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Y2S2 - Skills 🧑‍⚕️ > Medicine 🩺 > Flashcards

Medicine 🩺 Flashcards

1
Q

why do we take history?

A

History taking is the initial step to reach a diagnosis, and sometimes you can reach a diagnosis by history only.

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2
Q

what does history taking need?

A
  • good communication skills
  • sufficient knowledge.
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3
Q

what are items of medical history?

A
  1. personal history
  2. Chief complaint
  3. Present history
  4. Past history
  5. Family history
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4
Q

what are the items of personal history?

A

Example: Male patient, named XXX, aged 55 year old, from Mansoura, working as a teacher, marned and has 3 offsprings with the youngest one is 6 year old, He is a cigarette smoker with smoking index 400

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5
Q

what is somking index?

A

smoking index is a unit for measuring cigarettes consumption over a long period

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6
Q

what does smoking index equal?

A

smoking index = Ciggarettes per day × years of tobacco use

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7
Q

what are smoking index categories?

A

Smoking index categories are
- non-smoker
- less than 400
- 400-799
- more than 800

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8
Q

How to write chief complaint?

A
  • In patient own words
  • No scientific terms
  • Mention the duration of the complaint

Example:
- He started to complain of edema both lower limbs 2 weeks ago ❌
- He started to complain of swelling both lower limbs 2 weeks ago ✅

  • He started to complain of dyspnea ❌
  • He started to complain of shortness of breath or difficulty in breathing ✅
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9
Q

what are the items of present history?

A
  • onset, course, and duration
  • Analysis of the main complaint
  • Symptomatology of the same system
  • Symptomatology of other systems
  • Investigations & drugs
  • D.M. & H.T.N
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10
Q

onset & course of complaint

A

Example: complaint Shortness of breath (SOB)

  • The condition started with dyspnea 10 days ago of gradual onset and progressive course
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11
Q

analysis of the main complaint

A
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12
Q

what is chest symptomatology?

A
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13
Q

Investigations and drugs in present history

A
  • Laboratory
  • Radiology (X-ray, C.T, MRI, ..etc)
  • Culture
  • Other investigations
  • Drugs & prescriptions
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14
Q

DM and HTN in present history

A
  • Duration
  • Medications
  • controlled or not
  • complication
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15
Q

what are the items of past historty?

A
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16
Q

what are the items of family history?

A
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17
Q

Revise the summary

A

…

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18
Q

what are the items of general examination?

A
  • Appearance
  • Built
  • Mental status
  • Nutrition status
  • Decubitus &Gait
  • Complexion
  • Vital signs
  • Head and neck
  • Hand examination
  • Lower limb examination
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19
Q

examination of general appearance

A
  • Well
  • ill
  • Cachectic “wasting of face muscle & fat”
  • Infantile
  • Toxic
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20
Q

examination of mental status

A
  • Consciousness
  • Orientation (time, person, place)
  • Memory
  • Mood
  • Intelligence
  • Co-operative
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21
Q

what is the definition of built?

A

It is either (average built- overbuilt- under built)

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22
Q

how is built determind?

A

By body mass index (BMI) & skeletal proportions in relation to age, sex & race.

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23
Q

BMI

A
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24
Q

waist circumference

A
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25
Q

how is nutritional status examined?

A
  • Body Mass Index (BMI)
  • Fat fold measurement
  • Muscle wasting
  • Signs of vitamin deficiency
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26
Q

Fat fold measurement

A

Indirect measurement of fat mass:
- skin fold thickness

Sites:
- Biceps
- Triceps
- Subscapular
- Suprailliac
- Mid-thigh
- Mid-calf
- Abdomen

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27
Q

muscle wasting

A
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28
Q

signs of vitamin deficiency

A
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29
Q

decubitus

A

Position adopted by the patient during lying in the bed

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30
Q

Gait

A
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31
Q

examination of complexion

A
  • Pallor
  • Cyanosis
  • Jaundice
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32
Q

what are the sites of pallor?

A
  • Mucous membranes in the lips & conjunctiva
  • Palmar crease, (Pale palmer crease = Hb < 6-7)
  • Skin, Nail ,Tongue
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33
Q

what Is the definition of jaundice?

