GI

Question 1

Order of GI exam

Answer 1

Inspect
Auscultate
Percuss
Palpate

Question 2

Normal bowel sounds

Answer 2

Tympanitic

Question 3

Effect of inspiration on liver and spleen position

Answer 3

Moves them downward

Question 4

On what side of the patient do you stand during the GI exam

Answer 4

Right side

Question 5

AAA size

Answer 5

> 3cm diameter

Question 6

Striae

Answer 6

Large purple colored stretch marks seen in Cushing’s disease & steroid use

Question 7

Large normal colored stretch marks

Answer 7

Pregnancy
Weight gain
Rapid growth

Question 8

Dark line of pigmentation during pregnancy

Answer 8

Linea nigra

Question 9

Normal venous flow

Answer 9

upwards above umbilicus and downwards below umbilicus

Question 10

Caput medusae indication

Answer 10

IVC/portal venous obstruction

Question 11

SVC obstruction

Answer 11

Shunt blood downward

Question 12

Separation of rectus abdominis muscle

Answer 12

Diastasis recti (ridge when they lift head up in supine position)

Question 13

Free intraperitoneal fluid

Answer 13

Acites

Question 14

Suprapubic buldge

Answer 14

Full bladder
Tumor mass
Pregnancy

Question 15

Increased visible peristaltic activity

Answer 15

Intestinal obstruction/gastroenteritis

Question 16

Pulsations

Answer 16

AAA

Question 17

Surgical incisions

Answer 17

Subcostal
Median
Left paramedic
Gridiron (McBurney's pt.)
Transverse
Pfannenstiel (hysterectomy)

Question 18

Hyperactive gastric sounds

Answer 18

• Gastroenteritis
• Early intestinal obstruction
• Peritonitis
• Borborygmi

Question 19

High pitched tinkling bowel sounds

Answer 19

• Mechanical obstruction

* intestinal fluid under pressure

Question 20

Hypoactive bowel sounds

Answer 20

• Peritonitis

* Paralytic ileus

Question 21

Normal liver size

Answer 21

6-12cm

Question 22

Hepatomegaly

Answer 22

• Congestive heart failure
• Cirrhosis
• Hepatitis
• Abcess
• Tumor
• Cyst

Question 23

T/F; acites fluid flows to dependent part of abdominal cavity

Answer 23

True

Question 24

Test for acites

Answer 24

• Shifting dullness
• Fluid wave
• Succussion splash

Question 25

How to get rid of free abdominal fluid

Answer 25

Paracentesis

Question 26

Splenomegaly

Answer 26

* Mononucleosis * other infections * hematologic disorders * Cirrhosis w/ portal HTN * cysts * hypersplenism

Question 27

Upper abdominal refles

Answer 27

T7-T9

Question 28

Lower abdominal reflex

Answer 28

T11-T12

Question 29

Cremasteric reflex

Answer 29

T12-L2

Question 30

Common site of pain on palpation for diverticulitis

Answer 30

LLQ

Question 31

Explosive excruciating pain

Answer 31

* Coronary occlusion * Biliary colic * Ruptured viscus (peptic ulcer/bowel) * Ruptured aneurysm * Renal colic

Question 32

Severe constant pain

Answer 32

* Acute pancreatitis * Bowel strangulation * Mesenteric thrombosis

Question 33

Gradual onset steady pain

Answer 33

* Acute cholecystitis * Acute appendicitis * Diverticulitis * PID

Question 34

Intermittent colicky pain

Answer 34

* Subacute pancreatitis | * Mechanical small bowel obstruction

Question 35

Tests for acute appendicitis

Answer 35

* Rebound tenderness * Rovsing's sign * Psoas sign * Obturator sign * Rectal exam

Question 36

Psoas sign technique

Answer 36

* Raise right knee against resistance (tenses iliopsoas) | * pt lying on left side, hyper-extend right thigh (stretches iliopsoas)

Question 37

Obturator sign technique

Answer 37

right FADIR (stretches obturator)

Question 38

On what side do you do Rovsing's sign

Answer 38

Left, pain on right

Question 39

Test for liver inflammation

Answer 39

Murphy's sign

Question 40

Murphy's sign techique

Answer 40

* indirect percussion | * Palpation under costal margin and pt takes a deep breath

Question 41

Alternate murphy's sign

Answer 41

Hook of left thumb under right costal margin and take a deep breath- sudden cessation of inspiration = cholecystitis or liver inflammation