Clinical Examination of Abdomen/GU

Question 1

What are the red flags for testicular cancer?

Answer 1

Hard, discrete and claggy lumps

Question 2

What is a red flag for endometrial carcinomas?

Answer 2

Post menopausal bleeding

Question 3

What indicates a possible differential diagnosis of pancreatic cancer

Answer 3

Painless jaundice and fatty stools (non functioning pancreatic enzymes)

Question 4

What are the GI causes of clubbing?

Answer 4

MILC;
Malabsorption,
Inflammatory bowel disease,
Lymphoma,
Cirrhosis

Question 5

What is asterixis a sign of?

Answer 5

(course flapping tremor) which occurs with hepatic encephalopathy

Question 6

What is leuconychia?

Answer 6

white discolouration on the nail beds

Question 7

Name some potential findings upon close inspection of the hands

Answer 7

Palmar erythema - Potentially cirrhosis or liver disease.
Dupuytrens contracture - Alcohol excess.
Spider Naevus - potential liver disease,
Purpura - Low platelets associated with liver dysfunction

Question 8

What are some potential findings on close inspection of the face and mouth

Answer 8

• Jaundice - Yellowing of skin or sclera due to excess bilirubin.
• Pale conjuntiva,
• Stomatitis,
• Glossitis,
• Candidiasis,
• telangiectasia (can be sun damage related),
• Gingivitis

Question 9

What are you looking for when doing a close inspection of the chest and axilla?

Answer 9

Spider naevi, gynaecomastia and loss of axillary hair.

Question 10

When examining the abdomen what should you think when it is distended?

Answer 10

5 F’s - Fat, fluid, faeces, flatus (gas) or foetus

Question 11

When palpating the abdomen what are you palpating for?

Answer 11

Tenderness (guarding or re-bound tenderness), masses, organomegaly and abdo aorta. Make sure to watch the patients face.

Question 12

How do you palpate for hepatomegaly?

Answer 12

• Liver moves with respiration, it descends with inspiration. Start at right iliac fossa and ask patient to breath in and out deeply. Palpate upwards to right costal margin and feel for liver edge.

Question 13

What are some of the causes of hepatomegaly?

Answer 13

Hepatitis, alcohol liver disease, right heart failure, fatty infiltration, biliary tract obstruction, malignancy or haematological disorders

Question 14

What is Murphy’s sign?

Answer 14

• Method of feeling for gall bladder tenderness. Patient breaths whilst palpation of RUQ, mid clavic line. On liver descent contact with inflamed gallbladder causes tenderness and sudden arrest of inspiration

Question 15

What is Courvoisier’s sign?

Answer 15

• Painless jaundice and a palpable gallbladder which is likely due to extrahepatic obstruction eg, pancreatic cancer

Question 16

How can you palpate for splenomegaly?

Answer 16

Spleen descends on inspiration, ask the patient to breath in and out deeply and palpate upwards to left hypochondrium. Move hands between each breath.

Question 17

What are some of the causes of splenomegaly?

Answer 17

Haematological, infective, portal hypertension, rheumatological disorders and more rare causes eg, sarcoidosis, amyloidosis or glycogen storage disease

Question 18

What are some of the causes of renal enlargement?

Answer 18

Hyponephrosis, polycystic kidney disease, renal cell carcinoma, wilm’s tumour or solitary cysts.

Question 19

What are some causes of ascites?

Answer 19

Hepatic cirrhosis, intra-abdominal malignancy, nephrotic syndrome, pancreatitis and constrictive pericarditis etc

Question 20

What are the indications for a rectal examination?

Answer 20

Rectal bleeding, prostatic symptoms, a change in bowel habits and a possible spinal cord injury

Question 21

What is a bi-manual pelvic exam?

Answer 21

One hand palpates per vagina and the other per abdomen

Question 22

What are some indications for a pelvic examination?

Answer 22

Pelvic pain, abnormal vaginal bleeding or discharge and if considering a vaginal or uterine prolapse