The Abdominal Exam Flashcards
Which of the following correctly characterizes visceral pain?
A. Not localized and secondary to distention, stretching or contracting of hollow organs, stretching capsule organs, or organ ischemia
B. Localized and caused by stimulation of somatic pain fibers
C. Often alleviated by remaining still, and aggrevated by movement
D. Originates in the abdomen but is felt at distant sites which are innervated at approximately the same spinal levels as the disorder
Not localized and secondary to distention, stretching or contracting of hollow organs, stretching capsule organs, or organ ischemia
Which of the following correctly characterizes referred pain? (Bonus: what’s an example?)
A. Not localized and secondary to distention, stretching or contracting of hollow organs, stretching capsule organs, or organ ischemia
B. Localized and caused by stimulation of somatic pain fibers
C. Often alleviated by remaining still, and aggrevated by movement
D. Originates in the abdomen but is felt at distant sites which are innervated at approximately the same spinal levels as the disorder
Originates in the abdomen but is felt at distant sites which are innervated at approximately the same spinal levels as the disorder
Example:
- Biliary tree reffered to right shoulder
- duodenal and pancreatic pain reffered to the back
All of the following is true of parietal pain, EXCEPT which of the following that is true of visceral pain?
A. Secondary to inflammation in the parietal peritoneum
B. Localized and caused by stimulation of somatic pain fibers
C. Often alleviated by remaining still, and aggrevated by movement
D. Example is periumbilical pain with early appendicitis
E. All the above are correct
Example is periumbilical pain with early appendicitis
NOTE: a later findings of appendicitis is parietal pain, while in the early stage it is visceral
RLQ parietal tenderness is associated with which of the following?
A. Acute Diverticulitis
B. Acute appendicitis
C. GERD
D. All of the above
Acute appendicitis
LLQ parietal tenderness is associated with which of the following?
A. Acute Diverticulitis
B. Acute appendicitis
C. GERD
D. All of the above
Acute Diverticulitis
When a patient comes in presenting with abdominal pain, what is the most important thing you want to know in OLDCAARTS?
What is the second most important?
Location
Aggravating/Alleviating Factors
When performing a physical exam what is the appropriate sequence of events?
Inspection
Auscaultation
Percussion
Palpation
NOTE: INspection landmark- xiphoid process, costal margins, umbilicus, ASIS
According to Dr. Arnce’s lecture, what are the two main components found in RUQ that he bolded and want’s us to know?
Liver and Gallbladder
According to Dr. Arnce’s lecture, what are the two main components found in LUQ that he bolded and want’s us to know?
Stomach and (spleen)
According to Dr. Arnce’s lecture, what are the two main components found in RLQ that he bolded and want’s us to know?
Appendix and Ovary
According to Dr. Arnce’s lecture, what is the main component found in LLQ that he bolded and want’s us to know?
Colon
LLQ pain think diverticulitis I guess
Which of the following is the most likely culprit if a patient comes in epigastric pain?
A. Appendicitis
B. Right Lung
C. Larynx
D. Pancreas
Pancreas
Which of the following is the normal bowel sound per minute?
A. 1-100 clicks
B. 5-34 clicks
C. none for >2 minutes
D. none for 1 minute
E. >34 clicks
B. 5-34 clicks/ minute is within normal range
Which of the following rate of bowel sounds might indicate long-lasting intestinal obstruction, intestinal perforation, or mesenteric ischemia?
A. 1-100 clicks
B. 5-34 clicks
C. none for >2 minutes
D. none for 1 minute
E. >34 clicks
none for >2 minutes
Which of the following rate of bowel sounds might be due to diarrhea or early bowel obstruction?
A. 1-100 clicks/ minute
B. 5-34 clicks/ minute
C. none for >2 minutes
D. none for 1 minute
E. >34 clicks/minute
>34 clicks
aka INCREASED BOWEL SOUNDS
Which of the following rate of bowel sounds mgiht indicate post-surgical ileus or peritonitis?
A. 1-100 clicks/ minute
B. 5-34 clicks/ minute
C. none for >2 minutes
D. none for 1 minute
E. >34 clicks/minute
none for 1 minute
Which of the followinng bowel sounds suggests early intestinal obstruction?
A. Venus hum over epigastric and umbilical region
B. Friction rub over liver and spleen
C. Bruits
D. High pitched bowel sounds (raindrops on metal)
High pitched bowel sounds (raindrops on metal)
Which of the followinng bowel sounds suggests vascular obstruction?
