Block 2 exam PDI Flashcards
- What is the preferred order for examination of the abdomen?
(A) Inspection, auscultation, percussion, palpation
(B) Percussion, auscultation, palpation, inspection
(C) Auscultation, inspection, palpation, percussion
(D) Inspection, palpation, auscultation, percussion
(A) Inspection, auscultation, percussion, palpation
- You are in the emergency room assessing a patient with abdominal pain and fever. You are performing
an abdominal examination to assess for peritoneal signs. Which one of the following is NOT a
peritoneal sign?
(A) Rebound tenderness
(B) Involuntary guarding
(C) Rigidity of the abdomen
(D) Voluntary guarding
C
- A 15-year-old high school student presents to the clinic with a 1-day history of
nausea and anorexia. He describes the pain as generalized yesterday, but today it
has localized to the right lower quadrant. You palpate the left lower quadrant and
the patient experiences pain in the right lower quadrant. What is the name of
this sign?
(A) Psoas sign
(B) Obturator sign
(C) Rovsing’s sign
(D) Cutaneous hyperesthesia
C
A 25-year-old veterinarian presents to the clinic for evaluation of flank pain,
dysuria, nausea, and fever. A urine pregnancy test is negative. A urine dipstick is
positive for leukocyte esterase. On physical examination, what would be the most
likely sign expected?
(A) Psoas sign
(B) CVA tenderness
(C) Rovsing’s sign
(D) Murphy’s sign
B
A 40-year-old flight attendant presents to your office for evaluation of abdominal
pain. It is worse after eating, especially if she has a meal that is spicy or high in fat.
She has tried over-the-counter antacids, but they have not helped the pain. After
examining her abdomen, you strongly suspect cholecystitis. Which sign on examination
increases your suspicion for this diagnosis?
(A) Psoas sign
(B) Rovsing’s sign
(C) Murphy’s sign
(D) Grey Turner’s sign
C
A 22-year-old celebrity with a known history of intravenous drug use presents to
the emergency room for evaluation of a 5-day history of nausea, emesis, and rightupper-
quadrant abdominal pain. On general survey, he appears ill and his skin is
distinctly yellow. He has a temperature of 102.5°F and a heart rate of 112 bpm.
You provisionally diagnose him with acute hepatitis. What would you expect to
find on abdominal examination?
(A) Liver edge is tender and 4 to 5 finger-breadths below the RCM
(B) Liver edge is nonpalpable
(C) Liver edge is tender and 1 finger-breadth below the RCM
(D) Liver edge is nontender and 4 to 5 finger-breadths below the RCM
A
Match each numbered item with the appropriate lettered phrase or phrases. 1) LIVER EDGE 2) SPLEEN EDGE 3) ROVSING SIGN 4) PSOSA'S SIGN 5) OBTURATOR SIGN CUTANEOUS HYPERESTHESIA
(A) Palpable deep to the left costal margin during inspiration
(B) Palpable 6 cm below the right costal margin in the midclavicular line during
inspiration
(C) Pain elicited when the patient’s right thigh is flexed at the hip with the knee bent, and the leg is internally rotated at the hip
(D) Examiner’s hand is placed on the patient’s right knee and the patient is asked
to raise his or her right thigh against the examiner’s hand
(E) Pain elicited by gently picking up a fold of abdominal skin anteriorly without
pinching it
(F) Pain in the right lower quadrant during palpation of the left lower quadrant
- Liver edge - palpable 6 cm below the right costal margin in the midclavicular line during inspiration
- Spleen edge- palpable deep to the left costal margin during inspiration
- Rovsing’s sign -Pain in the right lower quadrant during palpation of the left lower quadrant.
- Psoas sign - Examiner’s hand is placed on the patient’s right knee and the patient is asked to raise his or her right thigh against the examiner’s hand
- Obturator sign -Pain elicited when the patient’s right thigh is flexed at the hip with the knee bent, and the leg is internally rotated at the hip
- Cutaneous hyperesthesia - Pain elicited by gently picking up a fold of abdominal skin anteriorly
Ms. G. is a 42-year-old housewife who makes an appointment at your clinic because she has been experiencing pain in her upper abdomen for the past 3 months. She describes the pain as an “ache” that sometimes radiates into her right upper back and right shoulder. The pain gets worse after eating fatty or greasy foods, so she has eliminated these foods from her diet. She feels nauseated when the pain occurs and sometimes vomits. She denies fever or chills, weight loss, chest pain, diarrhea, constipation,
melena, rectal bleeding, and dysuria. She has not been exposed to anyone who has
been sick.Ms. G. is healthy. She does not smoke, drink, or use illicit drugs.Her family history is significant for hypertension in her mother and diabetes in her father. Her mother had gallbladder surgery in her mid-40s.
