The Abdominal OSCE

Question 1

What are the sections the abdominal Osce can be divided into?

Answer 1

Set-up, Inspection, pre-viscera palpation, visceral palpation, percussion, auscultation and scope for further examination.

Question 2

List the steps of ‘Set up’?

Answer 2

explanation of exam;

Positioning and exposure

Question 3

List the steps of ‘Inspection’?

Answer 3

overall inspection;
peripheral examination (including hepatic flap);
Inspection of abdomen;
palpation of lymph nodes

Question 4

List the steps of pre-visceral palpation?

Answer 4

Enquire about pain;
Superficial palpation;
Deep palpation

Question 5

List the steps of visceral palpation?

Answer 5

Palpate for liver
Palpate for spleen
Palpate for both kidneys
Palpate for abdominal aorta

Question 6

List the steps of percussion?

Answer 6

percuss for border of liver, percuss for position of spleen,

percuss over any masses detected

Question 7

List the steps of auscultation?

Answer 7

Listen for bowel sounds using the diaphragm (for 10 secs)

Question 8

List the steps for further examination

Answer 8

State that you would examine hernial orifices, external genitalia and perform a digital rectal examination;
Be able to describe and demonstrated examination of ascites (by percussion and shifting dullness)

Question 9

What is involved in 2) Positioning and exposure?

Answer 9

Lies patient supine while supporting head

Adequately exposes abdomen

Question 10

What is involved in 3) overall inspection?

Answer 10

Inspects patient overall and comments on build, posture, demeanour and any abnormality

Question 11

What is involved in 4) Peripheral examination

Answer 11

Hands (nails, palms and hepatic flap)
Eyes (conjunctivae and sclerae)
Mouth (dentition and mucous membranes)

Question 12

What is involved in 5) Inspection of abdomen

Answer 12

Inspects for distention, scars, skin, movements;

Identification of visible hernias on coughing or lifting head off bed.

Question 13

What is involved in 6) palpation of lymph nodes

Answer 13

Palpate the supra-clavicular lymph nodes

Question 14

What is involved in 6) palpation of lymph nodes

Answer 14

Palpate the supra-clavicular lymph nodes

Question 15

What is involved in 7) Enquire about pain

Answer 15

Identify presence and location of any pain

Question 16

What is involved in 8) Superficial palpation

Answer 16

Palpate all 4 quadrants superficially, watching patient’s face for signs of tenderness

Question 17

What is involved in 9) Deep palpation

Answer 17

Palpate all 4 quadrants deeply whilst watching patient’s face;
Identify the presence of any mass and elucidate boundaries, surface, size and location.

Question 18

What is involved in 10) Palpation for liver

Answer 18

Using border of the hand, start in right iliac fossa and use respiratory movement.

Question 19

What is involved in 11) Palpation for Spleen

Answer 19

Start in right iliac fossa and move to left upper quadrant using inspiration

Question 20

What is involved in 12) Palpate for both kidneys

Answer 20

Palpate bimanually

Question 21

What is involved in 13) Palpate for abdominal aorta

Answer 21

Palpate bimanually

Question 22

What is involved in 14) Percussion

Answer 22

Percuss for border of liver, position of spleen,

over any masses detected

Question 23

What is involved in 15) Auscultation

Answer 23

Auscultate for bowel sounds using diaphragm for at least 10 seconds

Question 24

What is involved in 16) Further tests

Answer 24

State that you would examine hernial orifices, external genitalia and perform a digital rectal examination;

Question 25

What is involved in 17) examination of ascites by percussion and shifting dullness

Answer 25

Lie patient supine
percuss from umbilicus to flank, noting when transition from tympany to dullness occurs.
Lie patient of side and repeat
If ascites is present then the dullness would shift to the corresponding side.