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OSCE - examinations > Abdominal examination > Flashcards

Abdominal examination Flashcards

1
Q

What would you look at in the hands in an abdominal exam?

A
  1. Tendon xanthomata
  2. Dupuytren’s contracture
  3. Palmar erythema
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2
Q

What causes Dupuytren’s contracture?

A 
Chronic liver disease
Diabetes 
Heavy labour 
Phenytoin 
Trauma
Familial
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3
Q

What causes palmar erythema?

A

Chronic liver disease
Pregnancy
Hyperthyroidism
Rheumatoid Arthritis

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4
Q

What would you look at in the nails in an abdominal exam?

A

Finger clubbing
Leuconychia
Koilonychia

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5
Q

What is leuconychia?

A

White spots on the nails

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6
Q

What causes leuconychia?

A

Hypoalbuminaemia due to e.g. chronic liver disease

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7
Q

What causes koilonychia?

A

Iron-Deficient anaemia (e.g. GI bleeds)

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8
Q

What causes clubbing due to GI causes?

A

IBD
Cirrhosis
Lymphoma
Coeliac disease

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9
Q

What would you look at in the wrist in an abdominal exam?

A

Flapping tremor

Radial pulse rate

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10
Q

What causes a flapping tremor?

A

Hepatic failure

Respiratory or renal failure

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11
Q

What would you look at in the arms in an abdominal exam?

A

Bruising (CLD)

IV drug use marks (hepatitis B and C)

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12
Q

What would you look at in the face in an abdominal exam?

A 
Cushingoid (alcohol)
Parotid enlargement (alcohol)
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13
Q

What is part of a Cushingoid appearance?

A

Moon face
Plethora
Acne
Hirsute

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14
Q

What would you look at in the eyes in an abdominal exam?

A

Scleral icterus
Corneal arcus and xanthelasma
Episcleritis and conjunctivitis
Conjunctival pallor

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15
Q

What causes scleral icterus?

A

Serum bilirubin > 35 micromol/L

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16
Q

What are episcleritis and conjunctivitis a sign of?

A

IBD

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17
Q

What would you look at in the mouth in an abdominal exam?

A

Angular stomatitis and glossitis
Oral candidiasis
Apthous ulcers
Fetor hepaticus

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18
Q

What are angular stomatitis and glossitis a sign of?

A

Iron, folate or B12 deficiency

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19
Q

What is oral candiasis a sign of?

A

Immunodeficiency

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20
Q

What are apthous ulcers a sign of?

A

IBD (mainly Crohn’s)

21
Q

What is fetor hepaticus a sign of?

A

Hepatic failure (mercaptan accumulation)

22
Q

What would you look at in the neck in an abdominal exam?

A

Lymph nodes

23
Q

What lymph node is significant in an abdominal examination?

A

Left supraclavicular (Virchow’s)

Gastric cancer

24
Q

What would you look at in the chest and back in an abdominal exam?

A

Gynaecomastia
Loss of secondary sexual hair
Spider naevi

25
Q

What is gynaecomastia a sign of?

A

CLD
Drugs
Testicular failure

26
Q

What is loss of secondary sexual hair a sign of?

A

CLD

27
Q

What are spider naevi a sign of?

A

Chronic liver disease

28
Q

How would you position the patient the examine the abdomen?

A

Flat

Then inspect, palpate, percuss and auscultate

29
Q

What would you inspect for in an abdominal exam?

A

Abdominal distension: fat, fluid, faces, flatus, fetes, fecking big mass

Caput medusa: portal hypertension

Scars

30
Q

What scars could you see in an abdominal examination?

A
  1. Kocher’s (subcostal): open cholecystectomy
  2. Right paramedic laparotomy (pancreatic transplant)
  3. Midline laparotomy
  4. Nephrectomy
  5. Gridiron (appendicetomy)
  6. Laparoscopic
  7. Left paramedian - anterior resection of rectum
  8. Pfannenstiel/transverse suprapubic: TAH, Caesarian section
31
Q

What can cause ascites in CLD?

A
  1. Portal hypertension
  2. Hypoalbuminaemia
  3. Salt and water retention secondary to RAAS activation
32
Q

What are the causes of hepatomegaly (think 2 Is, 2 Bs, 2 Cs)

A

Infection
Infiltration

Blood-related
Biliary

Cancer
Congestion

33
Q

What are the infective causes of hepatomegaly?

A

Viral hepatitis
EBV
Malaria
Hepatic abscess

34
Q

What are the infiltrative causes of hepatomegaly?

A

sarcoid
Amyloid
Fatty liver
Haemochromatosis

35
Q

What are the blood-related causes of hepatomegaly?

A

Lymphoma
Leukaemia
Myeloproliferative disorders
Haemolytic anaemias

36
Q

What are the biliary causes of hepatomegaly?

A

Primary biliary cirrhosis

Primary sclerosis cholangitis

37
Q

What are the cancer causes of hepatomegaly?

A

Primary hepatocellular carcinoma

Metastatic deposits

38
Q

What are the congestive causes of hepatomegaly?

A

Right heart failure
Tricuspid regurgitation
Budd-Chiari syndrome

39
Q

How would you palpate in an abdominal examination?

A
  1. General palpation: tenderness, guarding, masses (WATCH THE FACE). Light then deep palpation, tell me if there is any pain
  2. Liver: RIF to right costal margin, feel for liver edge during inspiration. Percuss outer and lower hepatic borders
  3. Spleen: RIF - left costal margin. Feel during inspiration
  4. Ballot kidneys
  5. AAA
40
Q

What causes splenomegaly?

A 
Malaria 
Myelofibrosis 
CML
Infective endocarditis 
RA
41
Q

What would you percuss in an abdominal exam?

A

Shifting dullness

Usually 1.5< L of fluid if shifting dullness positive

42
Q

What would you auscultate in an abdominal exam?

A
  1. Bowel sounds (just below umbilicus)
  2. Renal bruits (superior and lateral to umbilicus)
  3. Liver bruit IF liver edge felt
43
Q

How would you describe bowel sounds?

A

Active, sluggish, tinkling, obstructive

44
Q

What causes liver bruits?

A

Hepatocellular carcinoma
AV malformation
TIPSS

45
Q

What would you feel for in the legs during an abdominal examination?

A

Peripheral oedema

Erythema nodosum

Pyoderma gangrenosum

46
Q

What is erythema nodosum a sign of?

A

IBD

47
Q

What is pyoderma gangrenosum a sign of?

A

IBD

RA

48
Q

What other examinations could you suggest after an abdominal examination?

A

Groin
Genitalia
DRE

OSCE - examinations (13 decks)

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