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NBCE Part 4 > Abdomin Exam > Flashcards

Abdomin Exam Flashcards

1
Q

Distention of the Upper abdomin: Which organs could be affected?

A

Stomach, Liver, GB, Spleen

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2
Q

Distention of the Lower abdomin: Possible diagnosis

A

Bladder, Hernia, Prego

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3
Q

Distention of both lower and upper abdomin is what pathology?

A

Ascities

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4
Q

Purple Striae in the abdomin could indicate?

A

Cushing’s OR Adrenal tumor that produces cortisol

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5
Q

Describe INC/DEC in peristalsis in both early and late bowel obstruction?

A 
INC = Early Obstruction
DEC = Late Obstruction
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6
Q

Pulsations in the abdomin could indicate

A

Abdominal aneurysm

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7
Q

Diastasis Recti (What is it and would you treat?)

A

It is a separation of the abdominal muscles towards the lateral sides caused by heavy lifting/Prego.
Not significant.

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8
Q

Grey Turner’s sign (Located where and what doe sit indicate?)

A 
Blood in Flanks
Indicates Pancreatitis (Rupture has already occurred)
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9
Q

Caput Medusa indicate?

A

Portal Hypertension

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10
Q

Definition of Borborygmi

A

Rumbling sounds heard in abdomin. Bowel sounds.

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11
Q

Tympani indicates?

A

Air

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12
Q

Dullness indicates?

A

Fluid

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13
Q

Liver size parasternal and midclavicular?

A 
Parasternal = 4-8cm
Midclavicular = 6-12cm
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14
Q

Dullness over the spleen indicates?

A

Normal spleen unless enlarged.

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15
Q

How do you palpate the liver?

A

Start at zyphoid and go around coastal margin to posterior axillary line

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16
Q

How do you palpate the KD?

A

Entrapment – Dr Beings pressing medially and with each breath out the dr moves lateral wo bunny hopping. Dr does this over 3 breaths. The other hand is placed underneath the PT. Dr always observes PTs face for pain.

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17
Q

How do you palpate the spleen?

A

Start at Anterior axillary line. Pull w left hand and push with right hand.

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18
Q

Name 3 tests and describe how they are performed for Ascities

A

Shifting dullness = Percuss horizontally across abdomen. If tympany changes to dullness over the center of the abdomen it could indicate air bubble. Have PT side-lying and repeat test. If there is no change in the location of the air then it is most likely gas trapped in the bowel and not from ascities. If it changes location it indicates ascities.
Fluid Wave = PT supine. Dr taps each side of the abdomen and observes for fluid wave indicating ascities.
Puddle Sign =

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19
Q

Name 3 tests and describe how they are performed for Ascities? Which sign is the most sensitive?

A

Shifting dullness = Percuss horizontally across abdomen. If tympany changes to dullness over the center of the abdomen it could indicate air bubble. Have PT side-lying and repeat test. If there is no change in the location of the air then it is most likely gas trapped in the bowel and not from ascities. If it changes location it indicates ascities.
Fluid Wave = PT supine. Dr taps each side of the abdomen and observes for fluid wave indicating ascities.
Puddle Sign = PT standing. Place Stethescope midline above umbilicus. Have PT forward flex. Percuss a few times to each side of the scope.
Puddle sign is the most sensitive test for Ascities.

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20
Q

Which condition is Blumberg’s Test used for and describe the test?

A

Blumberg’s Rebound tenderness for GB.

Palpate each of the 4 quadrants by pressing in slowly and releasing quickly. Go deep.

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21
Q

Describe how to perform Obturator and Psoas sign tests for GB

A

Psoas sign = PT side-lying. Hold PTs leg near knee and extend femur while bracing Hip w other hand. Pain near the GB indicates GB as pain generator bec psoas will irritate the GB.
Obturator sign = PT supine. Flex thigh to 90. To externally rot femur int rot leg.

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22
Q

What is the #1 cause of chest pain

A

Heart Burn

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23
Q

Hiatal hernia cause?

A

Weak Diaphragm

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24
Q

What is Achalasia? What disease causes it?

A

Distal narrowing of the Esophagus.