A

Yellowish discoloration of the sclera, mucous membranes and skin due to hyperbilirubinemia (2 - 3 mg/dl).

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34
Q

what are the types of jaundice?

A

Hepatocellular: liver diseases

Hemolytic: excess RBCs destruction

Obstructive: obstruction in biliary system

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35
Q

what is the definition of cyanosis?

A

Bluish discoloration of the skin and/or mucous membranes due to increase level of reduced Hb ≥ 5 gm/dl in capillary blood. (Normally reduced Hb not exceed 2.5 gm/dl)

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36
Q

what are the types of cyanosis?

A

Central & peripheral

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37
Q

what is the definition of central Cyanosis?

A

Reduction in the oxygen saturation of arterial blood below 80-85% eg: cyanotic heart disease

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38
Q

what causes peripheral cyanosis?

A
  • Due to stagnation of blood in peripheral circulation or vasoconstriction through the peripheral vascular bed with excessive O2 extraction from capillary blood. the arterial O2 saturation is normal unless cardiopulmonary disease is also present eg : PVD, cold weather
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39
Q

examination of vital signs

A
  • Temperature
  • Blood pressure
  • Pulse
  • Respiratory rate
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40
Q

what are the site of temperature measuring?

A

mouth ,axilla ,rectal

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41
Q

duration of temperature measurement

A

1 min

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42
Q

what is the normal body temperature?

A
  • Normal 36.6 – 37.2 0C
  • In axilla add 1⁄2 C
  • In rectum subtract 1⁄2 C
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43
Q

what does fever, hypothermia & hyper pyrexia mean?

A
  • Fever means temperature> 37.2°C
  • Hypothermia means temperature ≤35 C. (rectal)
  • Hyperpyrexia means temperature ≥ 41°C
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44
Q

pulse (heart rate) examination

A
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45
Q

Respiratory rate examination

A
  • Normal RR: 12- 18 cycle/min, regular in rhythm
  • Tachypnea: RR > 18
  • Bradypnea: RR < 12
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46
Q

what is the normal systolic blood pressure?

A

(90 -120 mmHg) which is the pressure exerted by blood (from left ventricle) on the arterial wall during systole “depends on LV contraction”.

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47
Q

what is the normal diastolic blood pressure?

A

(60 - 80 mmHg) which is the pressure exerted on the arterial wall as result of elastic recoil of the aorta “ depends mainly on the peripheral resistance”

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48
Q

what are the steps of measuring of blood pressure?

A
  • The patient better to be flat with arm & sphygmomanometer at the level of the heart
  • Remove any restrictive clothes & choose the appropriate size cuff
  • Put the cuff around the upper arm with its lower edge 3 cm above the elbow.
  • Palpate brachial pulse before applying stethoscope.
  • Inflate cuff until radial pulse is impalpable, check systolic pressure by auscultation, deflate slowly until diastolic pressure is reached
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49
Q

what are facies?

A

peculiar and unusual facial features that often are pathognomonic of a particular disease.

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50
Q

Neck examination

A
  • LN
  • Trachea
  • Neck rigidity
  • Neck vessels
  • Thyroid Gland
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51
Q

lymph node examination

A
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52
Q

examination of trachea

A
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53
Q

Neck vessels examination

A
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54
Q

what is the difference between internal jugular vein pulsation and internal carotid artery pulsation?

A
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55
Q

thyroid examination

A
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56
Q

hand examination

A
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57
Q

lower limb examination

A
  • Oedema
  • Foot deformities
  • Ulcer
  • Varicose veins
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58
Q

what are the parts of examination?

A
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59
Q

what does inspection include?

A
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60
Q

abnormalities of the shape of the chest

A
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61
Q

compare between normal symmetric chest, barrel shaped (emphysematous) chest & Chest alar (Flat chest) in terms of:

  • Description
  • Diameters
  • Subcostal angle
  • Ribs
  • Intercostal spaces
  • Moving with respiration
  • others
  • figure
A
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62
Q

Compare between Funnel shaped chest (Pectus excavatum), Pigeon shaped chest (Pectus carinatum) & Kyphoscoliosis in terms of:

  • Description
  • Etiology
  • Effects
  • Figure
A
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63
Q

what are the characteristcs of Rachitic chest?

