Abdominal Physical exam review

Question 1

Generalized abdominal pain common causes

Answer 1

● AAA
● Acute pancreatitis
● Bowel perforation
● Bilateral pleurisy

Question 2

Central/Umbilical abdominal pain

Answer 2

● Early appendicitis
● Ruptured AAA
● Acute pancreatitis
● Small bowel obstruction
● Mesenteric thrombus
● Umbilical hernia

Question 3

Epigastric abdominal pain causes

Answer 3

● Esophagitis
● Peptic/Duodenal ulcer
● Acute pancreatitis
● AAA

Question 4

Right upper quadrant abdominal pain causes

Answer 4

● Gallbladder disease
● Duodenal ulcer
● Acute pancreatitis
● Liver
● Renal
● Pneumonia/pleurisy

Question 5

Left upper quadrant abdominal pain causes

Answer 5

● Gastric ulcer
● Acute pancreatitis
● Sleenic
● Renal
● Constipation (splenic flexure)
● Pneumonia/pleurisy

Question 6

Suprapubic abdominal pain causes

Answer 6

● UTI
● Urinary retention
● Pelvic Inflammatory Disease
● Ectopic Pregnancy
● Constipation/Diverticulitis

Question 7

Lower right abdominal pain causes

Answer 7

● Appendicitis
● Meckel’s Diverticulum
● Crohn’s Disease
● PID
● Salpingitis
● Ovarian cyst
● Ectopic Pregnancy

Question 8

Lower left abdominal pain causes

Answer 8

● Diverticulitis
● Constipation
● IBS
● Ulcerative colitis
● Rectal cancer
● PID
● Ovarian cyst
● Ectopic pregnancy

Question 9

There are essentially three different types of
abdominal pain:

Answer 9

○ Referred Pain
○ Parietal Pain
○ Visceral Pain

Question 10

Referred Pain

Answer 10

Pain felt in more distant sites that have similar
innervation
Referred pain is usually well localized and often
develops as the initial pain becomes more severe

Question 11

Parietal Pain

Answer 11

○ Originates from inflammation of the parietal
peritoneum and is localized to that inflamed spot
○ Steady, aching, and severe, which is typically
aggravated by movement or coughing

Question 12

Visceral Pain

Answer 12

○ When hollow organs
contract forcefully or are distended
○ When solid organs like the liver distend and
stretch their capsule
○ Difficult to localize
○ Can be gnawing, burning, cramping, or
aching

Question 13

When also found with other signs
(buffalo hump, moon face,
hypertension, etc.), can be
suggestive of Cushing’s Syndrome

Answer 13

“Purple Striae”, also known as
stretch marks

Question 14

_____ can strengthen the case of suspected
intestinal obstruction

Answer 14

increased peristaltic waves

Question 15

increased aortic pulsations can be
seen with _____

Answer 15

aortic aneurysms

Question 16

Cullens sign Can be a sign of

Answer 16

■ Acute pancreatitis
■ Hemorrhage from trauma
■ Bleeding from a ruptured ectopic pregnancy

Question 17

This can be a sign of retroperitoneal
hemorrhage

Answer 17

Grey Turner’s Sign

Question 18

Retroperitoneal Organs – “SAD PUCKER”

Answer 18

■ Suprarenal (adrenal glands)
■ Aorta (+ inferior and superior vena cava)
■ Duodenum (2nd and 3rd segments)

■ Pancreas
■ Ureters
■ Colon (ascending and descending)
■ Kidneys
■ Esophagus
■ Rectum

Question 19

The _____ of bowel sounds changes with intestinal function

Answer 19

Frequency

Question 20

A normal liver may be palpable about ____
cm below the right costal margin at the
midclavicular line

Answer 20

3

Question 21

The normal diameter of an abdominal aorta is less than ____ cms.

Answer 21

3

Question 22

A protuberant abdomen that is _____
throughout suggests bowel obstruction

Answer 22

tympanic

Question 23

_____ in the flanks bilaterally may suggest
ascites and warrant further workup

Answer 23

Dullness

Question 24

If the percussion note at this site
changes from tympany to dullness
upon inspiration, this suggests possible
splenic _____

Answer 24

enlargement

Question 25

A positive Murphy’s Sign is highly
suggestive of an _____

Answer 25

Acute Cholecystitis

Question 26

This constitutes a positive Rovsing’s Sign

Answer 26

Pain in the RIGHT lower quadrant during
the LLQ palpation

Question 27

Pain in the RIGHT lower quadrant during
the LLQ palpation

Answer 27

Cutaneous Hyperesthesia