Physical Diagnosis Midterm '14

Front 1

Organs in the RUQ

Back 1

1) Small bowel
2) Liver/gallbladder
3) Pylorus/Duedenum
4) Upper portion of R kidney
5) portion of pancreas

Front 2

Organs in the LUQ

Back 2

1) Small bowel
2) Spleen
3) Part of liver
4) body of pancreas
5) stomach
6) Upper portion of kidney

Front 3

Organs in the RLQ

Back 3

1) Cecum and appendix
2) Lower portion of kidney

Front 4

Organs in the LLQ

Back 4

1) Sigmoid in color
2) Lower portion of kidney

Front 5

Visceral ABD Px characteristics?

Back 5

1) Often poorly localized
2) Gnawing/Burning/Vague deep ache
3) Cramping or colicky (comes and goes) in nature
4) Typically palpable near midline at levels that vary with structure involved

Front 6

Visceral Px is stimulated by?

Back 6

specific receptors (nociceptors) for stretch, inflammation, and oxygen starvation (ischemia).

Front 7

Parietal ABD Px characteristics?

Back 7

1) Precisely localized
2) Steady aching pain or Sharp
3) Aggravated by movement, couching
4) Patients typically prefer to lie still

Front 8

Parietal Px?

Back 8

Source – parietal peritoneum
Receptors activated - Somatic innervation (spinal nerves).

Front 9

Pain form a duodenal or pancreatic origin may be referred to?

Back 9

the back.

Front 10

Pain from the biliary tree Px may be referred to?

Back 10

right shoulder or right posterior chest

Front 11

Pleuritic pain or MI pain referred to

Back 11

the epigastric

Front 12

melena

Back 12

black, tarry stool

Front 13

hematochezia

Back 13

blood in the stool

Front 14

white or gray stools can indicate

Back 14

liver or gallbladder disease

Front 15

lower back in men

Back 15

may be prostrate Px

Front 16

Caput medusa

Back 16

vein destintion of cirrhosis or inferior vena cava obstruction

* usually from ascities

Front 17

Peristalsis increased in

Back 17

obstruction

Front 18

Friction rub upon auscultation of the ABD

Back 18

* Grating, scrapping, or rubbing sound produced be visceral pleura rubbing against parietal pleural

* Spleen (listen over spleen)
* Liver (listen over liver)

Front 19

Light Palpation is used for?

Back 19

Identifying any superficial organs, masses, areas of tenderness, or increased resistance to your hand

Front 20

Involuntary guarding indicates?

Back 20

peritoneal inflammation

Front 21

Deep Palpation is used for?

Back 21

1. Physiologic- pregnant uterus
2. Inflammatory- diverticulitis of the colon
3. Vascular- abdominal aortic aneurysm
4. Neoplastic- carcinoma of the colon
5. Obstructive- a distended bladder or dilated loop of bowel

Front 22

Dunphy’s Sign - def

Back 22

cough worsens ABD pain

Front 23

Rebound tenderness is due to?

Back 23

caused by rapid movement of an inflamed peritoneum

Front 24

Traube’s Space

Back 24

* It's a crescent-shaped space overlying the stomach.

* The surface marking: the left sixth rib,the left mid-axillary line andthe left costal margin.

* Percussion should be carried out at one or more levels of Traube’s space from medial to lateral.

Front 25

Splenic Percussion sign

Back 25

1) Percuss the lowest interspace in the left anterior axillary line. (should be tympanic)

2) Ask the patient to take a deep breath in and re-percuss. (normally remains tympanic)

* Positive sign is tympany to dullness on inspiration

Front 26

Ascites causes?

Back 26

1. Increased hydrostatic pressure in cirrhosis, CHF, constrictive pericarditis
2. Hepatic or inferior vena cava obstruction
3. Decreased osmotic pressure in nephrotic syndrome and malnutrition
4. Inflammatory from infection or masses

Front 27

Types of ascites?

Back 27

* Transudative – cirrhosis, CHF, hepatic or IVC occlusion, nephrotic syndrome, malnutrition

* Exudative – cancer, infection, pancreatitis, Tb

Front 28

Ascites - S/S?

Back 28

* Abdominal distension/bulging flanks
* SOB
* leg swelling
* bruising
* hematemesis
* encephalopathy
* Shifting dullness, fluid wave, dullness in dependent areas (due to gravity)

Front 29

Serum ascites-albumin gradient (SAAG) -
High gradient (>1.1 g/dL) indicates?

Back 29

ascites due to portal hypertension, usually related to cirrhosis, CHF

Front 30

Low gradient (<1.1 g/dL) SAAG indicates?

Back 30

ascites not due to portal hypertension as in nephrotic synd., Tb, cancers

Front 31

Shifting Dullness in ascites?

Back 31

* In the supine position:
Percuss from midline moving out towards the perimeter. Mark position where sound changes from tympany to dullness

* Pt in the lateral decubitus position:
Repeat percussion. Gravity dependent fluid will have shifted in a pt with ascites

Front 32

Fluid Wave in ascites?

Back 32

1) Have patient occlude midline of abdomen with the edge of his/her hand
2) Tap one flank
3) Feel for transmission of the sensation on the opposite flank

Front 33

Appendicitis S/S?

Back 33

* Initial periumbilical pain then localizes to RLQ, followed by, N/V, lastly fever
* Diarrhea very unlikely
* Peritoneal inflammation

Note: Perform a rectal examination in both sexes and a pelvic examination in women may help identify or suggest other causes of abdominal pain

Front 34

Rovsing’s sign - def?

Back 34

* Deep palpation in LLQ, then withdraw quickly.

* postive = pain w/ rebound in RLQ - appendicitis

Front 35

Psoas sign - def?

Back 35

* Ask the patient to raise the right leg with resistance applied above right knee (or on L side extend R hip).

* Increased pain with either = positive psoas sign (suggests irritation of the psoas muscle by an inflamed appendix)

Front 36

Obturator sign - def?

Back 36

* Flex the patient's right thigh at the hip with the knee bent, and rotate the leg internally at the hip. This stretches the internal obturator muscle.

* Positive = right hypogatric pain (suggests irritation of obturator muscle by inflamed appendix)

Front 37

Dunphy’s sign - def?

Back 37

Abdominal pain worsened with cough. (may be a sign of appendix irritation)

Front 38

McBurney’s point - def?

Back 38

point between umbilicus and ASIS, Px upon palpation is indicative of appendicitis

Front 39

Jar test - def?

Back 39

* Tap heel while supine
* Increased pain = positive