Clinical Examination

Question 1

What is Palmar erythema?

Answer 1

Palms of hands red - may feel slightly warm.

Question 2

What is petechiae?

Answer 2

Small red or purple spot on the skin. Caused by a minor bleed from broken capillary blood vessels.

Question 3

What are spider naevi?

Answer 3

Dilated blood vessels seen under the skin.

Question 4

What is jaundiced?

Answer 4

Yellowish discolouration of the skin - due to hyperbilirubin

Question 5

What is dysphagia?

Answer 5

Difficulty swallowing. Neurological or Mechanical

Question 6

What is odynophagia?

Answer 6

Pain on swallowing, often from hot liquids.

Question 7

What is Virchow’s node?

Answer 7

Lymph node in left supraclavicular fossa. Common site of distant lymph node metastasis.

Question 8

What is Haematemesis?

Answer 8

Vomiting of blood.

Question 9

What is Melaena?

Answer 9

Passage of tarry, shiny black stools with odour. Results from upper GI bleed.

Question 10

What is Haematochezia?

Answer 10

Passage of fresh blood through the anus, usually in or with stools.

Question 11

What is guarding?

Answer 11

Tensing of abdominal wall muscle - guard inflamed organs, within abdomen.

Question 12

What is ascites?

Answer 12

Abnormal accumulation of fluid in the abdomen (cirrhosis of liver)

Question 13

What is Flatus?

Answer 13

Gas in or from stomach or intestine produced by swallowing air or by bacterial fermentation.

Question 14

What is Flatulence?

Answer 14

Accumulation of gas in alimentary canal.

Question 15

What is a hernia?

Answer 15

An internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Usually between chest and hips.

Question 16

What is hepatomegaly?

Answer 16

Abnormal enlargement of liver

Question 17

What is Splenomegaly?

Answer 17

Abnormal enlargement of spleen

Question 18

If you find a abdominal mass what do you need to be able to describe?

Answer 18

Site
Size
Shape 
Surface (smooth/craggy)
Edge/outline (regular/irregular)
Tenderness to palpation 
Consistency (hard/soft) 
Mobility
Pulsatile?
Fluctuant?
Is it possible to get above the mass?

Question 19

Abdominal exam:

What do you look for in the hands?

Answer 19

Look at both hands and compare:
Tar staining
Nail colour - anaemia or leukonychia
Nail shape - clubbing (cirrhosis, IBD), koilonychia (iron deficiency anaemia)
Palms - Palmar erythema, pale palmar crease

Question 20

Abdominal exam:

What do you look for the arms?

Answer 20

Bruising (liver dysfunction)
Scratch marks/pruritus 
Muscle wasting 
Track marks (Hep B and C)
Forearms for loss of skin turgor (dehydration)

Look for tremor:
Flapping tremor (liver failure)
Fine tremor (alcohol and withdrawal) 

Pulse, Resp rate and BP.

Question 21

Abdominal exam:
What do you look for in head, face, eyes,mouth?
And the necklace region?

Answer 21

Face = parotid swelling (alcohol)
Eyes = Jaundice, anaemia
Mouth = Angular stomatitis and sore red tongue, odour of footer hepaticus ( liver failure)
Necklace region = Spider naevi, gynaecomastia, loss of body hair in males.

Question 22

Abdominal exam:

Lymph nodes?

Answer 22

Follow the full routine.
Scalene node on the left for Virchow’s node ( thoracic duct drains structures below diaphragm through this node)
Attend to anterior and posterior chain nodes (drains structures in neck)
Tonsillar - drains oropharynx
Submandibular - drains 2/3 tongue and floor of mouth
Submental - drains tip of tongue and anterior floor of mouth
Pre auricular - drains face including parotid.

Question 23

Abdominal exam:

Legs?

Answer 23

Peripheral oedema (liver failure/ hypoalbuminaemia)
Loss of body hair
Erythema nodosum (IBD) (red sores on legs)

Question 24

Abdominal exam:

Abdomen inspection

Answer 24

Patient lying supine:
Scars
Visible pulsation 
Movement with respiration 
Skin lesions 
Scratch marks (chronic cholestasis)
Abdominal shape 
Stoma 
Distended veins 
Petechiae - pin-head sized red spots
Striae (weight loss)
Abdominal distension ( 5Fs - fat, faeces, flatus, fluid or foetus)

Question 25

Abdominal exam:

Palpation

Answer 25

Always watch patients facial expression and ensure hands are as warm as possible.
Light palpation:
Palpation over the 9 regions:
- palpate for superficial masses, areas of tenderness, increased muscle tone (guarding) and rigidity.

Deep palpation over 9 regions:
Ask about firmness;
Areas of tenderness
May feel - Pulsation of abdominal aorta in epigastrium,
Caecum in right lower quadrant
Descending and sigmoid colon on the left side.
Liver edge in the right costal margin.