Competency

Question 1

hyperactive auscultation

Answer 1

(> 34 clicks/ gurgles/min): diarrhea, early intestinal obstruction

Question 2

hypoactive auscultation

Answer 2

(< 5 clicks/ gurgles/min): peritonitis

Question 3

normal auscultation

Answer 3

5-34 clicks or gurgles every min

Question 4

abdominal screening options

Answer 4

fist percussion
finger percussion
palpation

Question 5

kehrs sign

Answer 5

abdominal screening
left shoulder pain with palpation/pressure placed on upper abdomen

Question 6

renal disease or irritation screening

Answer 6

percussion
palpation

Question 7

hepatomegaly screening

Answer 7

finger percussion
fist percussion
palpation

Question 8

cholecystitis screening

Answer 8

murphys sign

Question 9

splenomegaly screening

Answer 9

finger percussion
fist percussion
palpation

Question 10

appendicitis screening

Answer 10

palpation of McBurney’s point
Rovsing sign

Question 11

peritonitis screening

Answer 11

rebound testing

Question 12

Slightly lift tested side from table by placing hand under posterior surface of inferior costal margin and lifting
Palpate anteriolateral abdomen between umbilicus & inferior costal margin

Abnormal Findings:
Tenderness
Enlargement
Rough surface

Answer 12

kidney palpation

Question 13

Place the left hand (open) on pt’s thorax with the 2nd or 3rd digit along mid-clavicular line
Beginning with 2nd or 3rd digit inferior to inferior border of liver, percuss dorsum of digit and observe for sound quality
Repeat as the hand is re-positioned cephalically

Abnormal Findings: Span of dull sound > 10 cm

Answer 13

liver finger percussion

Question 14

Dummy Hand: Over anteriolateral surface of right inferior ribs
Percuss with fist on dorsum of dummy hand

Abnormal Findings: Tenderness with percussion

Answer 14

liver fist percussion

Question 15

Slightly lift right side from table by placing left hand under posterior surface of inferior costal margin and lifting
Palpate with pads of fingers anteriolateral abdomen inferior to costal margin
Instruct pt to inhale deeply, as you palpate posteriorly & superiorly
At maximal inspiration, displace fingers anteriorly

Abnormal Findings: ability to palpate anterior edge of liver

Answer 15

liver palpation

Question 16

Standing, left side of pt.
Percuss inferior intercostal space that is vertically aligned with the anterior axillary line
Repeat at full inspiration

Abnormal Findings:
Dullness, or dullness with full inspiration

Answer 16

Castell’s finger percussion of the spleen

Question 17

Examiner Position: Standing to left side of pt.
Percuss area overlaying the spleen
Abnormal Findings: Tenderness with percussion

Answer 17

spleen fist percussion

Question 18

Examiner Position: Standing superior to pt’s left shoulder
Curl fingertips under left costal margin in posterior & superior direction

Abnormal Findings: Palpable Spleen

Answer 18

Middleton palpation method

Question 19

Examiner Position: Standing to right side of pt.
Slightly lift right side from table by placing left hand under posterior surface of inferior costal margin and lifting
Palpate with pads of fingers anteriolateral abdomen inferior to costal margin
Instruct pt to inhale deeply, as you deeply palpate right upper quadrant

Abnormal Findings:
Tenderness
Inspiratory arrest

Answer 19

Murphy’s sign for the gallbladder

Question 20

Deep palpation at a point 1/2 – 1/3 distance from the ASIS to the umbilicus
Rebound tenderness has also been described

Abnormal Findings: Tenderness

Answer 20

palpation of McBurney’s point (appendix)

Question 21

Examiner Position: Standing to right side of pt.
Rebound tenderness testing administered at the lower left quadrant

Abnormal Findings: right lower quadrant tenderness with remote rebound testing at the left lower quarter

Answer 21

Rovsing signs for appendix

Question 22

Gently grasp a fold of abdominal skin over McBurney’s point and pull away
Allow the skin to quickly recoil back against peritoneum

Positive Test: pain upon release of the skin fold

Answer 22

Pinch an inch

for appendix or peritonitis

Question 23

Examiner Position: Standing to right side of pt.
Rebound tenderness is administered in each quadrant

Abnormal Findings: Tenderness

Answer 23

rebound tenderness for peritonitis

Question 24

psoas
- ACTIVE– Iliopsoas muscle test– have the Pt actively perform a SLR and apply resistance to the distal thigh

• PASSIVE– place client in supine position and have them unweight their leg from you as you are palpating

heel tap– Gently pick up the pt’s involved leg and tap the heel
–> Positive test: RLQ pain

obturator muscle test– resisted IR (make sure hip is in ABD)

Answer 24

obturator or psoas abscess

Question 25

Administer finger percussion in supine
If pattern of dullness observed in perimeter of abdomen, repeat in side-lying
Abnormal Findings: Dullness shifts to dependent side during side-lying position

Answer 25

shifting dullness for ascites

Question 26

Tap one side with fingertips while palpating other side

Abnormal Findings: Palpable fluid wave

Answer 26

fluid wave for ascites

Question 27

Palpate (deep palpation) for aortic pulse superior & slightly left of umbilicus
Place palms on abdomen with index fingers on each side of aorta

Abnormal Findings: width > 3cm

Answer 27

abdominal aortic aneurysm