H&p Exam 2 Abdomen Exam

Front 1

Visceral pain in the right upper quadrant may result from what

Back 1

liver distention against its capsule in alcoholic hepatitis

Front 2

Visceral periumbilical pain may signify the early stages of this

Back 2

Acute appendicitis from distention of an inflamed appendix

Front 3

Visceral periumbilical pain from early appendicitis gradually changes to which type of pain

Back 3

parietal pain in the right lower quadrant

Front 4

Pain in the duodenum or pancreas is found where

Back 4

refereed back pain from the biliary tree to the right shoulder or right posterior chest

Front 5

Where would pain from pleurisy or acute MI be referred to

Back 5

Epigastric area

Front 6

These mediate interconnected symptoms of pain, bowel dysfunction and stress

Back 6

Neuropeptides (5-hydroxytryptophan and substance P)

Front 7

A pt who is doubling over with cramping colicky pain indicates what

Back 7

Renal stone

Front 8

Sudden knife like epigastric pain occurs when

Back 8

gallstone pancreatisis

Front 9

Epigastric pain occurs with what

Back 9

Gastitis or GERD

Front 10

What does right upper quadrant pain and upper abdominal pain signify

Back 10

Cholecystitis

Front 11

This can present as indigestion but is precipitated by exertion and relieved by rest

Back 11

Angina

Front 12

These can cause bloating

Back 12

inflammatory bowel disease
belching from aerophagia
swallowing air

Front 13

These can cause upper abdominal discomfort or pain which can last over 3 months

Back 13

Delayed gastric emptying
Gastritis
Peptic ulcer disease
psychosocial factors

Front 14

What are the symptoms for GERD

Back 14

Chronic upper abdominal pain discomfort
Heartburn
acid reflux
regurgitation

Front 15

What are the risk factors for GERD

Back 15

reduced salivary flow, prolonged acid clearance, delayed gastric emptying, selected medications, hiatal hernia

Front 16

Angina from inferior wall coronary ischemia along the diaphragm may present as what

Back 16

heartburn

Front 17

Patients with uncomplicated GERD who do not respond to empiric therapy, pts older than 55, pts with alarm symptoms all warrant what procedure

Back 17

endoscopy

Front 18

Endoscopy is used to detect what diseases

Back 18

esophagitis, peptic strictures, barrett's esophagus (30-fold increase risk of cancer),

Front 19

Approx what percent of GERD patients who have a endoscopy exam will have a disease detected

Back 19

50%

Front 20

Dysphagia, odyophagia, recurrent vomiting, evidence of gastrointestinal bleeding, weight loss, anemia, or risk factors for gastric cancer are what type of symptoms

Back 20

alarm symptoms

Front 21

Right lower quadrant pain or pain that migrates from the periumbilical region combined with abdominal wall regidity is most likely this disease

Back 21

Appendicitis
In females could also be PID, ruptured ovarian follicle, and ectopic pregnancy

Front 22

This usually is the cause of cramping radiating to the right or left lower quadrant

Back 22

renal stone

Front 23

Left lower quadrant pain with a palpable mass may be this

Back 23

diverticulitis

Front 24

Diffuse abdominal pain with absent bowel sounds and firmness, guarding, or rebound pain indicates this

Back 24

small or large bowel obstruction

Front 25

Change in bowel habits with mass lesion indicates this

Back 25

bowel cancer

Front 26

Intermittent pain for 12 weeks of the preceding 12 months with relief from defecation change in frequency of bowel movements, or change in form of stool without structural or biochemical abnormalities is usually what

Back 26

irritable bowel syndrome

Front 27

Regurgitation occurs in these diseases

Back 27

GERD, esophageal strictures, and esophageal cancer

Front 28

Vomiting and pain indicates this

Back 28

small bowel obstruction

Front 29

Fecal odor occurs with these diseases

Back 29

small bowel obstruction or gastrocolic fistula

Front 30

Hematemesis may accompany these diseases

Back 30

esophageal or gastric varices, gastritis, peptic ulcer disease

Front 31

Pt who complain of unpleasant abdominal fullness after light or moderate meals, early satiety, inability to eat a full meal usually suffer from this

Back 31

diabetic gastroparesis, anticholinergic medication, gastric outlet obstruction, gastric cancer, early satiety in hepatitis

Front 32

Gurgling or regurgitation of undigested food occur in this structural condition

Back 32

zenker's diverticulum

Front 33

Drooling, nasopharyngeal regurgitation, cough from aspiration in muscular or neurologic disorders affecting motility are indicators of what

