GIT

Question 1

What are you checking for when you palpate lightly and deeply

Answer 1

Light- for tenderness and if there’s a mass

Deep- characteristics of the mass and the organs
consistency, surface,size,edges

Question 2

What do you listen over a mass for?

Answer 2

Bruit

listen above the umbilicus over the aorta for bruit

lateral to the umbilicus to listen for renal artery bruits as in renal artery stenosis.

Question 3

Upper border of the liver is found where

Answer 3

located 1cm above the upper border of the right 5th rib in the midclavicular line.

Question 4

When the spleen enlarges, it enlarges towards the right iliac fossa.
True or false

Answer 4

True

Question 5

What’s re the causes of massive splenomegaly and moderate splenomegaly

Answer 5

Massive splenomegaly, ( >7 cm)
CML, Myelofibrosis, HMS (hyperreactive malarial splenomegaly), Leishmaniasis, Gaucher’s syndrom

Moderate splenomegaly, (3-7 cm)

infection (TB, malaria, endocarditis, schistosomiasis, EBV),Portal Hypertension (liver cirrhosis), Haematological (haemolytic anaemia, haemolytic anaemia, leukaemia, lymphoma), Connective tissue disease (rheumatoid arthritis, SLE), other causes include sarcoidosis and primary antibody deficienc

Question 6

listen with the stethoscope over the enlarged spleen and occasionally a splenic friction rub may be heard over the site of splenic infarct.
True or false

Answer 6

True

Question 7

Kidneys are palpable bimanually true or false

Answer 7

True

Question 8

Difference between enlarged spleen or enlarged kidney

Answer 8

1.One can get above the renal mass but cannot get above the splenic mass which ducks under the left lower ribs.
2. One can feel a notch on the medial border of a splenic mass but not on a renal mass.
3. A renal mass is bimanually palpable but a splenic mass is not.
4. As a renal mass is a retro-peritoneal mass, percussion over it is tympanitic because of
the overlying descending colon while percussion over a splenic mass is dull.

Spleen moves down on inspiration and kidney doesn’t move on respiration
Spleen is non ballotable but kidney is
Spleen can cross midline and kidney doesn’t

Question 9

There is no shifting dullness if fat is found to be the cause of the abdominal swelling true or false

Answer 9

True

Question 10

What methods are used to find the presence of fluid in the abdomen

Answer 10

1.Demonstration of fluid thrill.
2. Demonstration of shifting dullness.
The demonstration of shifting dullness is preferred as one needs an assistant to block the fat thrill in order to demonstrate fluid thrill while one does not need any assistance to demonstrate shifting dullness.
To demonstrate the presence of shifting dullness, start the percussion of the abdomen from the midline and move laterally. Fluid finds its own level and if there is ascites, the fluid will gravitate towards the flanks. So as one percusses from the midline towards the flanks, the percussion note will become dull. Now leave the hand on the flanks of the abdomen where the note is dull and ask the patient to roll to the other side. Fluid will now gravitate towards that side and the side where the hand is, which was previously dull, will now be tympanitic. Hence the dullness has shifted. This demonstrates the presence of fluid in the abdomen.
Feotus
The history of amenorrhoe

Question 11

intestinal obstruction, the bowel sounds are increased while in paralytic ileus, (Paralytic ileus is the occurrence of intestinal blockage in the absence of an actual physical obstruction )the bowel sounds are either reduced or they may be absent altogether. True or false

Answer 11

True

Question 12

Types of palpating

Answer 12

Dipping and hook method

Question 13

Observe the sclera for jaundice.

True or false

Answer 13

True

Question 14

BMI of 25-29.9 is

Answer 14

Overweight

Question 15

BMI greater than 40 ,35-40,30-35,18.25-25,16-18.5

Answer 15

VerySeverely Obese

Severely obese

Moderately obese

Normal

Underweight

Question 16

Which finger is used in digital rectal exam

Answer 16

Index

Question 17

What’s re the signs of chronic liver disease

Answer 17

 Spider naevi or angiomata-small telangiectatic superficial blood vessels with a central feeding vessel
 Clubbing
 Leukonychia - expansion of the paler half-moon at the base of the nail
 Palmar erythema - seen on the thenar and hypothenar eminences, often with a blotchy
appearance
 Bruising
 Dupuytren’s contracture - can occur in the absence of liver disease
 Scratch marks - particularly in cholestatic liver disease
Endocrine - due to excess oestrogens
 Gynaecomastia
 Testicular atrophy
 Loss of axillary and pubic hair
Other
 Parotid swelling - particularly in alcohol-related liver disease
 Hepatic fetor - characteristic sweet-smelling breath
 Hepatic flap - a sign of encephalopathy and advanced disease

Question 18

Spider naevi is seen where on the body

Answer 18

Face,neck,legs ,thighs,chest!!!

Question 19

Bowel sounds are auscultated for how long

Answer 19

1 minute

Question 20

After the GI exam, the person is checked to see if he or she has hernia and a DRA(digital rectal assessment )is don’t on the person true or false

Answer 20

True

Question 21

What is done during percussion

Answer 21

If fluid is suspected to be there,check for shifting dullness and fluid thrill
If there’s massive ascites go straight to using fluid thrill

Check the liver borders
Percuss from the right iliac fossa upwards till the note changes from resonant to dull indicating that you’ve reached the liver lower border
Continue to percuss upward till the note turns from dull to resonant indicating the upper border
Determine the size of the liver

Question 22

What do you check the mouth for ?

Answer 22

Hydration
(Check the tongue,capillary refill,skin turgor)
Angular stomatitis (Inflammation and small cracks in one or both corners of the mouth.
Saliva collecting at the corners of the mouth can cause a build-up of microorganisms, leading to angular cheilitis. )
Glossitis (Glossitis can mean soreness of the tongue, or more usually inflammation with depapillation of the dorsal surface of the tongue (loss of the lingual papillae), leaving a smooth and erythematous (reddened) surface, (sometimes specifically termed atrophic glossitis).)

Question 23

On inspection of the abdomen what do you look for

Answer 23

Scarification
Surgical scars
Caput medusa 
If it moves on inspiration and expiration 
Normally
If it looks full or flat or distended