Abdominal Examination

Question 1

What are the four steps of abdominal examination?

Answer 1

1. ) Inspection
2. ) Auscultation
3. ) Percussion
4. ) Palpation

Question 2

What is Grey Turner’s Sign?

Answer 2

flank ecchymosis (bruising) due to hemorrhage

Question 3

What is Cullen Sign?

Answer 3

ecchymosis around the umbilicus due to hemorrhage

Question 4

Describe normal bowel sounds?

Answer 4

5 - 34 clicks or gurgles per minute

Question 5

Describe abnormal bowel sounds?

Answer 5

high pitched sounds

decreased or absent sounds

Question 6

What are the vascular sounds that can be heard over the abdomen?

Answer 6

Aortic artery
Renal artery
Iliac artery
Femoral artery

Question 7

Where would your percussion bring about a dull sound in the abdomen?

Answer 7

over solid organs: liver or spleen
Feces
Over fluid in the peritoneum

Question 8

Where would your percussion bring about a tympanic sound in the abdomen?

Answer 8

air-filled viscera (majority of abdomen)

Question 9

What is the expected liver span?

Answer 9

6 - 12 cm along the mid-clavicular line

Question 10

What is the expected spleen span?

Answer 10

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

Question 11

Differentiate light, moderate, and deep palpitation?

Answer 11

light - 1 cm
moderate - 2 to 3 cm
deep - 3 cm

Question 12

What does rebound tenderness indicate?

Answer 12

peritoneal inflammation

Question 13

What does rebound tenderness at McBurney’s point indicate?

Answer 13

possible appendicitis

Question 14

What is Rovsing’s Sign?

Answer 14

pain in RLQ while applying pressure to the LLQ

indicates appendicitis

Question 15

What is the Iliopsoas Muscle Test? What’s a positive test and what does it indicate?

Answer 15

patient flexes hips at thigh against resistance

positive test: pain

Indicates: irritation of the psoas muscle due to inflammation of appendix

Question 16

What is the Obturator Muscle Test? What’s a positive test and what does it indicate?

Answer 16

patient’s right thigh is flexed (knee bent), hip rotated internally

positive test: right hypogastric pain

Indicates: irritation of the obturator muscle due to inflammation of the appendix

Question 17

What is the Heel Strike Test? What’s a positive test and what does it indicate?

Answer 17

patient supine, strike patient’s right heel

positive test: abdominal pain

Indicates: appendicitis or peritonitis

Question 18

How do you palpitate the liver?

Answer 18

patient supine, put your left hand below 11th and 12th rib.

with right hand direct fingertips cephalicly

have patient inhale

push down and up

Question 19

What is Murphy’s Sign? What’s a positive sign and what does it indicate?

Answer 19

palpate deeply under the right costal margin during inspiration to palpate the gallbladder

positive sign: pain

Indicates: acute cholecystitis

Question 20

What is Courvoisier’s Sign? What’s a positive sign and what does it indicate?

Answer 20

positive sign: an enlarged, but non-tender gallbladder

indicates: pancreatic disease/cancer

Question 21

How do you palpate the spleen?

Answer 21

pt. supine
place right hand under left rib cage
gently press inward and downward below left costal margin

(normal spleen should not be palpable)

Question 22

What is:
Lloyd punch
Kidney Punch
Costovertebral Angle tenderness (CVA)? What’s a positive test and what does it indicate?

Answer 22

patient sitting, tap the area of the back overlying kidneys

positive test: pain

Indicates: infection around kidney, renal stone

Question 23

How do you palpate the aorta?

Answer 23

palpate just above the umbilicus slightly left of midline

Aorta should be 2 - 3cm in width
pulsation should be anterior-inferior