Nu 554 Sacred Heart Thorax

Front 1

2 ways to divide the abdomen; 1 is by quadrants; name the other method

Back 1

Division into 9 sections wiht most common terms used: epigastric, umbilical and hypogastric (suprapubic)

Front 2

What is the predominant organ in the right upper quadrant?

Back 2

Liver

Front 3

What is generally not palpable that is located in the right upper quadrant?

Back 3

The gallbladder and the duodenum

Front 4

The 9th, 10th, and 11th ribs protect this and it may be palpated just below the left costal margin in some adults

Back 4

The spleen

Front 5

True or False In most healthy people, the pancreas can be palpated.

Back 5

False

Front 6

The sigmoid colon can be palpated here

Back 6

The lower left quadrant

Front 7

The S1 is commonly mistaken for a tumor or in women, these structures

Back 7

Uterus and ovaries

Front 8

Where is the appendix located?

Back 8

RLQ

Front 9

The bladder generally holds this amount of urine

Back 9

300 ml

Front 10

True or False Kidneys are anterior organs

Back 10

False

Front 11

Name origins of visceral pain

Back 11

when organs/tissue contracts unusually forcefully or are distended or are stretched

Front 12

Name characteristics of visceral pain

Back 12

diffuse, gnawing, burning, cramping, aching

Front 13

Name some diseases that elicit visceral pain

Back 13

appendicitis, alcoholic hepatitis

Front 14

Name characteristics of parietal pain

Back 14

steady, aching pain, more severe than visceral, more localized...often aggravated by movement or coughing

Front 15

Name a disease with parietal pain

Back 15

later stage of appendicitis

Front 16

Where does pain from biliary tree radiate to?

Back 16

right shoulder or right posterior back

Front 17

Doubling over pain that is colicky may indicate ?

Back 17

renal stones

Front 18

Where would pain be associated with cholecystitis?

Back 18

RUQ and upper abdomen

Front 19

With patients seeking care in the ED for nonspecific abdominal pain, 15-30% have these 3 conditions that require surgery

Back 19

appendicitis, cholecystitis, intestinal obstruction

Front 20

What is aerophagia

Back 20

swallowing air

Front 21

Name 2 causes of functional or nonulcer dyspepsia

Back 21

delayed gastric emptying, gastritis from H. Pylori, peptic ulcer disease, and psychosocial

Front 22

How often must patients complain of heartburn, acid reflux or regurgitation to be classified as having GERD until proven otherwise

Back 22

more than once a week

Front 23

Name things that can aggravate heartburn

Back 23

ingestion of alcohol, chocolate, citrus, coffee, onions, peppermint, bending over, exercising, lifting or lying supine

Front 24

True or False Some patients with GERD wheeze, cough, aspirate, are hoarse or have a chronic sore throat

Back 24

True

Front 25

Name 3 "alarm" symptoms

Back 25

dysphagia, odyophagia, vomiting, bleeding, weight loss, anemia

Front 26

True or False If diagnosed with Barrett's esophagus, the risk of esophageal cancer is increased by 15 times

Back 26

False; it is by 30 times

Front 27

True or False Angina from the lateral wall may present as heartburn

Back 27

Fals; it is from the inferior wall

Front 28

Name 2 causes of right lower quadrant pain that migrates to periumbilical region besides appendicitis

Back 28

pelvic inflammatory disease, rupture ovarian follicle, ectopic pregnancy

Front 29

What other symptoms should you assess for if the patient c/o left lower quadrant pain or diffuse pain

Back 29

Fever, loss of appetite

Front 30

Diverticulitis may be suspected if a palpable mass is found in this quadrant and the patient has pain

Back 30

left lower quadrant

Front 31

Name 2 symptoms of a small or large bowel obstruction

Back 31

diffuse abdominal pain, no bowel sounds, firmness, guarding or rebound

Front 32

If the patient has chronic lower abdominal pain, you need to ask about ?

Back 32

change in bowel habits

Front 33

Colon cancer may be indicated if patient has a mass and ?

Back 33

change in bowel habits

Front 34

Name symptoms of IBS

Back 34

intermittent pain with relief with defecation, change in frequency of BMs, change in color of BMs

Front 35

Name diseases or conditions that are often accompanied by anorexia, nausea and vomiting

Back 35

diabetic ketoacidosis, pregnancy, adrenal insufficiency, hypercalcemia, uremia, liver disease, drug reactions, emotions

Front 36

Fecal odor may indicate ?

Back 36

Small bowel obstruction or gastrocolic fistula

Front 37

True or False Hematemesis can be coffee ground in color

Back 37

True; it can also be red blood

Front 38

True or False Symptoms of blood loss such as syncope are generally seen when blood loss exceeds 250 ml

Back 38

False; generally over 500 ml

Front 39

Patients who c/o abdominal fullness or early satiey amy have these....

