Gastrointestinal Examination

Question 1

what can cause a flapping tremor?

Answer 1

hepatic encephalopathy

Question 2

on examination, list changes which can be seen on the nails and what causes them?

Answer 2

clubbing (cirrhosis, IBD, coeliacs)
leukonychia -milk spots on nails - (hypoalbuminaemia in liver disease)
koilonychia - spooning of nails - (iron deficiency anaemia)

Question 3

on examination, what changes can be seen on the hands and what causes them?

Answer 3

palmar erythema (hyperdynamic circulation from increased oestrogen in liver disease and pregnancy)
Dupuytren’s contracture (familial, liver disease)
fingertip capillary glucose monitoring marks (diabetes)

Question 4

on examination, what changes can be seen in the eyes? causes?

Answer 4

sclera for jaundice (liver disease)
conjunctival pallor (anaemia eg bleeding, malabsorption)
periorbital xanthelasma (hyperlipidaemia in cholestasis)

Question 5

what changes can be seen in the mouth?

Answer 5

glossitis/stomatitis (iron/B12 deficiency anaemia)
aphthous ulcers (IBD) 
breath odor (eg faeculent in obstruction, ketotic in ketoacidosis, alcohol)
lichen planus, xerostomia, angioedema

Question 6

Virchow’s node?

Answer 6

shows gastric malignancy - found in the supraclavicular fossa

Question 7

what may be present on back inspection?

Answer 7

spider naevi (>5 significant) 
skin lesions (immunosuppression)

Question 8

what may be present on chest inspection?

Answer 8

spider naevi (>5 significant)
gynaecomastia, loss of axillary hair (increase oestrogen in liver disease/pregnancy)

Question 9

name so signs which may be present on abdominal inspection, and what may be the causes of these signs?

Answer 9

distension (5F’s)
incisional hernias - ask the patient to cough
scars, striae (pregnancy, Cushing’s)
spider naevi
distended portal-systemic anastomoses (portal hypertension)

Question 10

on superficial palpation, what are we checking for?

Answer 10

tenderness

guarding and rebound tenderness (peritonitis)

Question 11

on deep palpation, what are we checking for?

Answer 11

masses, deep tenderness

if relevant, Rovsing’s sign (appendicitis) and Murphy’s sign (cholecystitis)

Question 12

hepatomegaly may indicate what?

Answer 12

metastasis/HCC
cirrhosis
hepatitis
RVF
leukaemia/lymphoma

Question 13

splenomegaly may indicate what?

Answer 13

lymphoma/leukaemia
myelofibrosis
malaria
portal hypertension
haemolysis

Question 14

spleen vs kidney

Answer 14

can’t get above it spleen
spleen notched
spleen not ballotable
spleen moves down on inspiration

Question 15

kidney ballot occurs at the renal angle - true or false?

Answer 15

true

Question 16

you ballot the kidney by flexing your metatarsophalangeal joint in your hand - true or false?

Answer 16

false. metacarpophalangeal joint in the hand.

- metatarsophalangeal joint is in your foot -

Question 17

what type of mass is a AAA? pulsatile or expansile?

Answer 17

expansile

Question 18

tympanic on percussion would suggest…

Answer 18

flatus

Question 19

when is a dull percussion note heard on the spleen?

Answer 19

only when the spleen is enlarged

Question 20

“tinkling noise on auscultation would be suggestive of obstruction” - true or false

Answer 20

true

Question 21

where is aortic and renal bruits listened at?

Answer 21

1cm superior and lateral to umbilicus bilaterally

Question 22

what would ankle oedema be suggestive of?

Answer 22

hypoalbuminaemia

Question 23

what additional equipment is required for a PR examination?

Answer 23

apron and gloves
lubricant
gauze

Question 24

on inspection of the buttocks, what would you be looking for?

Answer 24

any blood, rashes, fistulae, fissures, excoriations and wa

Question 25

asking the pateint to squeeze their bottom checks for anal sphincter competency - true or false?

Answer 25

true

Question 26

what additional surfaces would you check in a PR exam?

Answer 26

feel for prostate and cervix

Question 27

how would you describe a hernia?

Answer 27

(SSSCCCTTT): Site, Size, Shape, Consistency, Contours, Colour, Tenderness, Temperature, (Transillumination)

Question 28

why is it important to check dentition during a GI exam?

Answer 28

could be indicative of (excessive) vomiting