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Year 3 ICSM OSCE Examinations > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

1
Q

What should you look for at the end of the bed?

A
  • Nutritional supplements
  • Nasogastric tube
  • Stoma bag
  • Catheter bag
  • NBM status
  • Obvious anaemia
  • Jaundice
  • Tattoos
  • Distention or Scars
  • Cachexia or obesity
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2
Q

What should you ask the patient about?

A

Any pain, tattoos or bruises

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3
Q

Why should you ask the patient to lift their head or cough?

A

Shows divercation of the recti and any hernias

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4
Q

What should you look for on the dorsal surface of the hand?

A
  • Clubbing
  • Koilonychia
  • Leuconychia
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5
Q

What GI disorders can clubbing be a sign of?

A
  • Inflammatory bowel disease
  • Liver cirrhosis
  • Coeliac disease
  • Primary biliary cirrhosis
  • Oesophageal achalasia
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6
Q

What is leuconychia and what is it a sign of?

A

Leuconychia are white and opaque nails

It is caused by chronic liver disease and low serum albumin conditions (e.g. nephrotic syndrome)

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7
Q

What is koilonychia and what is it a sign of?

A

Nails become thin and brittle, flatten and ultimately become spoon shaped

Caused by iron deficiency

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8
Q

What should you look for on the palmar surface of the hand?

A
  • Palmar erythema
  • Dupytren’s contracture
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9
Q

What causes palmar erythema?

A
  • Pregnancy
  • Idiopathic
  • Thyrotoxicosis
  • Polycythaemia
  • Connective tissue disorders e.g. SLE
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10
Q

What is Dupuytren’s contracture what is it a sign of and how do you confirm a patient has it?

A

Thickening of palmar aponeurosis caused by:

  • Alcohol dependence
  • Epilepsy
  • Diabetes
  • Idiopathic

Results in a bending of one or more fingers towards the palm.

Extend the digit and feel for tightness of tendon

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11
Q

How to test for liver function using the hands?

A

Assess liver flap (30 seconds to say for sure)- Cerebral dysfunction in metabolic encephalopathy

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12
Q

What should you assess in the wrist and arm?

A

Radial pulse rate and volume and blood pressure

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13
Q

What should you look for in the eyes?

A
  • Conjunctival icterus- Jaundice
  • Conjunctival pallor- Anaemia
  • Corneal arcus
  • Xanthelasma
  • Kayser- fleischer rings (Brown-green crescents at 6 and 12 o’clock)
    • i. Wilson’s disease– Autosomal recessive genetic disorder in which copper accumulates in liver, basal ganglia and eyes
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14
Q

What should you look for in the mouth?

A
  • Angular stomatitis- inflammation around corners of mouth
  • Scurvy
  • Apthous ulcers
  • Buccal pigmentation
  • Telangiectasia- swollen blood vessels
  • Atrophic Glossitis- smooth glossy tongue
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15
Q

What is angular stomatitis and what does it suggest?

A

Inflammatory condition affecting the corners of the mouth suggesting Iron deficiency

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16
Q

What is scurvy and how may it present in the mouth?

A

Vitamin C deficiency causing soft haemorrhagic gums

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17
Q

What GI diseases cause apthous ulcers?

A
  • Inflammatory bowel disease
  • Coeliac Disease
  • Immunocompromised
18
Q

What is buccal pigmentation a sign of?

A
  • Cachexia
  • Malabsorption syndrome
  • Haemochromatosis
  • Peutz-Jeghers syndrome– Autosomal dominant condition where multiple hamartogenous polyps with low malignant potential affect gastrointestinal tract
19
Q

Identify and explain what to look for on the tongue when performing a GI exam?

A
  • Hydration status–dry or furring in fever/ dehydration
  • Smooth clean looking tongue (loss of papillae)
    • Iron/ Vitamin B12 deficiency
  • Hallitosis- malodorous breath due to decomposing debris or carious teeth
  • Fetor hepaticus– alcoholic/ sweet smell of ketones
20
Q

What should you inspect for on the neck?

A
  • Lymphadenopathy
  • Virchow’s node (Left supraclavicular fossa)
    • Intra-abdominal malignancy e.g. gastric
  • Acanthosis Nigricans
  • Raised JVP
21
Q

What signs should you look for on the chest?

A
  • Spider naevi (press them)
  • Gynaecomastia
  • Scars
  • Abnormal hair distribution
22
Q

What is spider naevi and what does it suggest?

A

They are visible arterioles with radiating capillary branches in the skin which disappear when you press them and refill from the centre. More than 5 are significant.

They are caused by chronic liver disease.

23
Q

What are some causes of gynaecomastia?