Back 39

diabetic gastroparesis, gastric outlet obstruction, gastric cancer, take anticholinergic medications or have hepatitis

Front 40

True or False A sensation of lump in throat or the retrosternal area unassociated with swallowing is dysphagia

Back 40

False

Front 41

Some indicators of oropharyngeal dysphagia include

Back 41

drooling, nasopharyngeal regurgitation

Front 42

True or False A motility disorder is not likely if patient has difficulty swallowing food and liquids

Back 42

False

Front 43

Name 3 causes of odynophagia

Back 43

esophageal ulceration, caustic ingestion,infections, pill induced such as aspirin or NSAIDs

Front 44

Name 2 causes of excessive flatus

Back 44

aerophagia, legumes or other gas producing foods, lactase deficiency, IBS

Front 45

True or False Diarrhea occurs when there has been over 100 grams of stool volume in 24 hours

Back 45

False; over 200 grams

Front 46

True or False Chronic diarrhea lasts 2 weeks or more

Back 46

False; 4 or more weeks

Front 47

What is the definition of tenesmus?

Back 47

constant urge to defecate

Front 48

True or False It is normal to have nocturnal diarrhea

Back 48

False

Front 49

What do you call fatty diarrheal stools and when might they occur?

Back 49

Steatorrhea; seen in celiac sprue, pancreatic insufficiency or small bowel bacterial overgrowth

Front 50

Name some medications that can cause diarrhea

Back 50

penicillin, macrolides, magnesium based antacids, metformin, herbal medications

Front 51

What is the criteria for constipation?

Back 51

Occurs for 12 weeks during last 6 months; and has 2 or more of: 3 or fewer BMs per/week, 25% or more defecations with straining or incomplete evacuation, lumpy or hard stools, need for manual evacuation

Front 52

What medications can lead to constipation?

Back 52

narcotics, anticholinergics, calcium channel blockers, and iron supplements

Front 53

What diseases can cause constipation to occur?

Back 53

diabetes, hypothyroidism, hypercalcemia, MS, Parkinson's, systemic sclerosis

Front 54

True or False The definition of obstipation is no passage of gas or feces

Back 54

True

Front 55

What color or hematochezia stools? and melena?

Back 55

red/maroon, black and tarry

Front 56

Which would you see with large blood loss from lower GI bleeding? hematochezia or melen

Back 56

Hematochezia

Front 57

True or False Blood on the toilet paper generally indicates an upper GI bleed

Back 57

False; generally hemorrhoids

Front 58

Name 4 mechanisms of jaundice

Back 58

Increased bilirubin production, decreased uptake of bilirubin, decreased ability of liver to conjugate bilirubin, decreased excretion of bilirubin into bile

Front 59

Name a disease associated with impaired excretion of bilirubin

Back 59

Viral hepatitis, cirrhosis, drug-induced cholestasis from oral contraceptives, methyl testosterone and chlorpromazine

Front 60

True or False Gallstones or pancreatic cancer can obstruct the common bile duct

Back 60

True

Front 61

What color are acholic stools and when might a patient have them?

Back 61

gray or light colored (without bile); common with obstructive jaundice

Front 62

True or False A patient may c/o itching with obstructive jaundice.

Back 62

True

Front 63

Name 5 risk factors for liver disease.

Back 63

Hepatitis, alcohol abuse, ingestion of toxins, gallbladder disease or surgery, hereditary disease

Front 64

What type of pain is associated with bladder infections?

Back 64

dull pressure in lower abdomen

Front 65

Where do men c/o of pain when they have prostatic pain?

Back 65

Rectum and perineum

Front 66

What is the term for voiding over 3 liters of urine in a 24 hour period?

Back 66

Polyuria

Front 67

Stress incontinence may be result from decreased contractility of sphincter or poor support of bladder. Urge incontinence usually occurs because of overactivity of ?

Back 67

Detrusor

Front 68

What food can discolor the urine red?

Back 68

Beets

Front 69

What type of pain is kidney pain and where does it radiate to?

Back 69

Viscera; dull, aching and steady; radiates to umbilicus

Front 70

Where does ureteral pain radiate to?

Back 70

lower abdominal quadrant or upper thigh, testicle or labium

Front 71

What are some physical findings upon exam of the abdomen would make you think that the patient may abuse alcohol?

Back 71

hepatosplenomegaly, ascites, caput medusa

Front 72

True or False There is a vaccine available against Hepatitis A, B and C

Back 72

False

Front 73

How is Hepatitis A transmitted?

Back 73

Fecal/oral

Front 74

What are some risk factors for developing colorectal cancer?

Back 74

Diabetes, alcohol, obesity, smoking, fatty diet, family member with colorectal cancer or adenomatous polyps

Front 75

True or False The U.S. Preventative Service Task Force recommends the use of aspirin for people with average risk of colorectal cancer

Back 75

False; poor evidence that aspirin reduces colorectal mortality but good evidence that aspirin increased GI bleeding and renal impairment

Front 76

Where might you see the aortic pulsation?