A
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64
Q

what does a normal chest look like (Regarding symmetry)?

A

Both halves are symmetrical.

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65
Q

what is the etiology of unilateral bulge of the chest?

A
  • Something Pushing

Pleural causes:
- Massive pleural effusion.
- Tension pneumothorax.
- Hydropneumothorax.

Lung causes:
- Unilateral emphysema.

Cardiac causes:
- Precordial bulge.

Chest wall causes:
- Abscess.
- Lipoma.

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66
Q

what is the etiology of Unilateral retraction of the chest?

A
  • Something Pulling
  1. Lung collapse.
  2. Lung fibrosis.
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67
Q

what is expansion of the chest differentiated by?

A
  • Normal part: moves freely with respiration.
  • Disease part: moves less.
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68
Q

Comment of respiratory movements

A
  • Respiratory rate
  • Rhythm
  • Type of breathing
  • Degree of chest expansion
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69
Q

Method of examination of respiratory rate

A
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70
Q

Rythm of respiratiory rate

A

Normally: Regular (Inspiration, Expiration then Pause).

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71
Q

what are types of breathing in males and females?

A

Normally:
* In females: Thoraco-abdominal respiration.
* In males: Abdomino-thoracic respiration.

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72
Q

Degree of chest expansion

A
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73
Q

Pulsations in (Chest examination)

A

Epigastric pulsation: as discussed in “Abdominal examination”
- To detect right Ventricular Enlargement (As in cor-pulmonale).

Other Pulsations: Will be discussed in “Cardiac examination” lecture.

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74
Q

How to comment in skin (In chest examination)

A
  1. Dilated veins.
  2. Pigmentation.
  3. Sinuses - Fistula.
  4. Nodules.
  5. Scars of previous operations.
  6. Skin rashes.
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75
Q

what are the most common causes of chest wall sinuses?

A
  1. T.B.
  2. Actinomycosis with characteristic sinus discharging sulphur granules.
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76
Q

Normal trachea

A
  • Trachea is central.
  • With both tendon of sternomastoid is symmetrical in shape & position
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77
Q

Abnormal trachea (In chest examination)

A

Trail’s sign:

  • Unilateral bulge of Sternomastoid tendon on side of tracheal shift.
  • Due to displacement of trachea behind the tendon.
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78
Q

what does Palpation include?

A
  1. Superficial palpation.
  2. Palpation of the trachea.
  3. Confirmation of chest movement.
  4. Tactile vocal fremitus (TVF).
  5. Palpable rhonchi or pleural rub.
  6. Confirmation of the origin of pulsations.
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79
Q

what are the causes of chest wall tenderness?

A
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80
Q

what are the methods of palpation of the trachea?

A
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81
Q

Findings on palpation of the trachea

A

Normal:
- Upper part: Central.
- Lower part: slightly deviated to the right.

Abnormal:
- Shifted: unequal distance being narrow at the side of tracheal isgist deviation.

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82
Q

what are the causes of tracheal shift?

A

Tracheal shift to the same side:
1. Lung collapse.
2. Lung fibrosis.
3. Lung agenesis.
4. Pneumonectomy.

Tracheal shift to the other side:
1. Pneumothorax.
2. Massive pleural effusion.
3. Tumors:
- Any large mass of the bronchi, lung or pleural cavity (including a benign or malignant tumor) may result in tracheal deviation.

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83
Q

Confirmation of chest movement

A

Accurate Method: Tap Test

Other method:
- Upper chest expansion
- Lower chest expansion
- Apical chest expansion
- Lower chest expansion of the back

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84
Q

what does Tactile Vocal Fremitus mean?

A
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85
Q

Method of TVF

A
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86
Q

what causes increased TVF?

A
  1. Consolidation.
  2. Cavitation: Cavity must be:
    * Big.
    * Superficial.
    * Around it an area of consolidation.
  3. Collapse with Patent main bronchus.
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87
Q

what causes decreased TVF?

A
  1. Thick chest wall.
  2. Pleural effusion or pleural fibrosis.
  3. Pneumothorax.
  4. Emphysema.
  5. Collapse with obstructed main bronchus.
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88
Q

Pulsations in (Chest examination)

A
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89
Q

Palpable adventitious sounds

A
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90
Q

what are other items in paplation during chest examination?

