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Gastrointestinal > Ch 2 & Ch 3 Physical Exam > Flashcards

Ch 2 & Ch 3 Physical Exam Flashcards

1
Q

Patient’s bladder should be:

A

Empty

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2
Q

Approach from the patient’s:

A

Right side

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3
Q

Placed over patient’s chest for warmth and privacy

A

Towel

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4
Q

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

A

Seated

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5
Q

Contracts the rectus abdominis muscles

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

A

Raising of the head off of the table

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6
Q

Bluish periumbilical discoloration

-suggests intraabdominal blooding

A

Cullen sign

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7
Q

Bluish flank discoloration

-Suggests retroperitoneal or intraabdominal bleeding

A

Gray-Turner sign

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8
Q

Purplish striae are indicative of:

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

A

Cushing disease

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9
Q

Umbilicus should be free of:

A

Inflammation

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10
Q

Umbilical swelling or bulges indicate:

A

Hernia

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11
Q

Asymmetrical distention seen on inspection may indicate:

A

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

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12
Q

Once inspection is completed the next step is:

A

Auscultation

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13
Q

What do you want to auscultate for?

A

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

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14
Q

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

A

5-35

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15
Q

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

A

5 minutes

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16
Q

Loud prolonged gurgles

A

Borborygmi

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17
Q

Increased bowel sounds can be created by:

A

Gastroenteritis

Early intestinal obstruction

Hunger

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18
Q

High pitched tinkling sounds suggest:

A

Intestinal fluid and air under pressure, as in early obstruction

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19
Q

Decreased bowel sounds occur with:

A

Peritonitis and paralytic ileus

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20
Q

High pitched sounds associated with respiration are indicative of:

A

Friction ribs

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21
Q

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

A

Umbilicus

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22
Q

Harsh or musical intermittent auscultatory sounds

Reflect blood flow turbulence and indicate vascular disease

A

Bruits

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23
Q

Listen for bruits at:

A

Aortic

Renal

Iliac

Femoral

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24
Q

Percussion to determine the lower border of liver

A

Umbilicus and percuss upward along the midclavicular line

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25
Q

Percussion to determine the upper border of liver

A

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

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26
Q

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

A

Sixth rib to the Tenth rib

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27
Q

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

A

Tympany of colonic air

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28
Q

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

A

Lower

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29
Q

Percuss the kidneys over the __________ angle

A

Costovertebral

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30
Q

Excessive intraabdominal fluid build-up

A

Ascites

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31
Q

Palpation technique used to assess a floating mass

A

Ballottement

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32
Q

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

A

Bi-manual

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33
Q

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

A

Positive Blumberg sign

34
Q

Rebound tenderness over the right lower quadrant suggests appendicitis.

A

McBurney’s sign

35
Q

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

A

2 inches (or 1/3)

36
Q

Iliopsoas muscle test with abdominal pain is considered positive for:

A

“psoas sign”

37
Q

When would conduct an Obturator muscle test when you suspect:

A

Appendicitis or a pelvic abscess

38
Q

Murphy’s sign assesses for:

A

Gallbladder irritation or inflammation

39
Q

Murphy’s sign is present and is suggestive for:

A

Cholecystitis

40
Q

Scaphoid or concave contour is seen in:

A

Thin adults

41
Q

Rounded or convex abdomen is the result of:

A

Fat or poor muscle tone

42
Q

Liver span is greater in:

A

Males and tall persons

43
Q

What mimics dullness of splenic enlargement?

A

Full stomach and intestinal feces

44
Q

Mimic abdominal masses

A

Muscles, arteries, and feces

45
Q

Signs of physiologic problems

A

Jaundice, cyanosis, and ascites

46
Q

Cullen sign suggests:

A

Intrabdominal bleeding

47
Q

Gray-Turner sign is suggestive of:

A

Retroperitoneal or intraabdominal bleeding

48
Q

A pearl-like umbilical node suggests:

A

Intraabdominal lymphoma

49
Q

Scarring from previous surgery is associated with:

A

Internal adhesions

50
Q

Distention is caused by:

A

Obesity, enlarged organs, fluid, or gas

51
Q

Venous hum is caused by:

A

Increased portal and systemic circulation

52
Q

Rigidity occurs over:

A

Peritoneal irritation

53
Q

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

A

Knee-chest

Left Lateral with hips and knees flexed

Standing with hips flexed and upper body supported by exam table

54
Q

Equipment used for a rectal exam

A

Gloves

Water-soluble lubricant

Penlight

Drapes

Fecal occult blood testing materials

55
Q

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

A

Ask the patient to bear down

56
Q

A lax sphincter could indicate:

A

Neurological injury or deficit

57
Q

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

A

Nodules, masses, polyps, tenderness or other irregularities

58
Q

What surface is the prostate gland located?

A

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

59
Q

Divides the prostate into right and left halves

A

Prostatic sulcus

60
Q

Healthy prostate size

A

4 cm

61
Q

How much of the prostate is protruded in the rectum?

A

1 cm

62
Q

Causes of the median sulcus to be obliterated

A

Hypertrophy or neoplasm

63
Q

Prostate

Rubbery or boggy consistency is indicative to

A

Benign hypertrophy or Infection

normal in older adults

64
Q

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

A

Retroflexed or retroverted

65
Q

The cervix may be palpable through the _____ wall

A

Anterior

66
Q

What requires a DRE?

A

Persistent pencil like stool

Light tan/gray stools

Tarry black stool

Bright red stool

67
Q

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

A

Persistent pencil like stool

68
Q

Type of stool that is caused by obstructive jaundice

A

Light/tan/gray stool

69
Q

Type of stool that is caused by an upper GI bleed

A

Tarry black stool

70
Q

Type of stool that is caused by a lower GI bleed

A

Bright red blood in stool

71
Q

Past Medical Hx

All patients should assessed for a history of:

A

Colorectal cancer

Hemorrhoids

Surgery

Spinal cord injury

72
Q

Past Med Hx

Data that is pertinent to females includes:

A

Episiotomy

Fourth-degree laceration during delivery

History of related cancers

73
Q

Personal and social history questions should center around:

A

Bowel habits/characteristics

Travel History

Dietary patterns

Risks for colorectal cancer (alcohol, smoking, diet)

Prostatic cancer

Use of alcohol

74
Q

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

A

Coarser and more darkly pigmented

75
Q

Upon normal palpation, the prostate feels like a:

A

Pencil eraser (firm, smooth, slightly moveable)

76
Q

Rectal pain is indicative of:

A

Local disease

77
Q

Prostate enlargement is classified by the:

A

Amount protruding into rectum

78
Q

Stony, hard nodular prostate suggest:

A

Carcinoma

Calculi

Chronic fibrosis

79
Q

Fluctuant softness of the prostate suggests:

A

Prostatic abscess

80
Q

Tenderness and inflammation of the perianal area suggest:

A

Abscess

Anorectal fistula or fissure

Pilonidal cyst

Pruritus ani (rectus itching)

Gastrointestinal (3 decks)

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