A. Venus hum over epigastric and umbilical region
B. Friction rub over liver and spleen
C. Bruits
D. High pitched bowel sounds (raindrops on metal)
Bruits
Which of the followinng bowel sounds suggests inflammation of the peritoneal surface of an organ?
A. Venus hum over epigastric and umbilical region
B. Friction rub over liver and spleen
C. Bruits
D. High pitched bowel sounds (raindrops on metal)
Friction rub over liver and spleen
Which of the followinng bowel sounds suggests increased collateral circulation between the portal and systemic venous systems?
A. Venus hum over epigastric and umbilical region
B. Friction rub over liver and spleen
C. Bruits
D. High pitched bowel sounds (raindrops on metal)
Venus hum over epigastric and umbilical region
Which of the following percussion sounds should predominate along the abdomen?
A. Resonance
B. Tympany
C. Hyperresonance
D. Dull
Tympany
NOTE: a protuberant abdomen that is tympanic throughout might indicate an intestinal obstruction
NOTE: large dull areas indicate a mass or enlarged organ
T/F: When palpating gently palpate in all 4 quadrants, then depply palpate in all 4 quadrants
True
A normal liver spans 6-12 cm vertically. All of the following cause an increase in the vertical span of the liver, EXCEPT which of the following that can increase or decrease the vertical span?
A. Lymphoma
B. Hepatitis
C. Right sided heart failure
D. Cirrhosis
E. Amylodosis and Hemachromatosis
Cirrhosis
A normal liver may be a slightly tender, soft, smooth surface. All of the following cause the liver to increase firmness or hardness that can be felt upon palpation, EXCEPT which of the following that creates irregular edges and nodules?
A. Cirrhosis
B. Hemachromatosis
C. Hepatocellular Carcinoma
D. Lymphoma
E. Amyloidosis
Hepatocellular Carcinoma
You start percussing from the cardiac border left of the anterior axilllary line. As you continue to percus laterally you note sounds of dullness at the mid-axillary line. Which of the following is likely?
A. Splenomegaly
B. Hemachromatosis
C. COPD
D. Gonorrhea
Splenomegaly
NOTE: Splenomegaly= portal hypertension, blood maligancies, HIV, hematoma, mononucleosis
T/F: The shifting dullness test is a specialty test for ascites. The test is positive if the dullness shifts to the dependent side and the tympanic stays on top
True
Of the following specialty tests for appendicitis: Which of the following is the most specific and sensitive, and tests by palpating the imaginary line between the ASIS and umbilicus?
A. Rovsing’s sign
B. Psoas Sign
C. Obturator sign
D. McBurney’s point Tenderness
D. McBurney’s point Tenderness
A positive Murphy’s sign, where the patient had a sharp increase in tenderness with sudden stop during inspiration, would indicate which of the following?
A. Acute appendicitis
B. Bilary Colic (gallstones passing through)
C. Ureterolithiasis
D. Acites
Bilary Colic (gallstones passing through)
What is a positive Rovsing’s sign?
A. Shifting of borders of tympany and dullness when PT changes from supine to lateral position
B. Tenderness upon palpation in the RUQ that causes the PT’s breathing to hitch
C. Pain when PT deeply percussed in the back with your fist
D. Deep palpation in the LLQ producing pain in the RLQ
Deep palpation in the LLQ producing pain in the RLQ
What are the 3 major signs of peritoneal inflammation, an “acute abdomen”?
Guarding (voluntary or involuntary)
Rigidity
Rebound Tenderness
What is the VINDICATE mneumonic Dr. Arnce told us to understand and help develop a broad DDx with a systematic Approach?
A close friend, who isn’t sure if you’re actually learning things in medical school, forwards you a list and asks you to choose all the Biliary disease. Which of the following is a biliary disease? (select all that apply)
A. Pancreatitis
B. Hepatitis
C. Cholelithiasis
D. Cholecystitis
E. UTI
C. Cholelithiasis
D. Cholecystitis
BOOM you’re a doctor
What are some medications that might indicate potential GI issues arizing, or are at least good to know the PT is on if they come in with abdominal pain?
T/F: A history of CHF which can lead to Right PLueral Effusion can result in a falsely increased vertical span of the liver
True
the english is a little wonky, but you get what I’m saying
T/F: When the spleen enlarges it typically expands upward, posteriorly, and laterally
False;
When the spllen enlarges it typically expands downward, anteriorly, and medially
DAM! Why can I feel the spleen all of a sudden
(probs low yield)