Back 76

Epigastrum

Front 77

These sounds suggest vascular occlusive disease

Back 77

Bruits

Front 78

Systolic and diastolic bruits heard in the epigastrum or costovertebral angle suggests...?

Back 78

Renal artery stenosis

Front 79

Friction rubs heard over the liver or spleen may indicate... ?

Back 79

liver tumor, gonococcal infection, splenic infarction

Front 80

What is the predominant sound heard in the abdomen when percussed?

Back 80

Tympanny

Front 81

Name the 5 categories of abdominal masses

Back 81

Physiologic, inflammatory, vascular, neoplastic, obstructive

Front 82

True or False Abdominal pain with coughing,or light palpation or rebound tenderness suggests peritoneal inflammation

Back 82

True

Front 83

What is the landmark for measuring the liver span?

Back 83

right midclavicular line

Front 84

True or False The span of liver dullness is decreased with an enlarged liver

Back 84

False

Front 85

True or False Liver span of men and tall people is normally larger than women and short people

Back 85

True

Front 86

True or False The dullness of a right pleural effusion or consolidated lung can falsely decrease the estimate of liver size

Back 86

False; it can falsely increase the size. Gas in the colon can cause falsely increased estimate of the liver

Front 87

What would a normal liver feel like when palpated?

Back 87

soft, sharp, regular and smooth

Front 88

The liver is best heard when? on inspiration or expiration

Back 88

On inspiration and is palpable 3cm below right costal margin in the midclavicular line

Front 89

What technique can be used to palpate the liver in an obese patient?

Back 89

Hooking technique

Front 90

True or False Tenderness over the liver could indicate hepatitis or heart failure

Back 90

True

Front 91

What is the name of the area percussed to assess for splenomegaly?

Back 91

Traube's space

Front 92

True or False If percussion tympanny is present in the Traube's space, it is highly suggestive of splenomegaly

Back 92

False; if percussion is dull it predicts splenomegaly 80% of the time

Front 93

True or False The splenic percussion sign may be positive when spleen size is normal

Back 93

True

Front 94

What causes splenomegaly?

Back 94

Portal hypertension, liver cancer, HIV, splenic infarct or hematoma

Front 95

What position might help bring the spleen forward to be able to palpate it more easily?

Back 95

Pt lying on right side with legs slightly flexed at hips and knees

Front 96

True or False Kidneys are easily palpable

Back 96

False

Front 97

Bilateral kidney enlargement suggests...?

Back 97

Polycystic kidney disease

Front 98

True or False Pain with pressure or fist percussion suggests pyelonephritis

Back 98

True

Front 99

What is the normal width of the aorta in people older than 50?

Back 99

<3.0 cm (average 2.5 cm)

Front 100

What are some risk factors for developing an abdominal aortic aneurysm?

Back 100

Age over 65, history of smoking, make, 1st degree relative with AAA repair

Front 101

True or False Rupture is 10 times more likely in AAAs> 3cm

Back 101

False; 15 times more likely in AAAs > 4cm

Front 102

Name some conditions in which ascites is present

Back 102

Cirrhosis, CHF, constrictive pericarditis, IFC or hepatic vein obstruction, decreased osmotic pressure in nephrotic syndrome and malnutrition

Front 103

True or False With ascites, dependent areas are tympanic and the top is dull

Back 103

False; dependent areas are dull and the top is tympanic

Front 104

Name 4 signs associated with diagnosing appendicitis

Back 104

Rovsing's, Psoas, Obturator, Cutaneous hypersthesia

Front 105

When the Murphy's sign is positive, you must suspect this problem...

Back 105

acute cholecystitis

Front 106

To assess for hernias, asking the patient to be in this position is helpful

Back 106

To raise both head and shoulders off the table

Front 107

When would a finding of Riedel's lobe be normal?

Back 107

Patients with a lanky build; liveris elongated so that right lobe is easily palpable as it projects towards the iliac crest

Front 108

True or False A smooth enlarged liver with a tender edge suggests cirrhosis

Back 108

False; suggests venous congestion such as right sided heart failure. A firm nontender liver suggests cirrhosis

Front 109

Generalized abdominal tenderness and muscle rigidity suggests what condition?

Back 109

Peritonitis

Front 110

What is acute salpingitis and what are the physical findings?

Back 110

Inflammation of the fallopian tubes; bilateral tenderness above the inguinal ligaments, possible rebound tenderness and rigidity; movement of uterus can cause pain

Front 111

True or False A venous hum may be heard with hepatic cirrhosis

Back 111

True

Front 112

What is the most common cause of a protuberant abdomen?

Back 112

Fat

Front 113

True or False An umbilical hernia is most common in adults

Back 113

False; in infants

Front 114

True or False Diastasis Recti is a medical emergency

Back 114

False