A
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91
Q

How to count the ribs?

A
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92
Q

Compare between types of percussion sounds

A
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93
Q

Fingers & movement in percussion

A
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94
Q

where to start percussion?

A
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95
Q

Percussion in chest

A
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96
Q

Last step in percussion

A
  • Whenever dullness is confirmed: its topography should be delineated.
  • Whenever flat stony dullness is present: shifting dullness should be elicited.
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97
Q

what are the types of percussion?

A
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98
Q

Percussion of anterior and posterior chest

A
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99
Q

Preparation for auscultation

A
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100
Q

Instructions for the patient during ausculatation

A
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101
Q

what to do during auscultation?

A
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102
Q

what do we report on during chest ausculatation?

A
  • Breath Sounds.
  • Intensity of breath sounds.
  • Type of breath sounds.
  • Vocal resonance.
  • Adventitious sounds.
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103
Q

Comments on breath sounds

A
  • Intensity
  • Type
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104
Q

Normal Intensity of breath sounds

A

Bilaterally equal.

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105
Q

what causes diminshing in intensity of Breath sounds?

A
  • Pneumothorax.
  • Lung collapse / Fibrosis.
  • Emphysema.
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106
Q

what causes abscence of Breath sounds?

A

Pleural effusion

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107
Q

what causes Increase in intensity of Breath sounds?

A

Children, Due to thin chest wall.

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108
Q

what are the types of Breath sounds?

A
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109
Q

Compare between Vesicular breath sound (Normal) & Bronchial breath sound

A
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110
Q

what is Vocal resonance?

A
  • It is the audible (by stethoscope) vibration of the vocal cords transmitted through respiratory passages to the chest wall..
  • When the patient says 4,4 in Arabic or 99 in English.
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111
Q

what are the causes of increased or decreased vocal resonance?

A

Causes of increased or decreased Vocal Resonance are same as TVF.

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112
Q

Compare between Rhonchi & Crackles

A
113
Q

what is pleural rub?

A

A scratching (To and Fro) sound heard due to friction between the two inflamed pleural surfaces against each other.

114
Q

what are the characters of pleaural rub?

A
  1. Leathery sound.
  2. Heard during inspiration and expiration.
  3. Localised over area affected by pleurisy.
115
Q

what increases pleural rub?

A
  • Increased by:
  • Deep inspiration.
  • Pressure of stethoscope.
116
Q

what decreases pleural rub?

A
  • Decreased on:
  • Stoppage of breathing.
  • Absent by effusion.
117
Q

Auscultation of the trachea

A
  • Normal breath sound heard over the trachea is called tracheal breath sound.
  • Auscultation of the trachea allows recognition of stridor.
118
Q

what is Stridor?

A

a wheeze found only in inspiration

119
Q

Positioning of patients during cardiac examination

A
120
Q

what is the precordium?

A

The region on the chest wall that overlays the heart area.

121
Q

what is the pericardium?

A

The fibrous sac that encloses the heart and the heart area & great vessels

122
Q

what are examples of chest wall abnormalities?

A
  • Precordial bulge
  • pectus excavatum (Funnel-shaped chest)
  • Pectus carinatum (Pigeon chest)
123
Q

Method of inspection of Precordial bulge

A
124
Q

what may cause precordial bulge?

A
125
Q

what are examples of scars you might see during cardiac examination?

A
126
Q

Dilated veins during cardiac examination

A
127
Q

Items palpated during cardiac examination

A
  • Apex & other pulsations
  • Thrill & palpable sounds
128
Q

what is the apex?

A

Outermost & Lowermost visible & strongest palpable point of cardiac pulsation (Point of Maximum Apical Impulse “PMI”).

129
Q

Comment on apex beat

A
130
Q

what should you do when the apex isn’t palpable?

A

Ask patient to lean in left lateral position.

131
Q

what is the definition of Absent apex?

A

Not visible neither palpable apex even on left lateral position

132
Q

what are the causes of Absent apex?

A
133
Q

abnormal sites of apex

A
134
Q

what are the characters of normal apex impulses?

A

A normal apical impulse: briefly lifts your fingers & is localized.

135
Q

what are the characters of abnormal apex impulses?