Back 33

oropharyngeal dysphagia

Front 34

Pointing to below the sternoclavicular notch indicates what

Back 34

esophageal dysphagia

Front 35

If solid foods provoke symptoms what should you consider

Back 35

esophogeal conditions including stricture, schaztki's ring, web ring, neoplasm

Front 36

if both solids and liquids provoke symptoms what should you consider

Back 36

motility disorder

Front 37

esophogeal ulceration from radiation, caustic ingestion, infection from candida, cytomegalovirus, herpes simplex, or hiv can cause this symptom

Back 37

Pain on swallowing (odynophagia)

Front 38

What would cause increased passing of excess gas

Back 38

aerophagia, legumes or other gas producing foods, intestinal lactase deficiency, irritable bowel syndrome

Front 39

What is the main cause for acute diarrhea

Back 39

infection

Front 40

This is usually noninfectious in origin. Two examples are Crohn's disease and ulcerative collitis

Back 40

Chronic diarrhea

Front 41

What is the origin of high-volume, frequent watery stools

Back 41

small intestine

Front 42

Small-volume stools with tenesmus, or diarrhea with mucus, pus, or blood occur in this condition

Back 42

rectal inflammatory condition

Front 43

This usually has pathologic significance

Back 43

nocturnal diarrhea

Front 44

Oily residue, sometimes frothy or floating occurs with this

Back 44

steatorrhea

Front 45

Fatty diarrheal stools occur from this

Back 45

malabsorption in celiac spure, pancreatic insufficiency, and small bowel bacterial overgrowth

Front 46

Medications such as penicillins, macrolides, magnesium-based antacids, metformin, and herbal alternative medicines all can cause this

Back 46

diarrhea

Front 47

Thin, pencil like stool occurs in this

Back 47

obstructing "apple core" lesion of the sigmoid colon

Front 48

Diabetes, hypothyroidism, hypercalcemia, multiple sclerosis, parkinson's disease, and systemic sclerosis all can cause this

Back 48

Constipation

Front 49

This is a condition of extreme and persistent constipation caused by obstruction in the intestinal system

Back 49

obstipation

Front 50

this signifies intestinal obstruction

Back 50

obstipation

Front 51

this is the passage of black tarlike stools containing blood that has been acted on by the intestinal juices

Back 51

melena

Front 52

The presence of as little as 100ml of blood in the upper gastrointestinal area can cause this

Back 52

melena

Front 53

If more than 1000ml of blood is present in the lower gastrointestinal area this can occur

Back 53

Hematochezia

Front 54

Blood on the surface of toilet paper is a sign of this

Back 54

hemorrhoids

Front 55

Impaired excretion of conjugated biliruben occurs with what diseases

Back 55

viral hepatitis, cirrhosis, primary biliary cirrhosis, drug-induced cholestasis

Front 56

These may obstruct the common bile duct

Back 56

Gallstones or pancreatic carcinoma

Front 57

Dark urine from bilirubin indicates this

Back 57

impaired excretion of bilirubin into the gastrointestinal tract

Front 58

Acholic (putty colored, lack of bile) stools may occur briefly in this disease

Back 58

viral hepatitis as well as obstructive jaundice

Front 59

Itching may indicates this

Back 59

cholestatic or obstructive jaundice

Front 60

Skin Pain may signify this

Back 60

a distended liver capsule, biliary cholic or pancreatic cancer

Front 61

Involuntary voiding or lack of awareness suggests this

Back 61

cognitive or neurosensory deficits

Front 62

This arises from decreased intraurethral pressure

Back 62

stress incontinence

Front 63

Trouble starting urine stream, weak flow and force, hesitation, dribbling are all common in men with this

Back 63

partial bladder outlet obstruction due to BPH and urethral stricture

Front 64

Pain of sudden overdisention accompanies this

Back 64

acute urinary retention

Front 65

Painful urination accompanies this

Back 65

cystitis or urethritis

Front 66

This symptom is found in bladder stones, foreign bodies, tumors, and acute prostitis

Back 66

Dysuria

Front 67

In women Internal burning occurs due to this

Back 67

urethritis and vulvovaginitis

Front 68

Urgency to urinate suggests this

Back 68

bladder infection or irritation

Front 69

In men painful urination without frequency or urgency suggests this

Back 69

urethritis

Front 70

Abnormal high renal production of urine suggests this

Back 70

polyuria

Front 71

frequency without polyuria during the day or night suggests this

Back 71

bladder disorder or impairment to flow at or below the bladder neck

Front 72

urination with increased intra-abdominal pressure suggests decreased contractility of urethral sphincter or poor bladder neck and is called this

Back 72

stress incontinence

Front 73

This is the inability to hold the urine and is a sign of detrusor overactivity

Back 73

urge incontinence

Front 74

type of incontinence where the bladder cannot be emptied until bladder pressure exceeds urethral pressure, this indicates anatomical obstruction by prostatic hypertrophy or stricture or neurogenic abnormalities

