GI and GU clinical examination

Question 1

what would a general examination involve

Answer 1

do they look well
in pain?
height, weight, BMI, stretch marks
liver disease

Question 2

what are the GI causes of finger clubbing

Answer 2

– Cirrhosis
– Ulcerative Colitis
– Crohn’s disease
– Coeliac disease

Question 3

what is asterixis

Answer 3

coarse flapping tremour

Question 4

what would you look for in the hands

Answer 4

leuconychia and koilonychias

palmar erythema

Question 5

what else could you look for on the skin

Answer 5

spider naevus 
purpurae
jaundice 
conjuctivae 
xanthelasma 
striae 
scratch marks/ redness
marks from IV injections

Question 6

what would you look for on the chest

Answer 6

gynaecomastia
spider naevi
axillae for body hair
striae

Question 7

how do you examine the mouth

Answer 7

tongue depressor and light

mouth, breath, lips, tongue, teeth, gums

Question 8

what stigmata might you find in the mouth

Answer 8

stomatitis, glossitis, candidiasis, ulcers, pigementation, telangiectasia, dentition, gingivitis, odour

Question 9

what is telangiectasia

Answer 9

small dilated blood vessels near the surface of the skin, usually on the lips

may be Cushing’s disease or congenital or Puetz jager

Question 10

what causes leukonychia

Answer 10

low levels of albumin - could be kidney or liver problem

they are white marks on the nails
may also be nail injury

Question 11

what could cause palmar erythema

Answer 11

excess oestrogen in men or women

may be due to pregnancy or liver damage

Question 12

what is dupytren’s contracture associated with

Answer 12

poor liver function test

Question 13

what is spider naeve a sign of

Answer 13

liver damage
around the distribustion of SVC
more than 5 is significant
blanches when touched

Question 14

what is purpurae a sign of

Answer 14

liver damage with coagulative factors
or side effect of drugs
does not blanch

Question 15

how should jaundice be examined

Answer 15

under natural light

ask about itchiness and pain

Question 16

what could cause xanthelasma

Answer 16

liver damage

lipid disorder

Question 17

what is fetor hepaticus

Answer 17

dead mouse smell with failing liver

Question 18

what does glossitis look like

Answer 18

beefy red tongue

Question 19

what are the GI causes of oedema

Answer 19

renal failure 
impaired sodium excretion 
reduced intravascular oncotic pressure 
liver cirrhosis 
also pregnancy

Question 20

what position do you examine the abdomen in

Answer 20

lying with head on one pillow

Question 21

what are the five Fs of distension

Answer 21

Fat, Fluid, Faeces, Flatus, Foetus

Question 22

how do you palpate the abdomen

Answer 22

warm hands 
kneel beside the bed 
ask pt to point to areas of pain 
palpate all 9 areas 
watch pts face

Question 23

what should you palpate for

Answer 23

tenderness, masses, organomegaly, abdominal aorta

Question 24

how do you describe hepatomegaly

Answer 24

smooth, nodular, generalised or focal enlargement

Question 25

what are causes of hepatomegaly

Answer 25

``` hepatitis alcoholic liver disease right heart failure fatty infiltration biliary tract obstruction malignancy haematological disorders ```

Question 26

how do you palpate for hepatomegaly

Answer 26

``` liver moves with respiraton begin in R iliac fossa ask pt to breathe in and out deeply palpate upwards to R costal margin feel for liver edge ```

Question 27

what are the causes of splenomegaly

Answer 27

– Haematological - Haemolytic anaemias / Leukaemias / Polycythaemia rubra vera / Lymphoma / myeloproliferative diseases / myelofibrosis – Infective (e.g. infectious mononucleosis, infective endocarditis, TB, malaria) – Portal hypertension – Rheumatological disorders – rheumatoid arthritis (Felty’s syndrome) / SLE – Rare causes – sarcoidosis / amyloidosis / glycogen storage diseases

Question 28

how do you palpate for splenomegaly

Answer 28

``` • Spleen moves with respiration • Ask the patient to breathe in and out deeply • Palpate upwards to left hypochondrium • Feel for edge of an enlarged spleen • Characteristic notch may be palpable ``` you should not be able to feel a normal spleen

Question 29

what are the causes of renal enlargement

Answer 29

hydronephrosis PCKD Renal cell carcinoma cysts use to hands in front and behind sit forwards and palpate from behind

Question 30

what organs should you percuss

Answer 30

liver and spleen percuss up to right costal margin for lower border of the liver percuss downwards from just above right nipple for upper border percuss towards left hypochondrium for lower border of the spleen

Question 31

what are the causes of ascites

Answer 31

``` – Hepatic cirrhosis – Intra-abdominal malignancy – Nephrotic syndrome – Cardiac failure – Pancreatitis – Constrictive pericarditis etc ```

Question 32

what does fluid sound like

Answer 32

dull

Question 33

what is shifting dullnes

Answer 33

ask patient to move postion, fluid will move changing areas of dullness

Question 34

what should be auscultated

Answer 34

listen to bowel sounds for 2 mins listen for silence ausculate for aortic bruits auscultate renal arteries metallic sounds could be bowel obstruction

Question 35

where may upper GI tract tumours metastasise to

Answer 35

left posterior cervical triangle (Virchow's node)

Question 36

what are the indications for a rectal exam

Answer 36

rectal bleeding prostatic symptoms change in bowel habit spinal cord injury

Question 37

what pathology might b found in a DRE

Answer 37

``` • Haemorrhoids • Rectal prolapse • Anal fissure • Skin tags • Anal carcinoma • Anal fistula • Prostatic enlargement – Benign prostatic hyperplasia – Prostatic carcinoma – Prostatitis (tender prostate) ```

Question 38

what are indications for female pelvic examination

Answer 38

pelvic pain abnormal bleeding abnormal vaginal discharge prolapse

Question 39

what female pelvic pathology might you find on examination

Answer 39

• Ovarian pathology – E.g. Ovarian cyst, malignancy • Uterine pathology – E.g. Uterine prolapse, fibroids, cervical carcinoma, carcinoma of body of uterus • Vaginal pathology – E.g. vaginitis , prolapse • Pelvic infection (Pelvic inflammatory disease) • Ectopic pregnancy - do a pregnancy test • Always consider a pelvic ultrasound scan

Question 40

what testicular pathology might be found on examination

Answer 40

``` – Infection (epididymitis, orchitis, epididmyoorchitis) – Testicular torsion – Epididymal cysts – Testicular tumours – Indirect inguinal hernia • Always consider USS ```

Question 41

what is orchitis

Answer 41

inflammation of the testicle