What parts of the exam would you like to perform? (Circle the appropriate areas.)
General Survey Breasts and Axillae
Vital Signs, Female Genitalia
Skin Male Genitalia
Head and Neck Anus, Rectum, and Prostate
Thorax and Lungs Peripheral Vascular/Extremities
Cardiovascular Musculoskeletal
Abdomen Nervous System
What physical findings are you looking for to help determine the diagnosis?
general survey vital signs skin thorax and lungs Cardiovascular Abdomen
History of Present Illness:
Mrs. M., a 30-year-old dental hygienist, presents to the clinic because of a grayish,
foul-smelling vaginal discharge that has been present for 1 week. There is no vaginal
itching or burning with urination. Mrs. M. is sexually active in a monogamous
relationship with her husband of 10 years. She states that she and her husband have
no other sexual partners. She reports no fever, chills, abdominal pain, or pelvic pain.
Her last menstrual period was 1% weeks ago.
Mrs. M.’s medical history is unremarkable; she had a bilateral tubal ligation after
the birth of her last child, 3 years ago.
What parts of the exam would you like to perform? (Circle the appropriate areas.)
General Survey Breasts and Axillae
Vital Signs Female Genitalia
Skin Male Genitalia
Head and Neck Anus, Rectum, and Prostate
Thorax and Lungs Peripheral Vascular/Extremities
Cardiovascular Musculoskeletal
Abdomen Nervous System
What physical findings are you looking for to help determine the diagnosis?
IDK
A 19-year-old sexually active college student presents for evaluation of a vaginal discharge. She has been in a monogamous relationship since becoming sexually
active and is married to her partner. She denies that he has been unfaithful. She denies fever or chills. She states that the discharge is thick, white, and curdlike, and although there is no bad odor, she does experience some itching. Upon physical examination of the vagina, you see an inflamed vulva, with a slightly red vaginal mucosa. The discharge is thick and white. There is no cervical motion tenderness.The uterus is normal in size without adnexal masses. Based on this information, what is your most likely diagnosis?
(A) Bacterial vaginosis
(B) Trichomonas vaginalis infection
(C) Candida vaginitis
(D) Pelvic inflammatory disease
C
A 35-year-old woman presents for evaluation of several new lesions on her vagina.
She denies any previous medical problems. She is sexually active. She has had four
pregnancies and has given birth to two children. She has had more than ten sexual
partners in her lifetime. She is currently divorced but involved in a new relationship
with a man whose past sexual history is unknown. On physical examination
of the external vagina, you see cauliflower-like lesions scattered on the labia. These
are nontender to palpation; the largest is 1 cm in diameter. The remainder of the
pelvic examination is unremarkable, and there is no vaginal discharge. Based on
this information, what is your most likely diagnosis?
(A) Epidermoid inclusion cysts
(B) Venereal warts
(C) Genital herpes
(D) Syphilitic chancre
B
A 28-year-old housewife presents for an annual checkup. When queried, she mentions
that she has noticed bleeding in between her periods for the past several months. She has been pregnant five times and has given birth to five infants. She is sexually active in a monogamous relationship with her husband. On physical examination of the uterus, you palpate an irregular nodule that is approximately 3 cm in diameter. Based on this information, what is your most likely diagnosis?
(A) Leiomyoma or fibroid
(B) Cervical cancer
(C) Uterine cancer
(D) Cystocele
A
A 23-year-old sex worker presents to the emergency room for evaluation of pelvic
pain and fever. You obtain a pregnancy test, which is negative. Her last menstrual
period was 1 week ago and was normal. You obtain a complete blood count, and
the white blood cell count is elevated. On pelvic examination, she has cervical
motion tenderness and a right adnexal mass that is larger than 5 cm in diameter
and is extremely tender to palpation. What is the most likely cause of this adnexal
mass?
