Week 10 — abdomen exam

Question 1

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

Select one:

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?

Select one:

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:

Select one:

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?

Select one:

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:

Select one:

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?

Select one:

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?

Select one:

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?

Select one:

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)?

Select one:

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?

Select one:

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

Essentially, pressing over the kidney may not be enough to illicit pain. So if no CVA pain with palpation, then go on to percussion. Because percussion over the kidney creates more force than palpation, it is more likely to re-create pain coming from an infected or inflamed kidney.

The problem with answer “a” is that you do NOT need to percuss the kidneys if you already determined that they are tender to palpation (by pressing on them).

The problem with “b” is that both an infected kidney and a musculoskeletal issue could be painful if you tap on them so you can’t use percussion to differentiate between the two.

See page 464 in Bates.
The correct answer is: you suspect pyelonephritis but CVA is nontender to palpation