Ch 2 & Ch 3 Physical Exam Flashcards by Chris Weber

Patient’s bladder should be:

Empty

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Approach from the patient’s:

Right side

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Placed over patient’s chest for warmth and privacy

Towel

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Begin inspecting the abdomen from a _____ position on the patient’s right side while the patient is laying down.

Seated

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Contracts the rectus abdominis muscles

Cause the rectus to contract or show signs of separation indicative of diastasis recti, hernias or certain masses

Raising of the head off of the table

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Bluish periumbilical discoloration

-suggests intraabdominal blooding

Cullen sign

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Bluish flank discoloration

-Suggests retroperitoneal or intraabdominal bleeding

Gray-Turner sign

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Purplish striae are indicative of:

Recent striae of recent origin are pink or blue but turn silvery gray/white over time.

Cushing disease

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Umbilicus should be free of:

Inflammation

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Umbilical swelling or bulges indicate:

Hernia

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Asymmetrical distention seen on inspection may indicate:

Hernia, tumors, cysts, bowel obstruction, or enlargement of abdominal organs

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Once inspection is completed the next step is:

Auscultation

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What do you want to auscultate for?

Bowel and vascular sounds (bruits, friction rubs, venous hums)

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How many bowel sounds are supposed to be heard per minute?

5-35

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How long do you have to auscultate for absent bowel sounds?

5 minutes

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Loud prolonged gurgles

Borborygmi

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Increased bowel sounds can be created by:

Gastroenteritis

Early intestinal obstruction

Hunger

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High pitched tinkling sounds suggest:

Intestinal fluid and air under pressure, as in early obstruction

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Decreased bowel sounds occur with:

Peritonitis and paralytic ileus

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High pitched sounds associated with respiration are indicative of:

Friction ribs

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Venus hums can be heard with the bell of the stethoscope in the epigastric region and around the:

Umbilicus

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Harsh or musical intermittent auscultatory sounds

Reflect blood flow turbulence and indicate vascular disease

Bruits

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Listen for bruits at:

Aortic

Renal

Iliac

Femoral

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Percussion to determine the lower border of liver

Umbilicus and percuss upward along the midclavicular line

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Percussion to determine the upper border of liver

Nipple line and percuss downward along the midclavicular line to determine the upper border of the liver

You may hear a small area of splenic dullness from the:

Sixth rib to the Tenth rib

The dullness of a healthy spleen is often obscured by the:

Tympany of colonic air

The gastric bubble is _____ in pitch than normal tympany of the intestine

Lower

Percuss the kidneys over the __________ angle

Costovertebral

Excessive intraabdominal fluid build-up

Ascites

Palpation technique used to assess a floating mass

Ballottement

Perform _______ ballottement to determine the presence and size of the mass

Bi-manual

Elicited if the removal of your hand causes a sharp stabbing pain at the site of peritoneal inflammation

Positive Blumberg sign

Rebound tenderness over the right lower quadrant suggests appendicitis.

McBurney's sign

McBurney's point is located how far from the Anterior Superior Iliac Spine (ASIS) on a straight line to the umbilicus

2 inches (or 1/3)

Iliopsoas muscle test with abdominal pain is considered positive for:

"psoas sign"

When would conduct an Obturator muscle test when you suspect:

Appendicitis or a pelvic abscess

Murphy's sign assesses for:

Gallbladder irritation or inflammation

Murphy's sign is present and is suggestive for:

Cholecystitis

Scaphoid or concave contour is seen in:

Thin adults

Rounded or convex abdomen is the result of:

Fat or poor muscle tone

Liver span is greater in:

Males and tall persons

What mimics dullness of splenic enlargement?

Full stomach and intestinal feces

Mimic abdominal masses

Muscles, arteries, and feces

Signs of physiologic problems

Jaundice, cyanosis, and ascites

Cullen sign suggests:

Intrabdominal bleeding

Gray-Turner sign is suggestive of:

Retroperitoneal or intraabdominal bleeding

A pearl-like umbilical node suggests:

Intraabdominal lymphoma

Scarring from previous surgery is associated with:

Internal adhesions

Distention is caused by:

Obesity, enlarged organs, fluid, or gas

Venous hum is caused by:

Increased portal and systemic circulation

Rigidity occurs over:

Peritoneal irritation

Rectal exam can be performed in any of the following positions:

Knee-chest Left Lateral with hips and knees flexed Standing with hips flexed and upper body supported by exam table

Equipment used for a rectal exam

Gloves Water-soluble lubricant Penlight Drapes Fecal occult blood testing materials

This will make fistulas, fissures, rectal prolapse, polyps, and internal hemorrhoids readily apparent

Ask the patient to bear down

A lax sphincter could indicate:

Neurological injury or deficit

What are you looking for when you palpate the posterior, lateral, and anterior rectal walls?

Nodules, masses, polyps, tenderness or other irregularities

What surface is the prostate gland located?

Posterior surface of the gland will be palpable on the anterior rectal wall

Divides the prostate into right and left halves

Prostatic sulcus

Healthy prostate size

4 cm

How much of the prostate is protruded in the rectum?

1 cm

Causes of the median sulcus to be obliterated

Hypertrophy or neoplasm

Prostate Rubbery or boggy consistency is indicative to

Benign hypertrophy or Infection | normal in older adults

What kind of uterus may be palpable during a rectal exam?

Retroflexed or retroverted

The cervix may be palpable through the _____ wall

What requires a DRE?

Persistent pencil like stool Light tan/gray stools Tarry black stool Bright red stool

Type of stool that may indicate permanent stenosis from scaring or presence of malignancy

Persistent pencil like stool

Type of stool that is caused by obstructive jaundice

Light/tan/gray stool

Type of stool that is caused by an upper GI bleed

Tarry black stool

Type of stool that is caused by a lower GI bleed

Bright red blood in stool

Past Medical Hx All patients should assessed for a history of:

Colorectal cancer Hemorrhoids Surgery Spinal cord injury

Past Med Hx Data that is pertinent to females includes:

Episiotomy Fourth-degree laceration during delivery History of related cancers

Personal and social history questions should center around:

Bowel habits/characteristics Travel History Dietary patterns Risks for colorectal cancer (alcohol, smoking, diet) Prostatic cancer Use of alcohol

Skin around the anus appears more _____ than the rest of the perineum

Coarser and more darkly pigmented

Upon normal palpation, the prostate feels like a:

Pencil eraser (firm, smooth, slightly moveable)

Rectal pain is indicative of:

Local disease

Prostate enlargement is classified by the:

Amount protruding into rectum

Stony, hard nodular prostate suggest:

Carcinoma Calculi Chronic fibrosis

Fluctuant softness of the prostate suggests:

Prostatic abscess

Tenderness and inflammation of the perianal area suggest:

Abscess Anorectal fistula or fissure Pilonidal cyst Pruritus ani (rectus itching)