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OSCE > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

On general inspection, what are you looking for?

A

Pain or discomfort

Abdominal distention

Obesity

Pallor

Colour (jaundiced?)

Muscle wasting

Scratch marks

Spider nave

Purpura

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2
Q

On general inspection, what are you looking for around the bed?

A

Abdominal drains, dressings, vomit bowl, medications

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3
Q

On inspection and assessment of the hands and arms, what are you looking for?

A

Finger clubbing

Leuchonychia (white nails)

Koilonychia

Palmar erythema

Dupuytren’s contracture

Purpura

Fistulae

Tunnelled lines

Spider naevi in upper arm

Injection marks

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4
Q

What are abdominal causes of clubbing?

A

Cirrhosis

Ulcerative colitis

Crohn’s disease

Coeliac disease

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5
Q

What can cause palmar erythema?

A

Increased circulating levels of oestrogens

Can be found in liver disease, pregnancy and oestrogen contraceptive pill

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6
Q

In what conditions may Dupuytren’s contracture be found?

A

Cirrhosis of liver

Diabetes

Alcohol dependence

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7
Q

What might a flapping tremor indicate?

A

Decompensated liver failure (hepatic encephalopathy)?

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8
Q

On inspection of the eyes, what are you looking for?

A

Xanthelasma

Jandice

Pallor (anaemia)

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9
Q

What might xanthelasma indicate?

A

Prolonged cholestasis e.g. in primary biliary cirrhosis

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10
Q

On inspection of the mouth, what are you looking for?

A

Ulcers

Pigmentation

Telangiectasia

Stomatitis

Glossitis

Poor dentition

Gingivitis

Candidiasis

Tonsillar infection

Note any odours

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11
Q

What might pigmentation of the lips indicate?

A

Peutz-Jehger’s Syndrome

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12
Q

What might telangiectasia indicate?

A

Hereditary Haemorrhagic Telangiectasia

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13
Q

Why are telangiectasia important to identify?

A

They can also occur in the gut, lung and nose and cause severe bleeding

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14
Q

What are stomatitis and glossitis evidence of?

A

Iron deficiency anaemia

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15
Q

What kind of ulcers may occur in crops?

A

Herpetic

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16
Q

What kind of ulcers are common and painful?

A

Aphthous ulcers

17
Q

What should a painless non-healing ulcer alert you to?

A

Squamous cell carcinoma

18
Q

Why should you check the breath for odors?

A

Alcohol

Vomit

DKA

19
Q

On inspection of the chest and axillae, what are you looking for?

A

Spider naevi

Gynaecomastia in men

Axillae for loss of axillary body hair

20
Q

What might cause gynaecomastia and loss of axillary hair in men?

A

Chronic liver disease (increased circulating oestrogens and decreased testosterone)

21
Q

On close inspection of the abdomen, what are you looking for?

A

Symmetry

Visible peristalsis

Absence of movement with respiration

Distention (fluid, flatus, fat, foetus, faeces)

Herniae

Stromas and scars

Striae

Distended veins

Scratch marks

Pulsations in abdomen

Grey Turner’s Sign (discolouration/ bruising in flanks)

Cullen’s Sign (umbilicus)

22
Q

What results in no visible movement with respiration?

A

Peritonitis (abdominal rigidity)

23
Q

What is a cause of striae other than pregnancy?

A

Cushing’s Syndrome

24
Q

When may distended veins be present?

A

Portal hypertension in chronic liver disease and in IVC obstruction

25
Q

When may scratch marks be present?

A

Jaundice (bile salts deposited in tissue leading to pruritis)

26
Q

What causes Turner’s Sign?

A

Bleeding within abdomen e.g. haemorrhage pancreatitis, ruptured aneurysm, ectopic pregnancy

27
Q

What are the 9 regions of the abdomen?

A

Right hypochondrium, epigastrium, left hypochondrium

Right lumbar, umbilical, left lumbar

Right iliac fossa, suprapubic, left iliac fossa

28
Q

What is Murphy’s Sign?

A

Intense pain and arrest of inspiration as inflamed gallbladder descends and contacts fingers

29
Q

What do absent bowel sounds suggest?

A

Paralytic ileum or, if abdomen is rigid, peritonitis

30
Q

What does a tinkling bowel sound suggest?

A

Obstruction

31
Q

What do you look/ feel for when you sit the patient forward to inspect their back?

A

Spider naevi

Renal scars

Palpate renal angle for renal tenderness

Palpate neck for cervical lymphadenopathy

32
Q

What is Virchow’s node?

A

A lymph node in the lower part of the left posterior cervical triangle containing a metastasis.

33
Q

What is the finding of Virchow’s node?

A

Troisier’s Sign

34
Q

What is Troisier’s Sign a sign of?

A

Stomach cancer or lung, head or neck cancer

35
Q

What other tests would you offer?

A

Inspection and examination of groin for hernias and lymphadenopathy

Examination of external genitalia

Digital rectal examination

Observation chart

Urine Dipstix

OSCE (6 decks)

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