Week 10

Question 1

Which of the following findings on inspection of the abdomen is abnormal?

a. old silver striae (stretch marks)
b. a few small dilated veins
c. pink-purple striae
d. peristalsis in a thin person

Answer 1

c. pink-purple striae

- suggestive of Cushing syndrome (too much cortisol)

Question 2

Which of the following conditions is NOT usually associated with altered bowel sounds?

a. constipation
b. adynamic (paralytic) ileus
c. bowel obstruction
d. peritonitis

Answer 2

a. constipation

Question 3

A patient with difficult to control hypertension and a systolic-diastolic upper abdominal bruit most likely has secondary hypertension due to:

a. obstructive sleep apnea
b. renal artery stenosis
c. Cushing syndrome
d. hyperaldosteronism

Answer 3

b. renal artery stenosis

Question 4

Diffuse tympany on percussion is expected with which of the following pathologies?

a. ovarian tumor
b. hepatomegaly (enlarged liver)
c. distended bladder
d. intestinal obstruction

Answer 4

d. intestinal obstruction

Question 5

On palpation of the abdomen, peritoneal inflammation is suggested by:

a. a soft abdomen with bulging flanks
b. guarding that resolves with position change
c. involuntary guarding
d. decreased tone on exhalation

Answer 5

c. involuntary guarding

Question 6

What is the most likely diagnosis in a patient with severe abdominal pain, a rigid abdomen, and rebound tenderness?

a. peritonitis
b. gastritis
c. GERD
d. colon cancer

Answer 6

a. peritonitis

Question 7

Which of the following techniques best describes proper percussion of liver size?

a. start below the right costal margin and percuss downward until tympanic sound results
b. start in a tympanic portion of the RLQ and percuss upwards until dull sound
c. percuss in all 4 quadrants for pain response
d. percuss as firmly as possible

Answer 7

b. start in a tympanic portion of the RLQ and percuss upwards until dull sound

Question 8

On palpation of the liver, which of the following findings is abnormal?

a. smooth surface
b. hard and irregular edge
c. soft but distinct edge

Answer 8

b. hard and irregular edge

Question 9

Which of the following conditions is NOT associated with dullness to percussion in Traube’s space (splenomegaly)?

a. portal hypertension from cirrhosis
b. blood malignancy such as leukemia
c. adrenal tumor causing Cushing syndrome
d. sickle cell anemia

Answer 9

c. adrenal tumor causing Cushing syndrome

Question 10

When should you attempt fist percussion (Murphy’s punch) over the kidneys?

a. if there is tenderness when pressing over the costovertebral angle(s) (CVA)
b. to differentiate pyelonephritis from a musculoskeletal cause of back pain
c. you suspect pyelonephritis but CVA is nontender to palpation

Answer 10

c. you suspect pyelonephritis but CVA is nontender to palpation