Abdomen

Question 1

What is the origin/insertion of the rectus abdominis?

Answer 1

origin: pubis, insertion: costal cartilages of ribs 5-7

Question 2

What nerves innervate the rectus abdominis?

Answer 2

Nerve roots T7 - T12

Question 3

What are the layers of the abdominal wall from most superficial to deep?

Answer 3

Skin, Camper’s fascia, Scarpa’s fascia, Rectus abdominis, External Oblique, Internal Oblique, Transverse abdominis, Pyramidalis muscle, Fascia, Pertonium

Question 4

Does the aorta bifurcate above or below the umbilicus?

Answer 4

above

Question 5

where is the gallbladder palpated anatomically?

Answer 5

R MCL

Question 6

Which renal artery is longer?

Answer 6

right

Question 7

Which kidney is positioned lower than the other?

Answer 7

right

Question 8

What could Costovertebral angle tenderness indicate?

Answer 8

pyelonephritis or MSK

Question 9

Where are bruits in the renal arteries auscultated?

Answer 9

on the posterior side of the abdomen

Question 10

which artery generally bleeds with a stomach ulcer?

Answer 10

gastroduodenal

Question 11

why is the order of inspection (inspection, auscultation, percussion, palpation) important especially on the abdominal exam?

Answer 11

you don’t want to cause pain with palpation before inspection of the pt

Question 12

Answer 12

Know these incisions for common surgical procedures

Question 13

what abdominal finding would be noted in a pt with Cuchings?

Answer 13

large abdomen with striae

Question 14

caput medusae is a sign of?

Answer 14

portal HTN, liver failure

Question 15

What is diastasis recti?

Answer 15

not technically a hernia - can become one, due to a weak linae alba

Question 16

how can you test for diastasis recti?

Answer 16

have the pt do a crunch, the abdomen should not bulge

Question 17

what populations are at risk for developing diastasis recti?

Answer 17

pre-mature infants, pregnant women

Question 18

What “technically” is required before documentation of no bowel sounds?

Answer 18

2 minutes of no bowel sounds

Question 19

what might cause increased bowel sounds?

Answer 19

gastroenteritis, hunger, early obstruction

Question 20

what might cause decreased bowel sounds?

Answer 20

peritonitis, adynamic ileus, late obstruction

Question 21

what can cause adynamic ileus?

Answer 21

surgery or anesthesia, gallstones

Question 22

most of the abdomen should sound tympanic on percussion except…

Answer 22

it is over a solid organ, the pt has just eaten, or if the pt is constipated

Question 23

what is WNL for liver span?

Answer 23

6-12cm

Question 24

how is splenic percussion performed?

Answer 24

percuss the lowest ICS, have pt take in a deep breath, percuss over the same area and it shouldn’t change

Question 25

methods for relaxing a ticklish patient?

Answer 25

have the take a deep breath in, bend knees to relax abdominal muscles

Question 26

where should palpation always be directed last during the exam?

Answer 26

the most tender area

Question 27

what should a normal liver border feel like?

Answer 27

smooth and soft/firm

Question 28

what are some abnormal findings on liver palpation?

Answer 28

hepatomegaly, hard liver, nodules, oval mass below the liver borders

Question 29

what is a normal aorta diameter?

Answer 29

3cm

Question 30

define acute appendicitis

Answer 30

poorly localized periumbilical pain followed by RLQ pain that is aggravated by movement/cough

Question 31

what is the peritoneums role in pain sensation with acute appendicitis?

Answer 31

once the peritoneum is inflammed, the pt will feel tenderness with any jarring/coughing movement

Question 32

where is the appendix palpated?

Answer 32

McBurney's point

Question 33

if a pt with appendicitis has right-sided rectal tenderness, where is there appendix most likely located?

Answer 33

retro-cecal

Question 34

will rebound tenderness be positive or negative with acute appendicitis?

Answer 34

positive

Question 35

What is rovsing's sign?

Answer 35

pain in the RLQ during LLQ palpation and LLQ withdrawal (referred rebound tenderness)

Question 36

which leg is the psoas sign performed with and what does a positive test indicate?

Answer 36

the right leg, indicates appendicitis

Question 37

if the psoas sign is positive, what might also be noted on exam?

Answer 37

pturia since the R ureter is so close to the appendix

Question 38

what is the obturator sign?

Answer 38

flex R hip 90 degrees and internally rotate the hip

Question 39

what is murphy's sign?

Answer 39

press firmly under the R costal margin while pt inhales deeply, inspiratory arrest occurs suggesting cholecystitis

Question 40

what is the fluid wave test?

Answer 40

2 people required, on person makes a roadblock in the midline of the abdomen while the other pushed back and forth on the abdomen - should feel waves if ascites present

Question 41

what is a normal superficial abdominal reflex?

Answer 41

muscle contracts in the direction of the skin stroke

Question 42

when is the superficil abdominal reflex decreased?

Answer 42

motor neuron disease, MS, neurogenic bladder

Question 43

what is Kehr's sign?

Answer 43

L shoulder pain with peritonitis due to irritation of the diaphram indicating ruptured spleen

Question 44

Where does pancreatic pain refer to?

Answer 44

the back

Question 45

where does uterine pain refer to?

Answer 45

the lumbar spine

Question 46

Where does a perforated ulcer refer to?

Answer 46

right trapezoid (shoulder)

Question 47

Where does biliary colic refer to?

Answer 47

right scapula

Question 48

where can renal colic refer to?

Answer 48

over the kidney or either side of lumbar spine

Question 49

where can ureteral pain refer to?

Answer 49

the scrotum or labia

Question 50

define hernia

Answer 50

translocation of a structure or viscous from its normal position to an abnormal position through a natural boundary

Question 51

what is a hiatal hernia

Answer 51

stomach moves through gastro-esophageal junction/esophageal hiatus into the thorax, most are sliding - could also be paraesophageal

Question 52

what is a herniated nucleus pulposus?

Answer 52

herniated disc/spine into the annulus fibrosis (could be due to dehydration, wear and tear, age, poor body mechanics )

Question 53

what are ventral hernias?

Answer 53

protrusion of a peritoneal-lined sac through some defect in the abdominal wall - could be epigastric, umbilical, incisional

Question 54

what are the 3 types of inguinal hernias?

Answer 54

direct, indirect, femoral

Question 55

what causes epigastric hernias

Answer 55

defect/weakness/destruction of the linea alba with protrusion of peritoneal contents

Question 56

who is at risk for epigastric hernias?

Answer 56

pregnant women, obesity

Question 57

what causes umbilical hernias?

Answer 57

fascial defect around the umbilicus

Question 58

when are umbilical hernias repaired?

Answer 58

strangulation of contents, in adults

Question 59

what causes incisional hernias?

Answer 59

defect/weakness at the site of surgical repair

Question 60

contrast direct/indirect/femoral hernia location

Answer 60

direct: right through femoral ring, indirect: peritoneal lined sac, femoral: under inguinal ligament

Question 61

which inguinal hernia is more prone to strangulation?

Answer 61

femoral

Question 62

who typically develops inguinal hernias?

Answer 62

direct: middle aged and elderly men (smokers, obese, weak abdomen), indirect: anyone, femoral: more common in women

Question 63

which inguinal hernias originate above inguinal ligament?

Answer 63

direct/indirect

Question 64

which inguinal hernias involve the scrotum?

Answer 64

direct: rare, indirect: common

Question 65

where is the impulse location of the inguinal hernias?

Answer 65

direct: side of finger in inguinal canal, indirect: tip of finger in inguinal canal, femoral: not felt in canal