(A) Ovarian tumor
(B) Ruptured ovarian cyst
(C) Ruptured tubal pregnancy
(D) Tubo-ovarian abscess
D
Mr. P., a 65-year-old retired farmer, comes to your office because he is worried about
a sudden loss of dark red blood from the rectum. He normally has a bowel movement
every other day; he does not need to strain. He drinks prune juice daily to keep his
bowel movements regular. He reports no fever, chills, night sweats, weight loss,
abdominal pain, tarry black stools, or rectal pain. He does feel weak and tired.
Mr. P. has had hypertension for 30 years, well controlled with medications.
He had a left inguinal hernia repair when he was 30 years old.
He has smoked three packs of cigarettes daily since the age of 15. He does not
drink alcohol, and he has never used illicit drugs.His mother died at age 60 of complications of colon cancer. His father had hypertension and died of a heart attack at age 85.
- As part of a routine checkup, you are examining the prostate of 65-year-old man.
He denies nocturia and urinary hesitancy. On physical examination, you palpate
the prostate gland and feel a mass. Which one of the following descriptors would
you use to characterize this mass?
(A) Color
(B) Size
(C) Presence of discharge
(D)Presence of rash
B
You are performing a routine physical examination on a 70-year-old retired banker.
On examination of the prostate, you palpate a mass that is 1 cm in diameter, hard,
and nontender. The patient has had a 6-month history of fatigue. He denies weight
loss and night sweats. What is your most likely diagnosis?
(A) Benign prostatic hyperplasia
(B) Internal hemorrhoid
(C) Prostatitis
(D)Prostate cancer
D
An 80-year-old retired secretary presents to the emergency room because of difficulty
having a bowel movement, stating that “it feels like something is coming
out.” She denies fever or chills and weight loss. She has had constipation and has
used an over-the-counter stool softener and increased her water intake. She denies
pain with defecation. On physical examination of the anus, you see a doughnut of
red tissue, with concentrically circular folds where the anus should be. What is
your most likely diagnosis?
(A)Thrombosed external hemorrhoid
(B) Anal fissure
(C) Rectal prolapse
(D)Rectal cancer
C
A 25-year-old pregnant woman (G1, P0) at 12 weeks’ gestation presents to your
office for routine prenatal care. When you ask her about how she is feeling, she
states that she has been unable to keep down food and that food tastes “funny” to
her. You look at her vital signs; she has lost 5 pounds since her previous visit. The
fetal heart tones are normal, and the rest of her examination is unremarkable.
What step should you take next with this patient?
(A) You reassure her that pregnancy-related nausea usually lasts only for the first trimester and that most likely her nausea and appetite will improve soon.
(B) You are concerned about a peptic ulcer and want to start her on medication.
(C) You are concerned about hyperthyroidism and obtain a thyroid-stimulating
hormone (TSH) level.
(D) You diagnose her with hyperemesis gravidarum and proceed with further diagnostic workup.
A
- A 35-year-old pregnant woman (G4, P3) at 24 weeks’ gestation presents to your
office for routine prenatal care. Her major concern is a backache that began 2
weeks ago and has not gone away. She denies dysuria, fever, and chills but does
admit to urinary frequency. She is taking a mild over-the-counter analgesic for the
pain and is using a heating pad. You obtain a urinalysis, for which the results are
normal. What step should you take next for this patient?
(A) You give her antibiotics for her pyelonephritis.
(B) You diagnose her with a kidney stone and ask her to strain her urine and increase her fluid intake.
(C) You diagnose her with meningitis and admit her to the hospital for treatment with intravenous antibiotics.
(D) You reassure her that this is a normal part of pregnancy because the hormones are causing relaxation of the joints and ligaments, which changes the normalcurvature of the lower spine.
D
You are performing a routine checkup on a pregnant woman who is at 37 weeks’
gestation. Her blood pressure is 110/65 mm Hg. The size of the uterus is appropriate
for her dates; the fetal heart rate is in the 140s. She has trace pedal edema. You
perform an examination for the size of the fetus and its position. What is this
maneuver called?