A
  • Diffuse, sustained and more forceful thrust -» indicates: Left ventricular hypertrophy OR hyperkinetic circulation.
  • A “tapping” apex beat: may be seen in mitral stenosis.
136
Q

what are areas of pulsation?

A
137
Q

what are basal pulsations?

A

Aortic & Pulmonary.

138
Q

what is Parasernal heave?

A

A heaving motion felt over the left parasternal area.

139
Q

How to palpate parasternal heave?

A

With the ulnar border of your hand.

140
Q

what is the medical significane of parasternal heave?

A
  • If present —> Suggests Right Ventricular Hypertrophy.
141
Q

Thrill and palpale sounds in cardiac examination

A
142
Q

what are sites of auscultation?

A
143
Q

what are the sounds that may be auscultated?

A
144
Q

what are the parts of stethoscope used in cardiac examination?

A
145
Q

Timing of auscultation

A
146
Q

Compare between normal heart sounds

A
147
Q

What to comment on during auscultation?

A
148
Q

what are additional sounds that may be auscultated?

A
149
Q

what are Murmurs?

A

audible series of vibrations due to turbulent blood flow

150
Q

what are synonyms of murmurs?

A
151
Q

what are types of murmurs?

A
  • Organic
  • Functional
  • Innocent
152
Q

what causes organic murmur?

A
153
Q

what causes functional murmur?

A
154
Q

what causes innocent murmur?

A
155
Q

Comment on murmurs

A
156
Q

Items inspected during cardiac examination

A
  • Chest wall (Skeletal) abnormalities
  • Scars
  • Dilated & Engorged veins
  • Apex & other pulsations
157
Q

Items auscultated during cardiac examination

A
  • Heart sounds
  • Additional sounds
  • Murmurs
158
Q

what is the abdomen divided into?

A
  • 4 Abdominal Quadrants
  • 9 Abdominal Regions
159
Q

what is the abdomen divided by? (Into 4 abdominal quarters)

A
  • Vertical median plane.
  • Horizontal trans umbilical plane.

(Both passes through the umbilicus)

160
Q

what is the abdomen divided by? (Into 9 abdominal regions)

A

2 Vertical lines:

  • Midclavicular sagittal plane on each side

2 Horizontal lines:
- Subcostal plane
- Intertubercular planes

161
Q

what is Subcostal plane?

A

A transverse plane passing through
the inferior limits of costal margin.

162
Q

what is Intertubercular plane?

A

Transverse plane passing through
the iliac tubercles.

163
Q

what are the contents of the four abdominal quarters?

A
164
Q

scheme for inspection of abdomen

A
165
Q

General considerations during examination of the abdomen

A
  • The patient must be exposed from the lower chest to the symphsis pubis.
  • The patient’s position:
    1. Hand should remain at his sides.
    2. Head resting on a pillow.
    3. Flexion on the knees may relax the abdomen.
  • The patient should have an empty bladder.
  • Warm room & adequate light must be provided.
  • For easy localization of any abnormalities: It is useful to divide the abdomen in 4 quadrants or 9 segments as before.
  • Watch the patient’s face for signs of discomfort during the examination.
166
Q

Steps of examination of shape of the abdomen (contour)

A
167
Q

aim of examination of the shape of the Abdomen (contour)

A
  • Describes the nutritional state.
  • Differential diagnosis for some conditions.
168
Q

what to comment on During examination of shape of the abdomen (contour)?

A
  • Ranges
  • Normal contour
  • abnormal contour
169
Q

ranges of abdomen

A
170
Q

normal contour of abdomen

A
  • Slightly scaphoid (convex) from up downwards.
  • Preserved waist (Convex) from side to side
  • With empty flanks.
171
Q

what does abnormal contour of the abdomen look like?

A
  • Marked Retraction (Scaphoid): Starvation + Wasting diseases “Malignancy”
  • Bulging (distention):
172
Q

what causes diffuse abdominal enlargement?

A
  • Free fluid (Ascites).
  • Fat (Obesity).
  • Flatus.
  • Fetus (in Female).
  • Fatal tumor growth.
  • Full urinary bladder.
  • Fluid in ovarian cyst.
173
Q

what causes localized abdominal enlargement?

