Abdoman

Question 1

Stress incontinence

Answer 1

• occurs when intra-abdominal pressure goes up during coughing, sneezing or laughing.
• usually due to weakness of pelvic floor with inadequate muscle support of bladder

Question 2

esophageal varices

Answer 2

• often found in alcoholic patients

- only when have a diagnosis of significant cirrhoisis

Question 3

symptoms of cirrhosis

Answer 3

• jaundice
• ascites
• spider hemangiomas
• dilated veins on abdomen (caput medusa)

Question 4

IBS

Answer 4

causes loose bowel movements with cramps but no systemic symptoms of fever, weight loss or malaise

• more likely in young women with alternating symptoms of loose stools and constipation
• stress usually makes the symptoms worse, as do certain foods

Question 5

Acute pancreatitis

Answer 5

• causes epigastric and luq pain
• oftern radiates into the back
• often a h/o long-standing gallbladder disease or recent alcohol ingestion
• severe abdominal pain and vomiting are often seen
• meds such as proton pump inhibitors can cause pancreatitis
• treatment includes hydration, pain mgmt and bowel rest

Question 6

Diverticulitits

Answer 6

• caused by localized infection within the colonic diverticula
• constipation, fever and abdominal pain are common
• typical pain is unusual in that it is not made worse by examination despite being severe

Question 7

splenic rub

Answer 7

• rough grating noise in luq

- can accompany splenic infarction

Question 8

Find small mass in abdomen - what do you do next

Answer 8

• exam with ab muscles tensed
• can determine if mass is actually in the abdominal wall versus in the abdomen by palpating with the abdominal wall tensed
• can be accomplished by having patient lift head off bed while supine
• usually ab wall masses can be observed, whereas intra-abdominal masses are more concerning

Question 9

Infectious mono

Answer 9

• dullness in last intercostal space in the anterior axillary line on left side with a deep breath
• presence of dullness with inspiration should raise attention to further exam of spleen
• note - dullness can occur in normal patients too

Question 10

Left-sided mass in abdomen (LUQ)

Answer 10

• more likely to be a kidney if there is no palpable “notch”
• you can push your fingers between the mass and the costal margin
• normal tympany over this area
• cannot push your fingers medial and deep to the mass

Question 11

risk of aortic rupture

Answer 11

-15 times greater if aorta measures > 4 centimenters

Question 12

ascites supported by

Answer 12

• tympany which changes location with patient position
• supported by findings that are consistent with movement of fluid and gas with changes in position
• fluid wave and edema would support this diagnosis as well

Question 13

Consistent with obturator sign

Answer 13

• right hypogastric pain with the right hip and knee flexed and hip internally rotated
• sign seen in appendicitis
• pain with the stretching of the internal obturator muscle because of inflammation

Question 14

Ischemia pain

Answer 14

-can be severe but not made worse with palation