Cause = Scleroderma

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25
Gastric Vs Duodenal ulcers (Course of pain after eating?)
Duodenal pain 2hrs after eating | Gastric pain during meal otherwise unpredictable.
26
Gastric Vs Duodenal ulcers (Course of pain after eating?)
Duodenal pain 2hrs after eating Gastric pain during meal (Could also be cancer so ask if pain unrelieved by position or medication) otherwise unpredictable.
27
Cause of Acute Gastritis?
Allergies/Sensitivities
28
Name one thing to be concerned about in chronic gastritis?
B12 deficiency | Low B12 -> Pernicious anemia -> PLS
29
Gastric Cancer causes which lymh node to become enlarged?
Left Virchow
30
Diseases ass w head of pancreas
Pancreatitis, Cancer
31
Pancreatitis Acute Vs Chronic SS
``` Acute = Fever, Ridgid Abdomin, Labs Chronic = Quiet, Normal Labs ```
32
SS of Pancreas Cancer (Head of pancreas)
Weight loss, jaundice, Pain at T10 straight through and knife like, Bruised flanks, Steatorrhea, Hx of drinking and smoking
33
If PT has Pain at T10 straight through and knife like think? But ask?
Pancreas; Do you have a Hx of drinking or smoking?
34
Cullen's Sign (Which Tests to order?)
CBC, CT, Amylase, Lipase
35
Diseases ass w tail of pancreas
DM1, DM2, Gestational DM
36
DM1 and 2 differences (General: Ages, body morphology, Tx)
``` DM1 = <35yo, thin, INSULIN DEPENDENT DM2 = ?35yo, obese, Diet controled ```
37
SS of DM1 or DM2
3Ps: Polydypsia, polyuria, polyphagia
38
GB (Tests?)
CBC w/ Diff, Bilirubin, UA, Cholecystogram, US cystography
39
Name 2 conditions ass w Gallbladder
Cholecystitis (AKA Cholangitis) = infection | Cholelithiasis = Stones
40
Cholelithiasis and Cholangitis Tx
Adjust T5, Diet
41
Pt has pain in inferior right scapula. What GI organ should you be concerned about?
GB
42
Name 3/5 diseases ass w spleen
``` Cancer Leukemia -- Spleen must handle excessive WBC Hodgkin's -- Splenic Enlargement Mono -- Splenic Enlargement Rupture -- From Truama ```
43
SS of Spleen disorder
Anemia, Frequent infections, Fatigue, Chronic illness
44
Spleen (Tests)
CBC, US, Biopsy (Cancer), CT)
45
What is the function of the Spleen?
Destroy old RBCs, make, store and remove WBCs
46
Which 4 organs are WBCs made
Thymus (T Lymphocyte maturation), Spleen and Lymph nodes (T and B Lympho), Marrow
47
MC Cause of Hepatitis?
Viral
48
Labs for Viral Hepatits
DEC Leukocytes | INC Lymphocytes
49
Lymphocytes Vs Leukocytes
Lymphocytes are a type of Leukocyte with 3 major types: NK cells, T-cells (Thymus cells) and B-cells (Bone cells). *Leukocytes refer to ALL WBC types.
50
Hep A
Oral; Scratch by butt eat my cookies
51
Viral Hepatitis: Which Ig will be high in Acute Vs Chronic hepatitis?
IgM is Acute | IgG is chronic
52
Acute Vs Chronic hepatitis tenderness?
Acute the liver is tender. Chronic = NO tenderness
53
Alcoholism causes which 3 liver conditions?
Cirrhosis and cancer
54
SS of alcoholic liver?
Jaundice, RUQ tenderness, right shoulder pain, varicosities
55
SS of alcoholic liver?
Jaundice, RUQ tenderness, right shoulder pain, varicosities (Portal (Liver) and splenic Veins)
56
Palpation for Cirrhosis and Cancer of liver reveals?
``` Cirrhosis = Nontender, hard and symmetrical enlargement Cancer = Non-tender, hard and lumpy, not symmetrical ```
57
Labs for for Cirrhosis and Cancer of liver reveals?
``` Cancer = Labs variable Cirrhosis = INC GGT ```
58
SGOT is?
1 of the 2 aminotransferases (SPGT and SPGT). | AST; Aspartate transaminase
59
SPGT is?
1 of the 2 aminotransferases (SPGT and SPGT). ALT; Alanine transaminase High after heart, pancreatitis, KD, or liver dx
60
GGT is?