Back 74

over flow incontinence

Front 75

This may arise from impaired cognition, musculoskeletal problems, or immobility

Back 75

Functional incontinence

Front 76

Signs and symptoms such as fever, pain, chills occur during this

Back 76

kidney pain

Front 77

This is caused by sudden obstruction of a ureter (urinary stones, blood clots)

Back 77

Renal or ureteral colic

Front 78

These are all classic findings of alcohol abuse

Back 78

spider angiomas, palmar erythema, peripheral edema

Front 79

this thrusts the abdomen foward and tightens the ab muscles

Back 79

arched back

Front 80

Pink-purple striae is a observed in this

Back 80

cushing's syndrome

Front 81

Dilated veins that can be observed on the abdominal exam are due to these diseases

Back 81

hepatic cirrhosis, inferior vena cava obstruction

Front 82

This can be a cause of bulging flanks

Back 82

ascites

Front 83

this can be a cause of supra pubic bulge

Back 83

distended bladder or pregnant uterus, hernias

Front 84

What can cause asymmetry of the abdomen

Back 84

enlarged organs or a mass

Front 85

What are some causes for lower abdominal masses

Back 85

ovarian/uterine tumor

Front 86

This can cause increased peristaltic waves

Back 86

intestinal obstruction

Front 87

These are causes of pulsations in the abdomen

Back 87

aortic aneurysm, increased pulse pressure

Front 88

Bruits heard in the abdomen suggests this

Back 88

vascular occlusive disease

Front 89

When might bowel sounds be altered

Back 89

diarrhea, intestinal obstruction, paralytic ileus, and peritonitis

Front 90

A bruit that is detected in an area with both systolic and diastolic components suggests

Back 90

renal artery stenosis which causes hypertension
also turbulent blood flow of partial aterial occlusion or arterial insufficiency

Front 91

Friction rubs heard while auscultating the liver are a sign of

Back 91

liver tumors, gonococcal infection around the liver, splenic infarction

Front 92

A protuberant abdomen that is tympanitic throughout suggests what

Back 92

interstinal obstruction

Front 93

Large dull areas on percussion can be due to

Back 93

pregnant uterus, ovarian tumor, distended bladder, large liver or spleen

Front 94

Dullness in both flanks may be a sign of this

Back 94

ascites

Front 95

This is a disease where the organs are reversed resulting in an air bubble on the right and liver dullness on the left

Back 95

Situs inversus

Front 96

Involuntary rigidity typically persists despite maneuvers to relax the abdominals this is causes by

Back 96

peritoneal inflammation

Front 97

This is an example of a physiologic abdominal mass

Back 97

pregnant uterus

Front 98

this is an example of a inflammatory mass

Back 98

divericulitis of the colon

Front 99

This is an example of a vascular abdominal mass

Back 99

abdominal aortic aneurysm

Front 100

This is an example of a neoplastic abdominal mass

Back 100

carcinoma of the colon

Front 101

this is an example of a obstructive abdominal mass

Back 101

distended bladder or dilated loop of bowel

Front 102

Abdominal pain with coughing or light percussion suggests this

Back 102

peritoneal inflammation

Front 103

Rebound tenderness suggests this

Back 103

peritoneal inflamation

Front 104

When is liver dullness increased

Back 104

when the liver is enlarged

Front 105

When is the span of liver dullness decreased

Back 105

when the liver is small or when free air is present below the diaphragm (perforated hallow viscus)

Front 106

Serial observations may show a decreasing span of dullness with what

Back 106

with resolution of hepatitis or congestive heart failure or fulminant hepatitis

Front 107

This is a cause of liver displacement downward by the lower diaphragm

Back 107

chronic obstructive pulmonary disease

Front 108

dullness of a right pleural effusion or consolidated lung if adjacent to liver dullness may falsely cause this

Back 108

increase the estimate of liver size

Front 109

Gas in the colon may produce this in the RUQ

Back 109

tympany

Front 110

Tympany in the RUQ, obscure liver dullness due to gas in the colon can lead to this

Back 110

underestimation of liver size

Front 111

When the edge of the liver is palpable this can lead to what

Back 111

a doubled likelihood of hepatomegaly

Front 112

Firmness or hardness of the liver, bluntness or rounding of its edge, and irregularity of its contour suggests what

Back 112

abnormality of the liver

Front 113

This forms an oval mass below the edge of the liver and is dull to percussion

Back 113

obstructed, distended gall bladder

Front 114

What does Tenderness over the liver suggest

Back 114

inflammation, hepatitis, congestion as in heart failure

Front 115

If percussion dullness is present palpation correctly detects this more than 80% of the time

Back 115

splenomegaly

Front 116

Fluids or solids in the stomach or colon may cause dullness in this space

Back 116

traube's space

Front 117

What is suggested when you appreciate a change in spleen percussion from tympany to dullness on inspiration

