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IM > GI PE IM PLAT > Flashcards

GI PE IM PLAT Flashcards

1
Q

Skin

Note for

A

Presence of scars, striae, rashes, ecchymoses

Dilated veins

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2
Q

Umbilicus

A

Observe contour

Location

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3
Q

Abdominal contour

A

Round
Flat
Scaphoid
Protuberant

Local bulges
Asymmetry

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4
Q

Violaceous striae is associated

A

Cushing’s syndrome

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5
Q

Umbilical bulge is seen in

A

Ventral hernia

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6
Q

Dilated veins is seen in

A

Portal hypertension and inferior vena caval obstruction

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7
Q

Bulging flanks is associated with

A

Ascites

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8
Q

Normal auscultation findings on the abdomen

A

Clicks and gurgles 5-34 per min

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9
Q

High-pitched rumbling sounds of hyperperistalsis that correspond with crampy abdominal pain

A

Borborygmi

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10
Q

For auscultation check fr

A

Borborygmi
Bruits
Friction rubs

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11
Q

Percussion

A

Percuss the abdomen lightly in all 4 quadrants
Assess distribution in the abdomen, characteristics of palpable masses ( fluid-filled, solid) and size of liver and spleen

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12
Q

Prominent peristaltic waves may be seen in

A

Intestinal obstruction

Thin individuals

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13
Q

Liver percussion

A

Lower border of liver dullness - start at level of umbilicus, right midclavicular line, percuss cranially until dullness is noted
Upper border of liver dullness- nipple line, right midclavicular line, percuss from lung resonance down to liver dullness

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14
Q

Normal liver span

A

Right midclavicular line 6-12 cm

Midsternal line 4-8 cm

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15
Q

How does the spleen expand

A

It expands anteriorly, downward and medially and replaces the general tympanitic tone with dullness

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16
Q

How to percuss the spleen

A

Percuss the left lower anterior chest wall
From border of cardiac dullness at the 6th rib -> anterior axillary line -> down to the costal margin

Tympany is prominent -> splenomegaly unlikel

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17
Q

Obliterated Traube’s space signifies

A

Splenomegaly

Or presence of fluids /solids in the stomach or colon

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18
Q

Splenic percussion sign

A

Change in percussion note from tympany to dullness on inspiration

19
Q

Predominant percussion tone

Due to gass in the abdomen

A

Tympany

20
Q

Signifies presence of underlying mass/organ, fluid or feces

A

Dullness

21
Q

Used to elicit tenderness, muscular resistance and presence of superficial organs and masses

A

Light palpation

22
Q

How to differentiate voluntary guarding from involuntary muscular spasms by

A

Asking patient to relax

ask patient to mouth-breathe with jaw dropped open

23
Q

How to position hands when palpating for liver dullness

A

Left hand -> behind he patient at the level of right 11 and 12th ribs

Right hand-> right abdomen lateral to the rectus muscle with finger tips below the lower border of liver dullness

ask patient to breathe deeply, then try to feel the liver edge as it comes in contact: note consistency, presence of contour irregularity, and any tenderness

24
Q

Splenic palpation

A

At the patient’s right side, reach over and around the patient using the left hand to support and press forward the left
right hand -> press below the left costal margin and press in toward the spleen contour and presence of any tenderness
Ask patient to take a deep breath, feel the splenic edge, note contour and presence of any tenderness
Measure the distance between the spleen’s lowest point and left costal margin
Repeat procedure but with patient assuming a right decubitus position

25
Q

Why right decubitus position in spleen palpation

A

Places the spleen forward and to the right and makes it more accessible to palpation

26
Q

Shifting dullness is seen in

A

Ascites

27
Q

Dullness shifting to more dependent side

A

Shifting dullness

28
Q

Palpable impulse on the side opposite the pressure (with hands pressed firmly on the midline of the abdomen)

A

Fluid wave

29
Q

Pain in the RLQ during left sided pressure

Also associated with referred rebound tenderness - RLQ pain on withdrawal of pressure on left side

A

Rovsing’s sign

30
Q

Abdominal pain on hip flexion and or extension

A

Psoas sin

31
Q

Right hypogastric pain on internal rotation of the right hip

A

Obturator sign

32
Q

Extreme pain on light touch over the area bound by the umbilicus, pubic tubercle and anterior superior iliac spine

A

Cutaneous hyperesthesia

33
Q

Sharp increase in RUQ tenderness with a sudden stop in inspiratory effort while pressure is applied under the costal margin lateral oto the border of the rectus muscle

A

Murphy’s sign

34
Q

Proper positioning for DRE

A

Ask patient to lie on his/her left side,flexing his/here knees, wit buttocks close to the edge of the examination table

35
Q

DRE STEPS

A 
Proper position of patient
1. With gloved hands, spread buttocks apart and inspect immediate area for 
A. Skin lesions
B. Ulcers
C. Masses 
D. Inflammation
36
Q

Sphincter tightness may be noted in

A

Anxiety
Inflammation
Scarring

37
Q

Sphincter laxity may be noted in

A

Some neurologic diseases

38
Q

Induration may be noted due to

A

Inflammation, scarring or malignancy

39
Q

Local hardening of soft tissue, firm, but not as hard as bone

A

Induration

40
Q

Soft, pliable tags of redundant skin at anal margin

Usually seen in most individuals

A

Skin tags

41
Q

Also known as semilunar space

A

Traube’s space

42
Q

Is an anatomic space
Crescent shaped space
Encompassed by the lower edge of the left lung, anterior border of the spleen. And left costal margin and inferior margin of the left lobe of the liver

A

Traube’s space

43
Q

Surface markings of traube’s space

A

Left sixth rib - superiorly
Left mid axillary line - laterally
Left costal margin inferiorly

44
Q

Obliteration of Traube’s space may indicate

Dullness instead of tympany

A

Splenomegaly
(Sensitivity of 62% and specificity of 72%)
Higher specificity if patient has not eaten in the last 2 hours

Normal finding after a meal
Left pleural effusion

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