Gamma-glutamyltransferase Is a transport molecule that helps body in detox High in liver cell or bile duct cell damage-- when these cells rupture they release GGT.
61
ALP is?
Alkaline Phos
62
Hep A and C Labs values for SPGT and SGOT?
Hep A: Very High SPGT and SGOT Hep C: Mild elevated SPGT and SGOT *Note: The levels of SPGT and SGOT do not correlate with the exact amount of liver damage. EX: Hep A PTs typically fully recover and Hep C PTs have extensive liver damage
63
Bilirubin: Direct abnormal (Organs affected and then SS)
Conjugated; Soluble; Post-hepatic: Liver, GB, Pancreas | SS Jaundice, Pale feces, yellow urine
64
Bilirubin: Indirect abnormal (Organs affected and then SS)
Unconjugated; Insoluble; Pre-hepatic: Liver, spleen, blood, rx SS Jaundice, green urine
65
Name 3/5 spleen diseases
``` Cancer Leukemia - Spleen makes excessive WBC Hodgkins - Spleen enlarged Mono - Spleen enlarged Rupture - trauma ```
66
Name a few SS of spleen diseases?
Anemia Frequent infections Fatigue Chronic Illness
67
What is Coomb's test for?
Tests for Antibodies to RBCs (IE Anti-globulin test); 2 Types: Direct and indirect Indirect tests for blood transfusion compatibility. Done before transfusion. Tests blood SERUM. **Direct tests for autoimmune-hemolytic anemia** Tests RBCs and not serum.
68
Name a few Hemolytic diseases
1. Hereditary Spherocytosis 2. Hereditary Elliptocytosis 3. Sickle Cell 4. G6PD deficiency 5. Pyruvate kinase deficiency ``` Autoimmune-hemolytic anemia (IgG attached to RBC which causes the problem): SLE RA IBD Leukemia Infectious (IgM agglutination) ```
69
KD Diseases: Name 3 types:
Nephritic KD/Nephritis -- Infection Stones Nephrotic -- Death
70
Name 6 tests for KD (Includes Labs)
``` IVP - Intravenous pyelogram Helical CT UA Creatinine Clearence Cystometric US ```
71
WHich has RBC casts: Nephritic or Nephrotic disease?
Nephritic
72
WHich has RBC casts: Nephritic or Nephrotic disease?
Nephritic
73
Nephrotic Syndrome = KD death. | Name 3 SS?
HTN Edema (Lots) Proteinuria (Positive UA) *Mnemonic is "HEP HEP HEP Me"
74
Toxemia of Prego will cause: Nephritic or Nephrotic disease?
Nephrotic bec KD will get smashed and will result in death of the KD "Not only eating for 2 but peeing for 2" -- Extra stress on KD
75
DID you know that Strep throat first infects the throat Then the KD!, Lastly the heart valves
If PT has Fever and LBP ask about "Have you had a sore throat in the last 2 weeks". Its not the first thing you think when a PT has LBP but fever and LBP could be a strep infection inside the KD!
76
Strep infection: Nephritic or Nephrotic disease?
Nephritic
77
Nephritic disease. Name a SS?
Fever Proteinuria (Not always) Strep MC cause (Dentist or Infection) RBC Casts
78
Name a few labs for diagnosis of Glomerular nephritis?
ASLO = Anti-streptolysin ANCA = Anti-neutrophil cytoplasmic antibodies -- Tests for IgG Anti-GBM = Glomerular basement mem -- Remember thinning of the basement membrane is what occur sin this dx Complement levels Anti-nuclear antibodies -- Tests for Autoimmune Antibodies
79
Medical name for Bladder infection?
Cystitis
80
KD Cancer: Name 2 SS
PainLESS bleeding, unexplained weight loss
81
KD Stones: Name 3 SS
Painful bleeding Colicky pain -- no position of relief Writhing Pain = PT cant stop moving or trying to find a position of relief PT hurts everywhere
82
KD Stones: Age and Gender
Male; 20s
83
MC Type of KD stones?
Oxalic Acid
84
Stones Tx:
INC Fluid DEC VIT C DEC Calcium DEC Green Vegi
85
Cystitis MC bacteria?
E-Coli
86
Cystitis: Age and Gender
Younger Female | Older Male esp w prostate problems
87
Cystitis Name 2 SS
