Clerical 3: Abdominal, testicular and rectal

Question 1

What routine should you follow at the start of every exam?

Answer 1

Choice
C consent
H hygiene and ppe
O offer assistance and privacy
Instruct and inform
Competence - position patient and perform exercises
Elicit and present findings

Question 2

What does IPPA stand for in clinical exam?

Answer 2

Inspection
Palpation
Percusión
Auscultation

Question 3

How should a chaperone be used for clinical exams?

Answer 3

Must be offered for all intimate exams
May be used for others
Must be a quila field healthcare professional
Is patient declines a chaperone this should be recorded in the patient notes

Question 4

How exposed should the patient be for an abdominal exam?

Answer 4

Nipple to knee - underwear allowed to be kept on

Question 5

How should the patient be positioned in an abdominal exam?

Answer 5

Fully flat on back
Head supported by pillow
Arms by side

Question 6

If the patient is is pain now should this influence the palpitation of the abdomen

Answer 6

Start palpitation in the area furthest away from pain

Question 7

What should be checked in the vernal examination for the abdominal exam?

Answer 7

Hands
Wrist - pulse
Arms
Face - eyes and mouth/tongue
Neck - lymph nodes
Chest
Legs

Question 8

What are the different parts of the abdominal exam?

Answer 8

Inspection
Palpitation
Percussion
Auscultation
Hernial orifices, rectal examination, consider external genital exam
Always offer urinalysis and consider vaginal, penile swabs and faeces analysis if indicated

Question 9

What is the general examination can indicate liver disease?

Answer 9

Jaundice
Pitting oedema
Heoatomegaly
Splenimegaky or small spleen
Palmar erythema

Question 10

What can cause pain in the right hyperchondriac region?

Answer 10

Gall stones
Stomach ulcer pancreatitis

Question 11

What can cause pain in the epigastric region?

Answer 11

Stomach ulcer
Heartburn indigestion
Pancreatitis
Gallstones
Epigastric hernia

Question 12

What can cause pain in the left hyoerchondriac region?

Answer 12

Stomach ulcer
Duodenal ulcer
Biliary colic
Pancreatitis

Question 13

What cause pain in the right lumbar region?

Answer 13

Kidney stones
Urine infection
Constipation
Lumbar hernia

Question 14

What causes pain in the umbilicus region?

Answer 14

Pancreatitis
Early appendicitis
Stomach ulcer
Inflammatory bowel disease
Small bowel
Umbilical hernia

Question 15

What cause pain in the left lumbar regikn?

Answer 15

Kidney stones
Constipation
Inflammatory bowel disease
Diverticula’s disease

Question 16

What cause pain in the right inguinal region?

Answer 16

Appendicitis
Constipation
Pelvic pain
Groin pain
Inguinal hernia

Question 17

What causes pain in the hypigasgric region?

Answer 17

Urine infection
Diverticula’s disease
IBD
Pelvic pain

Question 18

What causes pain in the left inguinal region?

Answer 18

Diverticula’s disease
Pelvic pain
Groin pain
Inguinal hernia

Question 19

What should you look for on the abdomen inspection?

Answer 19

Shape - normal or distended
Scars or stoma sites
Movement with respiration
Visible pulsation or peristalsis
Skin changes - erythema ab igne, spider naevi, caput medusae and stretch marks
Obvious swelling or organ megaly
Hernia
Symmetry

Question 20

How do you palpate the abdomen?

Answer 20

Ask if in any pain
Warm hands using flat of fingers
Light then deep palpitation in all nine areas - watch face for sign of uncomfortable throughout
Palpate for liver ( time with deep inspiration)
Palpate for spleen
Palpate for kidney
Palpate for aorta
Palpate for bladder

Question 21

What is being palpated for in abdominal exam?

Answer 21

Organ size
Muscle tone
tenderness Or pain
Pathological signs
* murohys sign and rovsing sign
Cough impulse at hernia orifice

Question 22

What is murphys sign?

Answer 22

Indicative of acute cholecystitis
Curl fingers/thumb around the right costal margin whilst the patient is exhaling.
Ask the patient to inhale deeply if the patient feel pain that means they need to stop inhalation - the sign is positive

Question 23

What is rovsing sign?

Answer 23

Sign of acute appendicitis
When palpating the left illiac fossa causes pain in the right illiac fossa

Question 24

What sould you percuss for in an abdominal exam?