(A) Nagele’s maneuver
(B) Leopold’s maneuvers
(C) Bickley’s maneuver
(D) Bates’ maneuver
B
What is Leopard Maneuver is
(A) Calculation to determine expected date of confinement
(B) Date of delivery
(C) Technique to determine size and position of the fetus
(D) Most recent onset of menses
C
e emergency room with a history of a football injury to the left flank earlier that day while at practice. He reports that at the time of the injury he only had the “wind knocked out of him” and he recovered in a few minutes. About 1 h later he began to experience pain in the left upper quadrant and left shoulder. He also feels dizzy and light-headed on standing. Physical examination demonstrates orthostatic changes in blood pressure and heart rate. Heart and lung examinations are normal. Abdominal auscultation reveals normal bowel sounds, but the patient complains of tenderness when palpating the left upper quadrant. Rectal
exam is normal. Which of the following is the most likely diagnosis?
a. Dislocation of the left shoulder
b. Left rib fracture
c. Left pneumothorax
d. Ruptured spleen
e. Contusion of the left kidney
D
- Which of the following is the
proper sequence for examination of
the abdomen?
a. Auscultation, percussion, inspection, palpation
b. Auscultation, inspection, palpation, percussion
c. Inspection, percussion, auscultation, palpation
d. Inspection, auscultation, percussion, palpation
e. Inspection, percussion, palpation, auscultation
D
Which of the following statements
is true regarding the term
“scaphoid” abdomen?
a. An unremarkable abdomen should be called scaphoid b. It is a convex abdomen c. It is seen in patients who have ascites d. It is absent in obese patients e. It implies guarding f. It implies rigidity
D
- Which of the following best
describes the location of McBurney’s
point?
a. In the midclavicular line just under the right costal margin
b. At the midpoint of a line connecting the symphysis pubis and the anterior superior iliac spine
c. Midway along the right inguinal ligament
d. One-third of the way along a line drawn from the right anterior superior iliac spine to the umbilicus
e. One centimeter to the right of the umbilicus
D
201. A 38-year-old man arrives at the emergency room with the chief complaint of hematemesis for 3 h. He does not drink alcohol and has no previous medical history. He spent the previous night vomiting approximately 10–12 times aftereating some “bad chicken.” The patient is squirming on the stretcherand is retching. He is afebrile with a heart rate of 120/min and a bloodpressure of 90/60 mm Hg. Abdominal exam is positive for diffuse tenderness,but the patient has no rigidity, guarding, or rebound tenderness. There is no hepatosplenomegaly. Rectal exam is negative for occult blood. A nasogastric tube is inserted and reveals bright red blood. Which of the following is the most likely diagnosis? a. Esophageal varices b. Mallory-Weiss tear c. Gastritis d. Peptic ulcer disease e. Boerhaave syndrome f. Dieulafoy lesion
B
202. A 24-year-old HIV-positive patient who has had AIDS for 3 years presents with painful swallowing and dysphagia to solids and liquids. He has no previous history of heartburn or reflux disease. His CD4 count is 41/μL and he recently required 3 wk of antibiotics for Pneumocystis carinii pneumonia. Examination of the pharynx reveals no oral thrush. Barium swallow demonstrates multiple nodular filling defects of various sizes that resemble a “cluster of grapes.” Which of the following is the most likely diagnosis?
a. Candida esophagitis
b. Reflux disease
c. Barrett’s esophagus
d. Pneumocystis esophagitis
e. Achalasia
f. Plummer-Vinson syndrome
E
- Which of the following statements
is true regarding the liver?
a. Macronodular cirrhosis is defined as liver nodules of 3 mm c. Normal liver size is 12 cm in the midclavicular line (MCL) d. Macronodular cirrhosis is most likely due to alcohol use e. Micronodular cirrhosis is most likely due to viral infection
C
204. A 70-year-old woman with a 25-year history of diabetes mellitus presents with early satiety, bloating, and nausea after meals. She has had previous surgery for gallbladder stones and appendicitis. Her diabetes is complicated by retinopathy and peripheral neuropathy. On physical examination, bowel sounds are normal. A succussion splash is audible. The abdomen is tympanic and there is no hepatosplenomegaly. There is no tenderness. Rectal examination is normal. Serum glucose is 310 mg/dL. Which of the following is the most likely diagnosis?
a. Celiac sprue
b. Whipple’s disease
c. Gastroparesis
d. Gluten-sensitive enteropathy
e. Tropical sprue
C