A
174
Q

how to differentiate between ascitis and obesity?

A
175
Q

method of examination of respiratory movements during abdominal examination

A

Count respiratory rate while you are simulating counting the pulse rate to distract the attention of the patient.

176
Q

what to comment on during Examination of respiratory movements during abdominal examination?

A
  • Rate
  • Rhythm
  • Depth
  • Type
177
Q

what is the type of respiratory movements in males?

A

in males: Mainly abdominal

178
Q

what is the type of respiratory movements in females?

A

in females: Mainly thoracic

179
Q

what causes abnormal types of respiratory movements?

A
  • Tense ascitis
  • peritonitis
180
Q

types of breathing in patient of tense ascitis

A
  • orthopenic
  • Thoraco-abdominal breath
181
Q

type of breathing in patient of peritonitis

A
  • Has a rigid dorsal decubitus
  • Has absolutely thoracic breathing
182
Q

abdominal movements during respiratory movements

A
  • Normally abdomen moves freely with respiration (bulge during inspiration & retract during expiration).
  • This movement (Limited in tense ascites - Absent in peritonitis).
183
Q

what technique is used in measuring subcostal angle?

A

Thumb test at xiphi-sternal junction.

184
Q

what is the normal subcostal angle?

A

Acute to right (90° +- 20)

185
Q

why does the subcostal angle range between 70 and 110?

A

Tall & thin has more acute angle than obese one.

186
Q

abnormal subcostal angle

A
  • Narrow or obtuse
187
Q

what causes Narrow subcostal angle?

A
  • Flat chest.
  • Pigeon chest.
188
Q

what causes obtuse subcostal angle?

A

Chronic Increased Intra-abdominal pressure as in:

  • Upper abdominal swelling:
    1. Hepatosplenomegaly (HSM).
    2. Ascites.

Chronic increased intra-thoracic pressure as in:
- Barrel shaped chest in COPD (Chronic obstructive pulmonary disease)

189
Q

what to comment on during examination of umbilicus?

A

4S + 2D

  • Site
  • Shape
  • Swelling
  • Skin pigmentation
  • Discharge
  • Dilated veins
190
Q

what is the normal site of umbilicus?

A

Midway between symphysis pubis & xinhisternum.

191
Q

abnormal side of Umbilicus and its causes

A

Shifted downwards:
- Ascites.
- Upper abdominal swelling as hepatic & splenic enlargement.

Shifted upwards:
- in pelvi-abdominal masses.

192
Q

normal shape of umbilicus

A
  • Inverted (Attached to umbilical ligament)
193
Q

abnormal shape of umbilicus and its causes

A
  • Everted umbilicus: Due to chronic increase of intra-abdominal pressure (Ascites - Hepatosplenomegaly “HSM”).
194
Q

normal umbilicus concerning swelling, skin pigmentation, discharge & dilated veins

A

Normally absent

195
Q

Abnormal umbilicus concerning swelling, skin pigmentation, discharge & dilated veins

A
196
Q

what is the definition of Divarication of recti?

A

Separation of rectus abdominis muscles.

197
Q

how to examine Divarication of recti?

A
198
Q

what causes Divarication of recti?

A

Chronic increase of the intra abdominal pressure (HSM - Ascites) + hypoproteinemia

199
Q

what are the signs of chronic increased intra-abdominal pressure?

A
  • Wide subcostal angle
  • Divarication of the recti
  • Umbilicus: Everted, shifted downwards +- umbilical hernia
200
Q

what is the normal arrangement of suprapubic hair?

A

In males: Triangular with apex directed upward toward the umbilicus.

In females: Triangular with upper horizontal line

201
Q

abnormal distribution of supra pubic hair in males and its causes

A
  • Feminine distribution as in LCF: Due to lack of destruction of estrogen by liver.
202
Q

what could lost hair in males and females indicate?

A

hypogonadism

203
Q

how to examine epigastric pulsation?

A
  • Ask the patient to hold respiration.
  • Looking tangential to abdomen.
  • You can also palpate: Place our hand longitudinal in the subcostal angle.
204
Q

compare between epigastric pulsations

A
205
Q

what causes visible peristalisis?

A

Normal: in thin person or in emaciated person.

