OSCE 5: Abdominal Exam

Question 1

What are the steps for a proper abdominal exam?

Answer 1

Inspection
Auscultation
Percussion
Palpation

Question 2

What is Cullen sign?

Answer 2

Ecchymosis around umbilicus secondary to hemorrhage

Question 3

What is Grey Turner sign?

Answer 3

Flank ecchymosis secondary to hemorrhage

Question 4

What are normal bowel sounds?

Answer 4

5-34 clicks or gurgles per minute

Question 5

What are abnormal bowel sounds?

Answer 5

High pitched

-decreased/absent

Question 6

What arteries should be auscultated for bruits?

Answer 6

Abdominal aorta
Iliac arteries
Renal arteries
Femoral arteries

Question 7

What type of percussion is heard in the majority of the abdomen?

Answer 7

Tympany

-air filled viscera

Question 8

What type of percussion is heard over solid organs

Answer 8

Dullness

• liver
• spleen

Question 9

Where is the liver normally percussed?

Answer 9

6-12 cm at the mid-clavicular line (right)

Question 10

Where is the spleen normally percussed?

Answer 10

Ribs 6-10 at mid-axillary line (left)

Question 11

What is rebound tenderness?

Answer 11

Pain upon removal of pressure rather than application of pressure to abdomen

Question 12

What does rebound tenderness indicate?

Answer 12

Peritoneal inflammation

Question 13

What is guarding?

Answer 13

Voluntary tightening of abdominal muscles secondary to pain

Question 14

What is rigidity?

Answer 14

Hard, involuntary reflex contraction of abdominal wall

Question 15

Where is McBurney’s point?

Answer 15

Point over right side of the abdomen that is ⅓ distance from ASIS to umbilicus
-roughly corresponds to appendix where it is attached to the cecum

Question 16

What does rebound tenderness over McBurney’s point indicate?

Answer 16

Appendicitis

Peritoneal irritation

Question 17

What is Rovsing’s Sign?

Answer 17

Pain in RLQ upon palpation in LLQ

-indicates possible appendicitis

Question 18

What is the Iliopsoas Muscle test?

Answer 18

Patient flexes hip against resistance.

-increased abdominal pain is a positive test for inflammation of appendix

Question 19

What is the Obturator Muscle test?

Answer 19

Flex patient’s right thigh at hip, knee bent, and rotate leg internally
-right hypogastric pain positive for appendix inflammation

Question 20

What is the heel strike test?

Answer 20

Strike patient’s heel while supine

-abdominal pain can indicate appendicitis or peritonitis

Question 21

What are ascites?

Answer 21

Accumulation of fluid in the peritoneal cavity, causing abdominal swelling

Question 22

How do you test for ascites?

Answer 22

Tap flank sharply and see if impulse is transmitted to another flank

Question 23

What is Murphy’s Sign?

Answer 23

Palpate deeply under right costal margin during inspiration

-pain can indicate acute cholecystitis or cholelithiasis

Question 24

What is Courvoisier’s Sign?

Answer 24

Enlarged non-tender gallbladder

-can indicate pancreatic disease or cancer

Question 25

What is Lloyd Punch/CVA Tenderness?

Answer 25

Tap the area in the back that overlies kidneys

-pain can indicate kidney infection, pyelonephritis, or renal stone