PCM II Abdominal signs and tests

Question 1

What kind of palpation is used for the tests?

Answer 1

deep palpation, at least 4 cm

Question 2

rebound tenderness

Answer 2

pain upon removal of pressure, rather than application of pressure to abdomen. tests for peritoneal inflammation

Question 3

guarding

Answer 3

voluntary versus involuntary

Question 4

rigidity

Answer 4

like it sounds, abdomen is hard, involuntary reflex

Question 5

rovsing’s sign

Answer 5

pain in the RLQ during left sided pressure-referred rebound tenderness seen in appendicitis

Question 6

McBurney’s Point

Answer 6

rebound tenderness or pain 1/2 of the distance from the ASIS to the umbilicus- may suggest appendicitis/peritoneal irritation

Question 7

Deep palpation of the liver first technique

Answer 7

doctor places left hand behind patient at 11/12 rib, and with the other presses anteriorly

Question 8

Deep palpation of the liver second technique

Answer 8

doctor places right hand just below the costal margin in the mid clavicular line, with fingers pointed cephalad in an oblique direction. gently press in and up with finger tips, trying to palpate the liver edge during patient’s inhalation

Question 9

Deep palpation of the liver “alternate “hooking technique”’

Answer 9

stand to the right of the patient’s chest and place both hands side by side, with fingertips along right costal margin. press in and up with fingertips, and try to palpate the liver edge during inhalation

Question 10

Gallblader tests

Answer 10

murphy’s sign and courvoisier’s sign

Question 11

murphy’s sign

Answer 11

palpate deeply under right costal margin during inspiration and observe for pain and/or sudden stop in inspiratory effort. tests for acute cholecystitis or cholelithiasis

Question 12

Courvoisier’s sign

Answer 12

enlarged non-tender gallbladder secondary to pancreatic disease or cancer

Question 13

spleen palpation one

Answer 13

doc places left hand over and around patient to support and press foward the lower left rid cage

NORMAL SPLEEN SHOULD NOT BE PALPABLE

Question 14

spleen palpation two

Answer 14

doc places right hand below left costal margin, while gentle pressing inward and tries to feel the tip of the spleen

NORMAL SPLEEN SHOULD NOT BE PALPABLE

Question 15

palpating kidneys 1

Answer 15

doc places cephalad hand behind patient, just below and parallel to the 12th rib and presses anteriorly

Question 16

palpating kidneys 2

Answer 16

place caudad hand just below the costal margin in the RUQ/LUQ, respectively and press down firmly and deeply

Question 17

palpating the aorta 1

Answer 17

palpate just above umbilicus, slightly to the left of midline
estimate width of aorta, normal is 2-3 cm
expected: pulsation in an anterior-inferior direction
unexpected: prominent lateral pulsation and more than 3cm in diameter

Question 18

Iliopsoas m. tet

Answer 18

have patient flex their hip against resistance, increased abdominal pain is a positive test

this suggests irritation of the psoas muscle from inflammation of the appendix

Question 19

obturator muscle test

Answer 19

flex the patients right thigh at the hip, with knees bent, and rotate the leg internally at the hip. right hypogastric pain is a positive test

this suggest irritation of the obturator muscle from an inflamed appendix

Question 20

Lloyd Punch/Kidney Punch/Costovertebral Angle (CVA) tenderness

Answer 20

gently tapping the area of the back overlying the kidney produces pain. this suggests and infection around the kidney (periephrin abscess) or pyelonephritis or renal stone

Question 21

Heel stroke

Answer 21

patient supine

doc strike patients heel

pain upon striking could indiciate appendicitis