Abnormal: Pyloric obstruction & Intestinal obstruction

206
Q

what are the characters of prestalitic wave?

A
  • Slow.
  • From the left rib margin to the right.
  • Exaggerated by:
    1. Massage.
    2. Gentle tapping.
    3. Drinking soda.
207
Q

how are peristaltic waves Confirmed?

A

Succussion splash.

208
Q

intestinal obstruction on x-ray

A

Step ladder pattern on x-ray

209
Q

what does hernia indicate?

A

Increased intraabdominal pressure + weak abdominal wall.

210
Q

what characterizes hernia?

A

Expansible impulses with cough.

211
Q

patient position during palpation of hernial orifices

A

Preferred in standing patient.

212
Q

what are types of hernia?

A
  • epigastric
  • Umbilical
  • Incisional (Old scar)
  • Abdominal
  • Inguinal (direct or indirect)
213
Q

epigastric hernia

A
  • Size: small.
  • Site: midline through a defect in the linea alba “Between the xiphoid process & umbilicus”
214
Q

umbilical hernia

A
  • Bulging defect at umbilicus
215
Q

incisional (Old scar) hernia

A

Cause: Defect in abdomen muscles after
surgical incision.

  • Must palpate the size of the defect.
216
Q

abdominal hernia

A

Hernia through the abdominal wall

217
Q

What is the difference between visible and dilated veins?

A

Visible veins: Straight - Narrow - Not raised.

Dilated veins: Tortuous - Wide - Raised above the level of the skin.

218
Q

what does dilatation of veins mean?

A
  • Prominent, dilated veins may represent collateral circulation through the abdominal wall that has developed to compensate for obstruction of either the inferior vena cava or increase portal vein pressure.
219
Q

compare between Caput Medusa and IVC obstruction

A
220
Q

what is the aim of milking test?

A

Determine the direction of blood flow in the veins of the anterior abdominal wall, Which is important in differentiating portal from systemic veins obstruction.

221
Q

steps of milking test

A
222
Q

pigmentations observed during abdominal examination

A
223
Q

compare between Cullen’s sign & Grey turner’s sign in terms of:

  • definition
  • Indication
A
224
Q

what does scratch marking indicate?

A
  • Denotes pruritus usually with obstructive jaundice.
225
Q

characters of scratch marking

A
  • Multiple.
  • Parallel.
  • Superficial.
  • In accessible area.
226
Q

what are the types of scars?

A
  1. Surgical scar
    * Name
    * Healing: 1ry or 2ry intention
    * Complications.
  2. Traumatic.
  3. Cautery.
227
Q

Etiology of stria

A

Due to rapid stretching of abdominal wall with rupture of elastic fibers.

228
Q

what are the types of stria? and when are they seen?

A
229
Q

subcutaneous hemorrhage

A
230
Q

General rules for patient during palpation (In abdominal examination)

A
231
Q

General rules for the doctor during palpation (In abdominal examination)

A
  1. Warm your hands.
  2. Ask patient if any part is tender -> examine that last.
  3. Superficial palpation, then deep palpation.
232
Q

what are types of abdominal palpation?

A
  • Superficial palpation.
  • Deep Palpation.
  • Per Rectal (PR).
  • Per Vaginal (PV).
233
Q

what is the aim of superficial palpation?

A
  • Gain patient’s confidence.

———

Detect:
* Tenderness.
* Hyperesthesia.
* Temperature.
* Tone (Guarding & Rigidity).
* Superficial swellings e.g., lipoma, Varicosities & hernia

234
Q

what is the aim of deep palpation?

A

Localize:
- Abdominal organs (e.g., for organomegaly).
- Deep abdominal masses.

235
Q

Method of superficial palpation

A
236
Q

How to differentiate between Abdominal wall mass & Intra abdominal mass?

A
237
Q

Assessment of muscle tone

A

There are 3 reactions that indicate pathology:

  • Guarding: Muscles contract as pressure is applied.
  • Rigidity: Rigid abdominal wall indicates peritoneal inflammation.
  • Rebound tenderness: Release of pressure -> pain.
238
Q

what to comment on during paplation of abdominal swelling?

