Chapter 11: The Abdomen

Question 1

Dilated veins visible upon inspection of the abdomen may be indicative of…

Answer 1

…hepatic cirrhosis or inferior vena cava obstruction.

p. 453

Question 2

Pink-purple striae may indicate…

Answer 2

…Cushing’s syndrome.

p. 453

Question 3

What percentage of healthy individuals have abdominal bruits?

Answer 3

4 to 20%

p. 454

Question 4

When is a bruit concerning?

Answer 4

When is has both systolic and diastolic components

p. 454

Question 5

In what conditions might you hear a friction rub in the liver or spleen?

Answer 5

hepatoma, gonococcal infection around the liver, splenic infarction, and pancreatic carcinoma
p. 455

Question 6

Involuntary ridigity of the abdomen suggests…

Answer 6

…peritoneal inflammation.

p. 455

Question 7

What is a positive splenic percussion sign?

Answer 7

A change in percussion note from tympany to dullness on inspiration.

Question 8

What is a positive Rovsing’s sign?

Answer 8

Pain in the RLQ during LEFT-sided palpation and release. (indicative of appendicitis)
p. 468

Question 9

How do you test for a psoas sign?

Answer 9

Place your hand just above the patient’s right knee and ask the patient to raise that thigh against your hand. Alternatively, ask the patient to turn onto the left side. Then extend the patient’s right leg at the hip. Flexion of the leg at the hip makes the psoas muscle contract.
Increased abdominal pain with either maneuver constitutes a positive psoas sign.
p. 468

Question 10

What is the significance of a positive psoas sign?

Answer 10

Increased abdominal pain on either maneuver suggests irritation of the psoas muscle by an inflamed appendix.
p. 468

Question 11

How do you test for an obturator sign?

Answer 11

Flex the patient’s right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. This maneuver stretches the internal obturator muscle.
Right hypogastric pain constitutes a positive obturator sign.
p. 468

Question 12

What is the significance of a positive obturator sign?

Answer 12

It suggests irritation of the obturator muscle by an inflamed appendix.
p. 468

Question 13

How do you check for Murphy’s sign?

Answer 13

Hook your left thumb or the fingers of your right hand under the costal margin at the point where the lateral border of the rectus muscle intersects with the costal margin. Ask the patient to take a deep breath. Watch the patient’s breathing and note the degree of tenderness. A sharp increase in tenderness with a sudden stop in inspiratory effort constitutes a positive Murphy’s sign.
p. 468

Question 14

What is the significance of a positive Murphy’s sign?

Answer 14

It indicates acute cholecystitis.

p. 468

Question 15

What is a ventral hernia?

Answer 15

A hernia in the abdominal wall exclusive of groin hernias.

p. 468

Question 16

The cause of intestinal obstruction or peritonitis may be missed by overlooking a…

Answer 16

…strangulated femoral hernia.

p. 468

Question 17

When trying to differentiate between a mass in the abdominal wall vs a mass in the abdominal cavity, it is important to remember…

Answer 17

…a mass in the abdominal wall remains palpable when the patient flexes the abdominal muscles, but an intra-abdominal mass is obscured by muscular contraction.
p. 469