Urinary Urgency | Burning
88
SI VS LI issue: Endoscopy or Colonoscopy
LI = Colonoscopy
89
Colon Cancer SS
Painless Bleeding
90
TX for all Colon issues?
Fiber
91
Crohns Disease marked by lesions where?
Skip Lesions | MC in Distal ileum
92
String Sign AKA
Skip Lesions
93
Crohns Disease invovles narrowing of the lumen forming strictures called Skip lesions Name 2 SS
Rectal bleeding - Red streaks | INC WBC
94
Ulcerative Colitis (UC) is marked by?
Local Megacolon
95
How does Megacolon occur in UC?
Sacral Plexus becomes damaged so GI cant contract and the colon spreads out. Can also be caused by repetitive straining or holding of stool -- IE waiting 30min to finish a move.
96
How does Megacolon occur in UC?
Sacral Plexus becomes damaged so GI cant contract and the colon spreads out.
97
Name MC location of UC
Descending Colon
98
Name 3 SS of UC? (BAI)
Bloody Diarrhea Arthritis (Large Joints) Iritis/Uveitis
99
HLA-B27 Suggests?
UC or Crohns
100
Crohns Tx:
Restrict Raw foods and high calorie foods Adjust Fecal Transplant -- Taking Stool from healthy person and implanting it into Crohns PT to restore GI microbiota -- For C. difficile colitis
101
UC Tx:
Electrolytes bec diarrhea Avoid Milk Adjust Fecal Transplant
102
IBS AKA?
Spastic Colon | Mucous Colitis
103
IBS is defined by what SS?
Alternating Diarrhea and constipation
104
Diverticulosis cause:
Repetitive straining or holding of stool -- IE waiting 30min to finish a move. This weakens the lumen and allows out-pouching
105
Outpouching occurs MC where?
Distal Colon
106
Outpouching is a SS of?
Diverticulosis
107
Diverticulosis Tx:
Avoid Nuts and seeds and popcorn | INC Water intake
108
Diarrhea lasting 2-4 hrs indicates?
Staph food poisoning
109
Diarrhea lasting a full day indicates?
Salmonella Food poisoning
110
What is an IVP
Intravenous pyelogram Used to look for KD Stones Uses Radiography and a dye
111
Describe Cystometric test?
Pumps water into the bladder. The device then measures the amount of fluid present in the bladder when you first feel the need to urinate, when you are able to sense fullness, and when your bladder is completely full. The time required to begin voiding and the size, force, and continuity of the urinary stream is recorded. The amount of urine, how long the voiding took, and the presence of straining, hesitancy, and dribbling are also recorded.
112
What is the Cystometric test for?
Urinary Incontinence
113
UA is used as a KD screen
Looks for Proteinuria
114
Creatinine Clearance
For End stage Renal disease PT will be very Swollen Used to determine if PT needs dialysis that day and if they need a KD transplant
115
UCRAPE B27 AKA U CRAPe B27
``` Ulcerative Collitis Crohn's Reiter's AS Psoriatic Enteropathic ```
116
HLA - B27 *Neg sign means its Seroneg
Seroneg arthritis:
117
Which are the Seroneg arthritis?
RAPE from UCRAPE Reiters, AS, Psoriatic, Enteropathic **These are the arthritides that attack the spine and make SYNDESMOPHYTES
118
Which conditions Make Syndesmophytes?
RAPE Reiter's AS Psoriatic Enteropathic
119
Which conditions Make Syndesmophytes?
RAPE Reiter's AS Psoriatic Enteropathic
120
What are Syndesmophytes?
Calcified ligs of the spine
121
Name 2 SS of enteropathic arthritis?
Back Ache and Bloody Diarrhea
122
Calcification of the Lig around the spine indicate what radiological finding?
Osteophytes unless Reiter's, AS, Psoriatic, or Enteropathic | Then Syndesmophytes
123
What tissue does RA and OA target?
RA -- Synovium of joints (Cartilage) | OA -- Targets end plates and Joints

NBCE Part 4 (5 decks)

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