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PCM2 Midterm > OSCE: ABD Exam > Flashcards

OSCE: ABD Exam Flashcards

1
Q

What are the 4 steps to an ABD exam?

A

inspection, auscultation, percussion, palpation

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2
Q

What is Cullen sign and Grey Turner sign?

A

Cullen sign: periumbilical ecchymosis secondary to hemorrhage
Grey Turner sign: flank ecchymosis secondary to hemorrhage

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3
Q

Which part of the stethoscope do you use to listen to bowel sounds? What is normal vs abnormal?

A

diaphragm of the stethoscope
Normal: 5-34 clicks/gurgles per minute
Abnormal: high pitched, decreased/absent

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4
Q

Which part of the stethoscope do you use to list for ABD vascular sounds? Which arteries should you listen to?

A

bell of stethoscope (for bruits)

ABD aorta, iliac As., renal As. and femoral As.

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5
Q

What 2 things can you hear when you percuss the ABD? What does each mean?

A

Tympany: found in majority of ABD due to air-filled viscera
Dullness: flat sound heard over solid organs (liver/spleen), fluid in the peritoneum or feces

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6
Q

What is the expected liver span?

A

6-12 cm at the mid-clavicular line on the right

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7
Q

What is the expected spleen span?

A

from ribs 6-10 at the mid-axillary line on the left

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8
Q

Explain differences between light, moderate, and deep palpation

A

Light: use tips of fingers to lightly touch skin; up to 1cm
Moderate: use fingers or sides of hands to lightly touch skin, 2-3 cm
Deep: use fingers and palms to palpate more than 3 cm

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9
Q

What is rebound tenderness?

A

pain upon removal of pressure -> indicates peritoneal inflammation

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10
Q

What is guarding?

A

voluntary tightening of ABD muscles secondary to pain

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11
Q

What is rigidity?

A

ABD is hard, involuntary reflex contraction of ABD wall

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12
Q

Describe visceral pain

A

secondary to distention, stretching or contracting; usually felt in midline at level of structure involved; not localized

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13
Q

Describe parietal (somatic) pain

A

secondary to inflammation in parietal peritoneum; usually constant and more severe; localized; aggravated by movement or coughing; alleviated by remaining still

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14
Q

What is McBurney’s point? What does it indicate?

A

rebound tenderness or pain 1/3 of the distance from ASIS to umbilicus
Indicates: possible appendicitis/peritoneal irritation

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15
Q

What is Rovsing’s Sign? What does it indicate?

A

pain in the RLQ while palpating the LLQ

Indicates: possible appendicitis

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16
Q

What is the Iliopsoas Muscle Test? What does it indicate?

A

have pt flex their hip against resistance; positive test is increased ABD pain
Indicates: irritation of psoas muscle from inflammation of appendix

17
Q

What is the Obturator Muscle Test? What does it indicate?

A

flex pt’s right thigh at hip w/ knee bent and internally rotate hip; right hypogastric pain is positive
Indicates: irritation of obturator muscle from inflammation of appendix

18
Q

What is the Heel Strike? What does it indicate?

A

w/ pt supine, strike pt’s heel; positive test is ABD pain

Indicates: possible appendicitis or peritonitis

19
Q

How should you palpate the liver?

A
  • place left hand behind pt’s back to support 11th and 12th ribs and lightly press anterior
  • place right hand just below costal margin in mid-clavicular line w/ fingers pointing cephalad; gently press in and up w/ fingertips (palpate liver edge during inhalation)
20
Q

What is the alternative “hooking technique” for liver palpation?

A

stand to right of pt’s chest and place both hands side-by-side w/ fingertip along right costal margin. press in and up w/ fingertips (palpate liver edge during inhalation)

21
Q

What is Murphy’s sign? What does it indicate?

A

palpate deeply under right costal margin during inspiration; positive is pain and/or sudden stop in inspiratory effort
Indicates: acute cholecystitis or cholelithasis

22
Q

What is Courviosier’s Sign? What does it indicate?

A

enlarged non-tender gallbladder

Indicates: pancreatic disease/cancer

23
Q

How do you palpate for the spleen? What should you find?

A
  • place left hand under rib cage and press forward for support
  • place right hand below left costal margin and gently press inward
  • normal spleen should NOT be palpable
24
Q

How do you palpate the kidneys?

A
  • place cephalad hand behind pt, just below and parallel to 12th rib, press anteriorly
  • place caudal hand just below costal margin in RUQ/LUQ, press down firmly and deeply at peak of pt’s inspiration
25
Q

What is Lloyd’s Punch/Costovertebral Angle (CVA) Tenderness? What does it indicate?

A

gently tap area of back overlying kidney (costovertebral angles); positive is pain
Indicates: infection around kidney (perinephric abscess), pyelonephritis, or kidney stone

26
Q

How do you palpate the aorta? What is normal vs abnormal?

A
  • just above the umbilicus slightly to the left of midline
  • estimate width of aorta
  • Normal: 2-3 cm width, pulsation in an anterior-inferior direction
    Abnormal: >3cm win width w/ prominent lateral pulsation

PCM2 Midterm (3 decks)

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