Back 117

splenic enlargement (this is a positive splenic percussion sign

Front 118

Splenic percussion sign may be positive when the spleen is what

Back 118

normal

Front 119

What are causes of splenomegaly

Back 119

portal hypertension, hematologic malignancies, hiv, infection, and splenic infart or hematoma

Front 120

When is splenomegaly eight times more likely to occur

Back 120

when the spleen is palpable

Front 121

Where is the spleen tip just palpable

Back 121

left costal margin

Front 122

What might left flank mass represent

Back 122

marked splenomegaly or an enlarged kidney

Front 123

When might you suspect splenomegaly

Back 123

if a notch is palpated on medial border,
the edge extends beyond the midline,
percussion is dull,
fingers can probe deep to the medial and lateral borders but not between the mass and the costal margin

Front 124

What attributes favor an enlarged kidney over an enlarged spleen

Back 124

preservation of normal tympany in LUQ,
ability to probe your fingers between the mass and the costal margin but not deep to its medial or lateral borders

Front 125

Where is an enlarged spleen palpable

Back 125

2cm below the left costal margin on deep inspiration

Front 126

What are causes of kidney enlargement

Back 126

hydroenphrosis, cysts, tumors

Front 127

what does bilateral enlargment suggest

Back 127

polycystic kidney disease

Front 128

What does pain with pressure or fist percussion of the kidneys suggest

Back 128

pyelonephritis or may be musuloskeletal

Front 129

What can cause bladder distention

Back 129

outlet obstruction due to urethral stricture, prostatic hyperplasia, medications neurological disorders

Front 130

This is the main symptom of bladder infection

Back 130

suprapubic tenderness

Front 131

The following are risk factors for what disease.
age 65 years or older, history of smoking, male gender, and a first degree relative with this disease

Back 131

Abdominal aortic aneurysm

Front 132

Whar do periumbilical or upper abdominal mass with expansile pulsations that are 3cm or more wide suggest

Back 132

AAA

Front 133

Screening by palpation followed by ultrasound decreases mortality for this disease

Back 133

AAA

Front 134

Rupture is 15 times more likely to occur in AAA that are this size

Back 134

>4cm

Front 135

What are the causes of ascites

Back 135

hydrostatic pressure in cirrhosis, congestive heart failure, constrictive heart failure, constrictive pericaritis, inferior vena cava/ hepatic vein obstruction,decreased osmotic pressure in nephrotic syndrome, malnutrition, ovarian cancer

Front 136

When does dullness shift to the more dependent side whereas tympany shifts to the top

Back 136

ascites

Front 137

A positive fluid wave, shifting dullness, peripheral edema help make a positive diagnosis for what

Back 137

ascites

Front 138

An easily palpable impulse in the abdomen suggests what

Back 138

ascites

Front 139

Where does the pain of appendicitis classically begin

Back 139

umbilicus

Front 140

During appendicitis pain originates around the umbilicus and then shifts to which abdomanal area

Back 140

RLQ
increased by coughing
not as common to occur in older patients

Front 141

Localized tenderness anywhere in the right lower quadrant even the right flank indicates what

Back 141

appendicitis

Front 142

Early voluntary guarding during appendicitis may be replaced with what

Back 142

involuntary muscular rigidity

Front 143

Right sided rectal tenderness may be caused by this

Back 143

inflammed andex or inflammed seminal vesicle

Front 144

What does rebound tenderness suggest

Back 144

peritoneal inflammation in appendicitis

Front 145

What does pain in the right lower quadrant during left pressure suggest

Back 145

appendicitis (this is a positive rovsing's sign)

Front 146

What does right lower quadrant pain on quick withdrawal indicate

Back 146

appendicitis (referred rebound tenderness)

Front 147

This test involves you placing your hand above the patient's right knee and asking them the raise that thigh against your hand. Then the patient will turn onto the left side and extend the right leg at the hip.

Back 147

psoas sign for appendicitis

Front 148

This test involves flextion of the patient's right thigh at the hip with the knee bent and the let rotating internally at the hip.

Back 148

Obturator sign for appendicitis

Front 149

This test involves you picking up a fold of skin along a series of points along the abdomen

Back 149

cutaneous hyperesthesia
localized pain with this maneuver in all or part of the RLQ is a sign of appendicitis

Front 150

What does a sharp increase in tenderness with a sudden stop in inspiratory effort indicate

Back 150

positive murphy's sign of acute cholecystitis

Front 151

How do you expose a bulge of a hernia in a supine patient

Back 151

have them raise their head and shoulders off of the table

Front 152

What is the reason why intestinal obstruction or peritonitis causation may be missed

Back 152

overlooking a strangulated femoral hernia as a possible cause

Front 153

A mass in the abdominal wall can be palpable true or false

Back 153

true

Front 154

an intraabdominal mass is obscured by what

Back 154

muscular contraction