Abdominal exam refresher

Question 1

Grey Turner Sign

Answer 1

-Flank echymosis secondary to hemorrhage

Question 2

Cullen sign

Answer 2

-ecchymosis around the umbilicus secondary to hemorrhage

Question 3

Steps in abdominal exam

Answer 3

• IAPP
• auscultate before touch
• It’s usually IPPA

Question 4

Normal gurgle clicks per minute?

Answer 4

-5-34

Question 5

Rosving’s sign

Answer 5

• pain in RLQ during left-sided pressure

- referred rebound tenderness seen in appendicitis

Question 6

McBurney’s point

Answer 6

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

Question 7

Murphy sign

Answer 7

• palpate deeply under right costal margin during inspiration
• observe for pain or sudden stop in inspiratory effort
• tests for acute cholecystitis or cholelithiasis

Question 8

Courvoisier’s sign

Answer 8

-enlarged non-tender gallbladder secondary to pancreatic disease or cancer

Question 9

Symp for esoph

Answer 9

-T2-8

Question 10

Symp for stomach

Answer 10

-T5-9

Question 11

Symp for liver

Answer 11

-T6-9

Question 12

Symp for gallbladder

Answer 12

-T6-9

Question 13

Symp for small intestine

Answer 13

-T9-11

Question 14

Symp for colon

Answer 14

-T10-L2

Question 15

Symp for pancreas

Answer 15

-T5-11

Question 16

Symp for appendix

Answer 16

-T12

Question 17

Parasymp down to transverse colon?

Answer 17

-OA, AA (vagus)

Question 18

Parasymp for the lower portion

Answer 18

-S2-4 (pelvic splanchnic n.)

Question 19

Iliopsoas muscle test

Answer 19

• have pt flex their hip against your resistance
• increased ab pain is +
• suggests irritation of the psoas muscle from inflammation of the appendix

Question 20

Obturator muscle test

Answer 20

• flex pt right thigh at the hip, with the knee bent
• rotate the leg internally at the hip
• right hypogastric pain is +
• suggests irritation of the obturator muscle from an inflamed appendix

Question 21

Lloyd punch

Answer 21

• gently tapping the area of the back overlying the kidney produces pain
• suggests an infection around the kidney, pyelonephritis, or renal stone

Question 22

Heel strike

Answer 22

• pt supine
• doc strikes pt’s heel
• pain upon striking could indicate appendicitis or possible peritonitis