A

Benign enlargement of male breast tissue associated with conditions which alter the oesradiol-testosterone ratio

  • Physiological – puberty/ senility
  • Kleinfelter’s syndrome
  • Cirrhosis
  • Drugs e.g. spironolactone, digoxin
  • Testicular tumour, orchidectomy
  • Endocrinopathy e.g. hyper/hypothyroidism
24
Q

What is Greys sign?

A

Bruising of the flanks indicating retroperitoneal haemorrhage

25
Q

What is Cullens sign?

A

Oedema and bruising of subcutaneous fatty tissue around umbilicus caused by enzymes tracking down falciform ligament

Commonly associated with severe acute pancreatitis

26
Q

What are the general signs should be observed on the patients abdomen?

A
  • Scars – describe site, length, likely indication
  • Striae- stretch marks
  • Distension – bowel obstruction
  • Stomas – site, spouted/ flush, bag contents
  • Caput Medusa- A sign of severe portal hypertension with porto-systemic shunting through umbilical veins
  • Grey turner’s sign- associated with severe acute pancreatitis
  • Cullen’s sign- associated with acute pancreatitis
27
Q

What should you ask before beginning palpation?

A

Are you in any pain or discomfort?

28
Q

What are the signs of chronic liver disease?

A
  • Signs of chronic liver disease
  • Caput medusa
  • Scratch marks
  • Body hair loss
  • Bruising
  • Testicular atrophy
  • Needle marks
  • Tattoos
  • Ascites
    • Cirrhosis
    • Carcinomatosis
    • CCF
29
Q

What are the stages of general abdominal palpation

A

Ask patient if they have any pain

Palpate beginning away from the pain using the flat of the hand while looking at the patients face

Light palpation to assess for areas of tenderness and guarding

Deep palpation to assess organomegaly or masses in 9 quadrants

Assess for rebound and percussion tenderness

Assess epigastric area for AAA – Pulsatile and expansile?

30
Q

How should you palpate for the liver?

A

Start in RIF using side of your hand to feel for a liver edge

Ask patient to fully expire and rest hand on area

Ask patient to inspire deeply and palpate deeply on inspiration

Move hand as patient expires deeply

Percuss the liver along the same line

Note the number of fingers below costal margin

31
Q

What are some causes of hepatomegaly?

A
  • Cirrhosis (e.g. Alcoholic)
  • Carcinoma (primary or metastatic)
  • CCF
  • Infectious (HBV, HCV)
  • Immune (PBC, PSC, AIH)
  • Infiltrative (Amyloid, myeloproliferative disorder)
32
Q

How should you palpate for the spleen?

A

Start in RIF moving up towards left costal margin (diagonally)

Ask patient to expire fully and rest hand on abdomen

Palpate deeply on inspiration

Percuss along the same line

33
Q

What are some causes of splenomegaly?

A

Massive splenomegaly (>8cm)

  • Myeloproliferative disorders (CML, MF)
  • Tropical infections (Malaria, kala-azar)

Moderate (4-8cm)

  • Myelo/ lymphoproliferative disorders
  • Infiltration (amyloidosis)

Tip (<4cm)

  • Myelo/lymphoproliferative disorder
  • Portal hypertension
  • Infections (EBV, IE, HBV/ HCV)
34
Q

How should you palpate the kidneys?

A

Bimanual technique to ballot kidneys

35
Q

What are some causes of unilateral renal enlargment?

A
  • PCKD
  • Renal cell carcinoma
  • Simple cysts
  • Hydronephrosis
36
Q

What are some causes of bilateral renal enlargment

A
  • PCKD
  • Bilateral RCC (5%)
  • Bilateral hydronephrosis
  • Tuberous sclerosis
  • Amyloidosis
37
Q

How to assess for shifting dullness (in a patient with suspected ascites)?

A

Percuss the abdomen from umbilicus laterally until the percussion note becomes dull

Hold your finger at the point where the note changes

Ask the patient to roll towards you and wait for 30 seconds keeping your hand in the same position

Percuss in the same area again. Is the percussion note still dull? If not this represents shifting dullness i.e. ascetic fluid moving in the abdomen

38
Q

Where should you auscultate and why?

A

Listen for bowel sounds for 1 minutes or until they are heard- bowel obstructions sounds like a tinkling tap

Listen for abdominal bruits indicating stenosis

Aorta

Renal arteries

Iliac arteries

39
Q

Where should you inspect for oedema?

A

Sacrum and ankle (leg)

40
Q

What further examinations should be requested to close an abdominal examination?

A

To examine the external genitalia

To examine the hernia orifices

To perform a digital rectal examination

Urine dipstick

Year 3 ICSM OSCE Examinations (4 decks)

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