Answer 24

Check all quadrants for normal pattern of resonance
Sidtinguish fluid from faltus is distended abdomen
Check margin of:
Liver - RIF upwards
Spleen -RIF diagonal
Bladder - downwards in the midline from the umbilical region
Test for shifting dullness

Question 25

What are you auscultating for in the abdomen?

Answer 25

Bowel sounds - should hear within 30seconds Should listen for 3 minutes before can declare the bowel sounds absent Listen for the character Listen for vascular buits from the abdomen aorta and the kidneys

Question 26

What are the causes of abdomen distention?

Answer 26

Fluid Flatus Foetus Faeces

Question 27

What exams may you request to finish the abdominal examination?

Answer 27

Examine the external genitalis Examine hernial orifice including checking for cough impulses Examine the einguinal lymph nodes Offer urinalysis and a pregnancy test in acute setting record vital signs

Question 28

What would you consider in a urinalysis?

Answer 28

Consider gross appearance (colour, turgidity and suspended soilds) Perform a dipstick test and if positive send for microscopy, culture and sensitivities

Question 29

What would you consider in a faeces analysis?

Answer 29

Colour Consistency Blood Mucus

Question 30

How do you prepare for a digital rectal exam?

Answer 30

Offer a chaperone Position patient - left lateral, knees drawn up Wash hands and wear gloves Lubricate finger.

Question 31

What is part of a digital rectal exam?

Answer 31

Inspect for skin changes such as swellings, fistulae and external haemorrhoids Palpate - use lubrication and insert with a gentle rocking notation

Question 32

What should you be looking for when palpating the rectum?

Answer 32

Anal tone/spasm (ask patient to clench around finger) Pain Feel wall of anal canal Masses (feel for prostate) Contents - stool,blood or melaena Inspet glove on removal - colour/consitentncy of faeces Describe the potision, shape and consistency of any mass

Question 33

What are the different types of hernia?

Answer 33

Incisional - anywhere on the abdomen Groin - inguinal (above and medial to pubic tubercle) - Femoral - below and lateral to pubic tubercle Direct inguinal hernia - directs through posterior wall of the inguinal canal directly through the abdominal muscles Indirect inguinal hernia - through deep inguinal ring and follows inguinal canal

Question 34

How do you set up for the male external genitalis examination?

Answer 34

Wear gloves and an apron Chaperone Patient should be positioned to start sitting/standing then lie flat

Question 35

What are you looking for on insepction of the rectum?

Answer 35

Skin excoriation Rashes haemorrhoids Anal fissure. Bleeding Fistula Absecesses

Question 36

How do you assess for rectal tone?

Answer 36

Ask patient to squeeze finger breifly.

Question 37

How to prepare for a testicilar exam?

Answer 37

Wear apron Wash hands Normal comms intro (identity, explain exam, consent) Offer chaperone

Question 38

How do you prepare a patient for a testicular examination?

Answer 38

Get behind sheet to get ready Remove underwear and trousers Lie on back - use sheet to cover Ask for permition to come back into the room, ask for permission to lift the sheet up

Question 39

What is a good way to describe the testicular and rectal exam to a patient?

Answer 39

Look and a feel of your backpassage and surrounding area Look and feel of your penis, testicules and surrounding area.

Question 40

What do you look for in the general examination of the genitalia?

Answer 40

Skin changes Rashes Ulcers Obvious deformity (ask patient to extract foreskin) Look for redness, rashes and ulcers (ask patient to lift testes up) Check for symmetry, rashes, redness and skin changes

Question 41

How do you palpate the testicle?

Answer 41

Start at the right begin at top and role the testical Repeat on other side. Starting and posterior lateral side examine for epididymis and follow up for spermatic duct May perform prehns test and cremasteric reflex.

Question 42

How do you examine the penis

Answer 42

Look underneath

Question 43

What do you perform on the external genital exam when the patient is standing up?

Answer 43

Repeat observation Pen torch look for translumination.

Question 44

What is meant by tenesus?

Answer 44

Feeling the urge to fo to the toiler but then not actually needing to go

Question 45

What questions are important to ask about abdominal pain?

Answer 45

above or below the belly button, ask patient to point. Onset related to food,bowel changes, duration, how long it lasts for. timing - sleep. worse with motion.