GI exam

Question 1

Rovsing’s sign?

Answer 1

L iliac fossa palpation= pain in R iliac fossa

usually due to peritonitis

Question 2

Murphy’s sign?

Answer 2

right costal margin in the mid-clavicular line at the liver’s edge

deep breath

stops mid-breath due to pain= cholecystitis

Question 3

Aorta palpation- abnormal finding?

Answer 3

hands move outwards= expandable mass

e.g. AAA

Question 4

Causes of enlarged kidneys?

identified if ballotable kidneys

Answer 4

bilateral= polycystic kidney disease

unilateral= renal tumour

Question 5

Aortic bruits where to listen?

Answer 5

auscultate 1-2 cm superior to the umbilicus

linked to AAA

Question 6

Renal bruits where to listen?

Answer 6

auscultate 1-2 cm superior to the umbilicus and slightly lateral to the midline

linked to renal artery stenosis

Question 7

Examining for ascites?

Answer 7

shifting dullness:

percuss from umbilical region to left flank
roll patient to right side- dullness no longer there and resonant now= ascites

Question 8

Koilonychia?

Answer 8

spoon-shaped nails

associated with iron deficiency anaemia

Question 9

Leukonychia?

Answer 9

whitening of the nail bed

associated with hypoalbuminaemia

Question 10

Palmar erythma?

Answer 10

redness in heel of palm

linked to chronic liver disease

Question 11

Dupuytren’s contracture?

Answer 11

thickening of palmar fascia
=development of cords of palmar fascia which eventually cause contracture deformities of the fingers and thumb

*found when palpate the palm feel cords/bands

Question 12

Excoriations?

Answer 12

scratch marks that may be caused by the patient trying to relieve pruritis

Question 13

acanthosis nigricans?

Answer 13

benign or linked to: insulin resistance or GI malignancy

Question 14

Perilimbal injection?

Answer 14

inflammation of the area of conjunctiva adjacent to the iris

sign of anterior uveitis= linked to IBD

Question 15

Hyperpigmented macules?

Answer 15

Peutz-Jeghers syndrome (AD genetic disorder- polyps in GI tract)
*usually in mouth

Question 16

Virchow’s lymph node?

Answer 16

can be one of the first clinical signs of metastatic intra-abdominal malignancy

(receives lymphatic drainage from abdominal cavity)

Question 17

physiological and medical causes of gynaecomastia?

Answer 17

physiological= excess oestrogen
medical= digoxin and spironolactone

Question 18

Cullen’s sign?

Answer 18

bruising of the tissue surrounding the umbilicus associated with haemorrhagic pancreatitis (a late sign)

Question 19

Grey-Turner’s sign?

Answer 19

bruising in the flanks associated with haemorrhagic pancreatitis (a late sign)

Question 20

Sign of portal hypertension?

Answer 20

caput medusae

Question 21

stoma locations?

Answer 21

colostomies (no spout)= left iliac fossa

ileostomies and urostomies (spout)= right iliac fossa

Question 22

Causes of hepatomegaly (11)?

Answer 22

Hepatitis (infective and non-infective)
Hepatocellular carcinoma
Hepatic metastases
Wilson’s disease
Haemochromatosis
Leukaemia
Myeloma
Glandular fever
Primary biliary cirrhosis
Tricuspid regurgitation
Haemolytic anaemia

Question 23

Causes of splenomegaly (5)?

Answer 23

Portal hypertension secondary to liver cirrhosis
Haemolytic anaemia
Congestive heart failure
Splenic metastases
Glandular fever