin

32
Q

Where are the lower poles of the kidney palpable?

A

The lower poles of the kidneys are palpable through the anterior abdominal wall just below the costal margins.

33
Q

Are the upper poles of the kidneys palpable?

A

The upper poles are not palpable because they are inaccessible.

34
Q

What is the renal (costophrenic) angle?

A

Renal angle is the angle between the posterior median line and the lower border of the 12th rib

35
Q

Where is the abdominal aorta palpated?

A

The abdominal aorta is usually palpated above the umbilicus just left of the midline.

36
Q

Where should the ulnar borders of the fingers lie during palpation of the abdominal aortic pulse?

A

The ulnar borders (little finger side) lie parallel to the right and left costal margins.

37
Q

How does a normal abdominal aorta pulse feel?

A

In a normal abdominal aorta you will be able to feel a pulsation under your fingers

38
Q

When would you suspect AAA?

A

if the abdominal aorta was a pulsatile and expansile (pushes up against your fingers) mass.

39
Q

Where does the upper border of the liver usually lie?

A

The upper border of the normal liver lies at the level of the 5th rib or 5th intercostal space in the right midclavicular line.

40
Q

Where do you percuss downward from to estimate the liver span?

A

Percuss downwards from the right 4th rib along the midclavicular line

41
Q

What should you listen to when percussing from the liver downwards from the right 4th rib along the midclavicular line?

A

Carefully listen for a change in the percussion note from a resonant note over the air filled lung tissue to a dull note over the solid liver tissue.

42
Q

What is the end position of percussion of the liver?

A

This will be usually at the right costal margin for a normal liver.

43
Q

What is the distance between the upper and lower limits of the liver normally in a healthy adult?

A

13 cm

44
Q

In order to detect any splenic enlargement which does not cross over the costal margin it is possible to percuss over the:

A

Lowest intercostal space in the left anterior axillary line whilst the patient lies in supine position.

45
Q

What is the lowest intercostal space?

A

10th intercostal space between 10th & 11th ribs

46
Q

When would you suspect splenomegaly during percussion of the spleen>

A

If you find the percussion note becomes dull on full inspiration

47
Q

During which phase of respiration do you percuss for splenic enlargement?

A

During both expiration and full inspiration

48
Q

During which phase of respiration do you percuss the liver?

A

Full expiration

49
Q

What is ascites?

A

Ascites is the accumulation of fluid in the peritoneal cavity

50
Q

What is a classic cause of ascites?

A

Liver cirrhosis

51
Q

How does liver cirrhosis lead to ascites?

A

In the subsequent liver failure, there is a decreased metabolism of aldosterone and antidiuretic hormone by the liver, leading to retention of salt and water; decreased production of albumin leading to decreased oncotic pressure, all causing a leak of fluid into the peritoneal space.

52
Q

What are 2 alternative causes of ascites to liver cirrhosis?

A

Liver cancers

Heart failure

53
Q

How long do you wait for fluid to shift when turning patients onto the opposite side to examine for shifting dullness?

A

10 seconds

54
Q

What is the main aim of auscultation of the abdomen?

A

To detect bowel sounds

55
Q

Where do bowel sounds originate from?

A

Most of the sounds originate in the stomach, some from large and small intestines.

56
Q

What are normal bowel sounds heard as?

A

Gurgling noises

57
Q

Why are normal bowel sounds are heard as gurgling noises?

A

Due to the peristalsis of the gastrointestinal tract.

58
Q

Where can the bowel sounds be heard?

A

The bowel sounds can be heard all over the abdomen.

59
Q

Are bowel sounds well or poorly localised?

A

Poorly localised

60
Q

What is the significance of bowel sounds being poorly localised during abdominal auscultation?

A

Therefore it is sufficient to listen to them in one or two places on the abdomen rather than in all regions.

61
Q

How long should you normally listen for bowel sounds?

A

60 seconds

62
Q

How long should you listen for bowel sounds before coming to any conclusion that bowel sounds are absent?

A

You should listen for at least 3-4 minutes before coming to any conclusion that bowel sounds are absent

63
Q

Why may the bowel sounds be absent?

A

In paralytic ileus or peritonitis

64
Q

Why may bowel sounds become high pitched and frequent?

A

Intestinal obstruction

CPA Exam (6 decks)

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