Midterm Practical: Abdomen exam

Question 1

Abdomen Exam Patient Position & Gown

Answer 1

Supine with hands by side Pillow behind head
Knees bent throughout entire exam
Gown open to the front

Question 2

Inspecting the Abdomen Steps

Answer 2

1) Ask patient if its okay for you to examine their abdomen
2) State you’re inspecting the surface for Contours and Movements

Question 3

Areas of Auscultation for Abdomen

Answer 3

4 abdominal Quadrants (DIAPHRAGM)
Hepatic & Splenic Rubs (DIAPHRAGM)
Vascular Abnormal Bruits (BELL)

Question 4

Auscultation of 4 Abdominal quadrants

Answer 4

Use Diaphragm of Scope
Scope directly on Skin
Listen to 2 areas of each quadrant (NOT over the ribs)
Listen for 3-5 Seconds

Question 5

Auscultation of Hepatic and Splenic Rubs

Answer 5

Use Diaphragm of Scope
Scope directly on Skin
Listen for 3-5 Seconds (each)

Question 6

Location of Hepatic Rub Auscultation

Answer 6

Right Costal Margin @ Mid-Clavicular Line

Question 7

Location of Splenic Rub Auscultation

Answer 7

Left Costal Margin @ Anterior Axillary Line

Question 8

Auscultation for Abdominal bruits Steps

Answer 8

Use the Bell of the Scope
Scope directly on skin with LIGHT pressure
Stethoscope placed at correct positions

Question 9

Locations for Auscultating Abdominal Bruits

Answer 9

[5]
Aorta
B/L Renal Arteries
B/L Iliac Arteries

Question 10

Steps in percussion the Abdomen

Answer 10

1) All 4 quadrants
2) Superior & Inferior Borders of the Liver
3) Percussion for Splenic Dullness
4) Murphy’s Kidney Punch

Question 11

Percussion of the 4 Abdominal Quadrants Steps

Answer 11

1) 2 Locations in each quadrant
2) Indirect Percussion
3) Elicit Good Tympany Sounds

Question 12

Percussion of S & I borders of the Liver Steps

Answer 12

1) Shield Breasts
2) First, start @ 2nd/3rd ICS and percussion down until dull (@ Right Mid-Clavicular)
3) Second, Percuss good Tympany and percussion up until dull (@ Right Mid-Clavicular)

Question 13

Percussion for Splenic Dullness Steps

Answer 13

1) Shield Breasts
2) Location: Left Costal margin & Inferior-most Interspace
3) Go past the anterior Axillary line
4) Elicit good Tympany sounds
5) Repeat steps WHILE PATIENT HOLDS THEIR BREATH

Question 14

Murphy’s Kidney Punch test Steps

Answer 14

1) Explain to Patient the Procedure
2) Bring patient to seated position
3) Place palm of hand over costovertebral angle
4) Strike back of hand with Ulnar surface (fist) of other hand
5) Ask patient at each strike if any Tenderness

Question 15

Exam Sequence for the Abdomen Exam

Answer 15

Inspection, Auscultation, Percussion, Palpation

Question 16

Areas of Palpation for the Abdomen Exam

Answer 16

4 Quadrants
Liver & Gallbladder
Appendix
Right Kidney
Left Kidney
Spleen
Abdominal Aorta

Question 17

Palpating the 4 Abdominal Quadrants [Superficially]

Answer 17

Use One Hand using pad of the digits
1 Inch Depth
Palpate 2 spots in each quadrant
Move hand in Circular Motion

Question 18

Palpating the 4 Abdominal Quadrants [DEEPLY]

Answer 18

Use Two Hands (top hand reinforcing bottom hand)
Up to 3 inch Depth OR Patient Tolerance
2 Spots in each quadrant
Use Pads of the digits of inferior hand while pressure is being placed by the superior hand
Use a Circular Motion

Question 19

4 Abdominal Quadrant Palpation verbals

Answer 19

“Circular Motion” (superficial)
“Circular Motion” (deep)
Ask patient if there is any tenderness

Question 20

Palpation of the Liver Steps

Answer 20

1) Sheild Breasts
2) Use Hooking Technique
3) Patient Inhales and Holds Breath
4) Palpate while patient is holding inhalation

Question 21

Hooking technique for palpating the liver

Answer 21

• Stand on RIGHT side of Patient CEPHALAD to costal margin
• Hook Fingers under right costal margin
• Centered at Mid-Clavicular Line

Question 22

Murphy’s Sign of the Gallbladder Technique

Answer 22

1) Dr. On Pt’s Right side using fingers to press under Right Costal Margin with both hands stacked
2) @ Right Mid-Clavicular
3) Patient instructed to Inhale/Exhale
4) On Exhalation Dr. Presses fingers deeper
5) Patient Inhales one more time
6) Hold Fingers in place during 2nd Inhale

Question 23

Appendix Palpation: McBurney’s Point Location

Answer 23

2 inches from ASIS on a line between ASIS and Umbilicus

Question 24

Appendix Palpation: Rovsing Sign

Answer 24

[Rebound Tenderness in the Left Lower Quadrant]
1) Use 2 hands
2) Slowly Press into LLQ
3) Quickly remove hands

Question 25

Appendix Palpation: Psoas Sign

Answer 25

1) Ask patient to flex their Right Hip
2) Dr. provides resistance over Right Thigh

Question 26

Appendix Palpation: Heal Jar

Answer 26

1) Explain procedure to Patient
2) Dr. Strikes plantar surface of Right shoe
3) MUST USE ULNAR SURFACE OF FIST

Question 27

Right & Left Kidney Palpation

Answer 27

1) Stand on Right/Left side of Patient
2) Dr’s Left/Right hand placed under pt’s lower right ribs
3) Put P-A pressure on ribs
4) Dr’s Right/Left hand put pressure on RUQ with fingers facing Cephalad near the costal margin @ Mid-clavicular Line
5) Instruct patient to Inhale
(As pt inhales dr. Tries to catch the kidney)

Question 28

Palpation of the Spleen

Answer 28

1) Dr. On right side of pt
2) Reach across and put left hand under lower left ribs
3) Initiate P-A pressure to lower ribs
4) Use right hand to palpate for the spleen
FINGERS MUST FACE CEPHALAD AND PLACED NEAR COSTAL MARGIN @ LEFT ANTERIOR AXILLARY LINE
5) Instruct patient to Inhale
6)During inhalation LIGHTLY palpate for the spleen

Question 29

Palpation of the Abdominal Aorta

Answer 29

Place fingers of each hand alongside expected lateral margins of the aorta with fingers facing cephalad