A

For any abdominal swelling comment on:

  • Intra or extra-abdominal.
  • 4 S: Site - Shape - Size - Skin over.
  • Edge.
  • Pulsations.
  • Movement with respiration.
  • Consistency.
  • Tenderness.
  • Regional LN.
239
Q

what is teh surface anatomy of the liver?

A
240
Q

Methods of palpation of the liver

A
241
Q

what are the techniques used to palpate the lower border of the liver?

A
  • Ordinary method
  • Tip of hands (Hutchinson’s) method
  • Bimanual method
  • Hooking method
  • Dipping method
  • Auscultatory method
242
Q

Ordinary method of liver palpation

A
243
Q

Tip of hands (Hutchinson’s) method of liver palpation

A
244
Q

Bimanual method of liver palpation

A
245
Q

Hooking method of liver palpation

A
246
Q

Dipping method of liver palpation

A
247
Q

Ausculatatory method (Macleod) of liver palpation

A
248
Q

what is the surface anatomy of the spleen?

A
249
Q

what are methods of palpation of the spleen?

A
250
Q

Comment on liver & spleen

A
251
Q

Give example for a comment on liver

A

Intra-abdominal swelling, moves up & down with respiration, in Rt. hypochondrium, 3 fingers below costal margin, not tender, not pulsating, sharp edge, firm in consistency, smooth surface, mostly it’s Rt lobe of liver.

252
Q

Give example for a comment on spleen

A
  • Intra-abdominal swelling moves up & down with respiration, oblong in shape in left hypochondrium, Extending to … cm (or … finger breadth) below left costal margin in left mid clavicular line (or Huge), Not warm, not tender, not pulsatile, Firm in consistency, sharp anterior border with smooth, surface.
  • Hand can’t reach the upper pole as you can’t insinuate fingers between costal margin.
253
Q

Size (Dimensions) of the kidney

A

12 * 6 * 3 cm

254
Q

Position of the kidney

A
255
Q

Surface anatomy of the kidney

A
256
Q

what are the methods of palaption of the kidney?

A
  • bimanual & ballotment
257
Q

Bimanual technique in palpation of kidney

A
258
Q

Ballotment method in palpation of kidney

A
259
Q

What to commen on if kidney is identifiable?

A
260
Q

Can kidneys be palpated in normal cases?

A

Yes, In thin persons

261
Q

what is the difference between kidney & spleen?

A
262
Q

what is tyhe surface anatomy of gall bladder?

A
263
Q

methods of palpation of gall bladder

A
264
Q

Method of palpation of the colon

A
265
Q

Abdominal percussion

A
  1. Ascites.
  2. Liver borders: for liver span.
  3. Spleen: for splenomegaly.
  4. Kidneys.
  5. Bladder: for enlarged bladder or pelvic mass.
  6. Masses.
266
Q

what are types of ascitis? and fluid volume in each

A
267
Q

Technique of percussion in case of mild ascitis

A
268
Q

Technique of percussion in case of severe (tense) ascitis

A
269
Q

Technique of percussion in case of moderate ascitis

A
270
Q

Auscultation of the abdomen

A
  • Intestinal sounds
  • Vascular sounds
  • Scratch test
  • Succession splash
  • Puddle sign
  • Friction rubs
271
Q

what is another name of Intestinal sounds?

A

Also called “Borborygmi”

272
Q

what are vascular sounds?

A
  • Venous Hum.
  • Arterial Bruit.
273
Q

Technique of scratch test

A
  • Place the diaphragm over the area of liver/spleen.
  • Then scratch parallel to the costal margin until the sound intensity drops of marking the edge of the liver.
274
Q

Succession splash

A
  • Auscultaion of stomach.
  • Detected in gastric outlet obstruction e.g., pylori ulcer or neoplasm.
275
Q

Technique of succession splash

A

Technique:

  • Place the stethoscope on the epigastrium.
  • Then shake both iliac crests.
  • While shaking, listen to splash from retained fluid.
276
Q

puddle sign

A
  • Auscultaion in knee elbow position.
  • For detecting small amounts of ascites as small as 120 ml.
277
Q

Friction rubs

A
  • In Rt. & Lt. upper quadrant.
  • Grating sound with respiratory movement.
  • Indicates inflammation of peritoneal surface of an organ.
278
Q

Comment on case of tense ascitis

A

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