Ch 2 & Ch 3 Physical Exam Flashcards
Patient’s bladder should be:
Empty
Approach from the patient’s:
Right side
Placed over patient’s chest for warmth and privacy
Towel
Begin inspecting the abdomen from a _____ position on the patient’s right side while the patient is laying down.
Seated
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
Bluish periumbilical discoloration
-suggests intraabdominal blooding
Cullen sign
Bluish flank discoloration
-Suggests retroperitoneal or intraabdominal bleeding
Gray-Turner sign
Purplish striae are indicative of:
Recent striae of recent origin are pink or blue but turn silvery gray/white over time.
Cushing disease
Umbilicus should be free of:
Inflammation
Umbilical swelling or bulges indicate:
Hernia
Asymmetrical distention seen on inspection may indicate:
Hernia, tumors, cysts, bowel obstruction, or enlargement of abdominal organs
Once inspection is completed the next step is:
Auscultation
What do you want to auscultate for?
Bowel and vascular sounds (bruits, friction rubs, venous hums)
How many bowel sounds are supposed to be heard per minute?
5-35
How long do you have to auscultate for absent bowel sounds?
5 minutes
Loud prolonged gurgles
Borborygmi
Increased bowel sounds can be created by:
Gastroenteritis
Early intestinal obstruction
Hunger
High pitched tinkling sounds suggest:
Intestinal fluid and air under pressure, as in early obstruction
Decreased bowel sounds occur with:
Peritonitis and paralytic ileus
High pitched sounds associated with respiration are indicative of:
Friction ribs
Venus hums can be heard with the bell of the stethoscope in the epigastric region and around the:
Umbilicus
Harsh or musical intermittent auscultatory sounds
Reflect blood flow turbulence and indicate vascular disease
Bruits
Listen for bruits at:
Aortic
Renal
Iliac
Femoral
Percussion to determine the lower border of liver
Umbilicus and percuss upward along the midclavicular line
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
Anterior
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)
