GI and Groin Signs

Question 1

What is this and what disease can they occur frequently in?

Answer 1

Aphthous mouth ulcer

• Crohn’s disease
• Ulcerative colitis

Question 2

What is this?

Answer 2

Colostomy

Question 3

Should you normally feel the spleen?

Answer 3

No - needs to be 3x normal size

Question 4

What is this called?

Answer 4

Angular stomatitis

Question 5

What is this?

Answer 5

Leukonychia

Question 6

What can glossitis be a sign of?

Answer 6

• Iron deficiency
• B12 deficiency
• Folate deficiency

Question 7

What is this?

Answer 7

Koilonychia

Question 8

What is generalised guarding suggestive of?

Answer 8

Peritonitis

Question 9

What is the difference between colostomy and ileostomy in terms of examination?

Answer 9

Normally an ileostomy is found in the RIF and colostomy in the LIF (colosotmy can be found at other sites however so be aware and probs just best to call a stoma bag suggestive of bowel resection)

Question 10

What is Caput medusae a sign of?

Answer 10

Portal hypertension due to liver disease

Question 11

What scar is Daniel Craig modeling here on his abdomen?

Answer 11

Appendicectomy

Question 12

What appearance does this patient have?

Answer 12

Anaemia

Question 13

What is angular stomatitis a sign of?

Answer 13

Iron deficiency

Question 14

Are Cullen’s or Grey-Turner’s likely to come up in an OSCE?

Answer 14

No - unless the examiner wants you to watch a patient die pretty quickly

Question 15

What is Cullen’s sign suggestive of?

Answer 15

Retroperitoneal bleed e.g. due to pancreatitis/ruptured AAA

Question 16

What is this?

Answer 16

Striae (stretch marks)

Question 17

What is Grey-Turner’s sign suggestive of?

Answer 17

Retroperitoneal bleed

Question 18

What is this bruising called?

Answer 18

Cullen’s sign

Question 19

What is this?

Answer 19

Acanthosis nigricans

Question 20

What is this bruising called?

Answer 20

Grey-Turner’s sign

Question 21

What is this most likely to be?

Answer 21

Femoral hernia

Question 22

What is this scar from?

Answer 22

Laparotomy

Question 23

What can a flap (after holding hands dorsiflexed for 15 seconds) be a sign of?

Answer 23

• Hepatic encephalopathy
• Uraemia
• CO₂ retention

Question 24

What is the abnormality here?

Answer 24

Enlarged Virchow’s node - possible metastasis of GI malignancy

Question 25

What is this most likely to be?

Answer 25

Inguinal hernia

Question 26

What can cause palmar erythema?

Answer 26

* Liver disease * Pregnancy

Question 27

What is xanthelasma a sign of?

Answer 27

Hyperlipidaemia

Question 28

What does this patient show and what may they be at risk of?

Answer 28

Track marks from IV drug use - Risk of BBV including Hep B and C

Question 29

What can cause stretch marks?

Answer 29

* Pregnancy * Cushing's * Chronic abdominal distension (with/without loss of distension e.g. after ascites)

Question 30

What can cause acanthosis nigricans?

Answer 30

* GI adenocarcinoma * Obesity

Question 31

What procedure is this scar from?

Answer 31

C-section

Question 32

What is a significant number of spider naevi on the chest suggestive of?

Answer 32

Chronic liver disease

Question 33

What is this a sign of?

Answer 33

Oral candidiasis - possibly due to immunodeficiency

Question 34

What is dupuytren's contracture associated with?

Answer 34

* Alcohol excess * Family history

Question 35

What is this?

Answer 35

Caput Medusae

Question 36

What is this a sign of?

Answer 36

Significant anaemia

Question 37

Should you normally feel the liver?

Answer 37

No

Question 38

What GI problems can cause finger clubbing?

Answer 38

* IBD * Cirrhosis * Coeliac disease

Question 39

Should you normally feel the gallbladder?

Answer 39

No

Question 40

What can excessive bruising suggest?

Answer 40

Abnormal coagulation secondary to liver failure

Question 41

What is tinkling bowel sounds suggestive of?

Answer 41

Bowel obstruction

Question 42

What is this?

Answer 42

Xanthelasma

Question 43

What does this patient have?

Answer 43

Abdominal distension (due to ascites)

Question 44

What does this patient show and what can it be a result of?

Answer 44

Excoriations Itching due to cholestasis

Question 45

What is this sign and what does it suggest?

Answer 45

Coffee bean sign Sigmoid volvulus

Question 46

How many spider naevi on the chest are relevant?

Answer 46

\>5

Question 47

What is rebound tenderness a sign of?

Answer 47

Peritonitis

Question 48

What is this?

Answer 48

Spider naevi

Question 49

What happens in Dupuytren's contracture?

Answer 49

Thickening of the palmar fascia

Question 50

What signs can you see here?

Answer 50

* Glossitis * Angular stomatitis

Question 51

What does this AXR show?

Answer 51

Large bowel obstruction

Question 52

What does this AXR show?

Answer 52

Small bowel obstruction

Question 53

What is this?

Answer 53

Dupuytren's contracture

Question 54

What can cause leukonychia?

Answer 54

Hypoalbuminaemia - (liver failure)

Question 55

What is this a sign of?

Answer 55

Jaundice i.e. hyperbilirubinaemia

Question 56

What is absent bowel sounds suggestive of?

Answer 56

* Ileus * Peritonitis

Question 57

What is the abnormality and what may it be suggestive of?

Answer 57

Gynaecomastia May suggest liver cirrhosis

Question 58

What is this?

Answer 58

Ileostomy

Question 59

What can cause koilonychia?

Answer 59

Chronic iron deficiency

Question 60

What is this?

Answer 60

Palmar erythema

Question 61

What appearance does this patient have?

Answer 61

Jaundice

Question 62

What is this?

Answer 62

Finger clubbing

Question 63

With your hand over the deep inguinal ring and asking the patient to cough, the hernia re-appears, what is the likely type of hernia?

Answer 63

Direct inguinal hernia

Question 64

What is the site of weakness in a direct inguinal hernia?

Answer 64

Hesselbach's Triangle

Question 65

What does the viscera pass through in an indirect inguinal hernia?

Answer 65

Deep inguinal ring

Question 66

Where does bowel herniate into in a femoral hernia?

Answer 66

Femoral ring