Abdominal NP615

Question 1

Hx and Physical exam

Answer 1

Rule out pregnancy
beware cervical motion tenderness
Unilateral, localized abdominal pain, beware in a women.

Question 2

Hx and physical exam-appendicitis

Answer 2

includes pelvic for females
low grade fever
abdominal tenderness when coughing
localized tenderness is vaulable dx tool.
McBurneys point RLQ, between umbilicous and the anterosuperior iliac spine.
guarding, reboun d tenderness
obturator and Psoas sign
Obturator=passive rotation of the R leg with the patient supine and the R hip and knee flexed.
Psoas=supine client to raise the straight R leg against resistance by the provider
Heel-jar test-stand on tip toes and then drop suddenly on heels. Pain=appendicitis

Question 3

Diagnostics

Answer 3

Mostly done by H& PE. 
CT scan
Normal C-reactive protein level in patients for 24 hrs suggest not appendicitis
Elevated WBC count in 70-90%
immediate referral

Question 4

H & PE for AAA

Answer 4

During dissection, a pulsatile, painful mass can be palpated in the abdomen between the ixphoid process and the umbilicus
Peripheral pusles may be unequal or absent
US in early stages
CT scan is the standard of evaluation once it is found
Hospitalize immediately

Question 5

H & PE for AAA

Answer 5

In routine examination, palpation is evidence based for older men.
Supine with knees flexed AAA suspected when at least 3 cm.
More sensitive when girth is ,40 inches.
only 30-40% noted on PE
Ultrasound for initial confirmation
Risk for rupture over 5cm

Question 6

For AAA

Answer 6

Refer any AAA over 4.0 cm

Question 7

Cholesystitis

Answer 7

RUQ pain, epigastric pain
N/V/anorexia
Murphys sign -curl fingers under rib cage.  Pain = + or direct fist percussion from left to right=Pain =+
Ultrasound for dx
Cramping behind right should blade

Question 8

Cholecystitis

Answer 8

happens a lot during pregnancy. Weight management, vitamin C
Antibiotics/ow fat diet.

Question 9

pregnancy

Answer 9

Always rule out pregnancy
Could be PID if cervical motion tenderness
US to Dx but usually not positive. Treat empirically with Ceftriaxone 250 mg

Question 10

Pregnancy

Answer 10

ectopic
unilateral pain,
Do US, then rising hCG titer
REFER!!!

Question 11

Iliopsoas muscle test.

Answer 11

This test involves having the patient lie on the left side while the right hip and leg are passively extended backward, which
stretches the right iliopsoas muscle. In about onethird of patients with appendicitis—those in whom the appendix is retroperineal and in contact with this muscle—this will cause right-lower-quadrant pain, a positive result (psoas sign).

Question 12

Cutaneous hyperesthesia test.

Answer 12

In this test the clinician gently lifts a fold of skin between thumb and index finger, without pinching, at a series of
points on the abdomen, moving from the upper to the lower quadrants. Localized pain in the right lower quadrant, especially over McBurney’s point, Pain= +