gi exam

Question 1

introduction?

Answer 1

intro myself name and stage( clean hands)
confirm name and DoB
‘ I am going to perform an abdo exam ths will involve looking at your hands, face, chest and abdomen followed by a feel of your tummy? is that ok?
offer a chaperone.

Question 2

next step?

Answer 2

look if patient seems well- pale, in pain

look around bed for cues and aids - catheher, walkng aids, medications

Question 3

next step what are you looking for?

Answer 3

hands  and nails:
tendon xanthomas
clubbing 
palmar erythema 
oncholychia
leukoclychia
duptens contracture

Question 4

what can tendon xanthomas indicate?

Answer 4

hyperlipidemia

Question 5

what can tend palmar erythema indicate?

Answer 5

CLD hyperthyroidism RA pregnancy

Question 6

what can clubbing indicate?

Answer 6

lymphoma
cirrhosis
ibd
coeliac diease

Question 7

duputrens contracture

Answer 7

phenytoin
lvier disease
diabetes

Question 8

koilonychia and leuconychna

Answer 8

iron def anaema

hypoalbuminia

Question 9

next step?

Answer 9

check for hep tremor -liver disease

pulse - characteristic, regular/iregg/ bpm

Question 10

next step and what are you looking for?

Answer 10

arms
ivd marks and bruising
exorciation -itching

Question 11

next step?

Answer 11

axilla
- feel for lymph nodes
look for acatan nigrans - malignancy

Question 12

then what?

Answer 12

face- puffing - alcoholism moon face, acne
eyes - conjunctiva, kayser fleicher ring (Wilson disease), corneal arcus ad xanthelasma - hyperlipidemia and jaundice
mouth - glottitis IBD
ulcers- coeliac disease, IBD
pear breath- lier disease, failure diabetes

Question 13

then?

Answer 13

feel thyroid lymph nodes and supraclavicular - gastric maliganacy

Question 14

then?

Answer 14

ask to exposure patient stomach down to top of bladder
ask if any pain and to lie down
INPSECT for scars- gynaemastica, bloating
caputa medusa

Question 15

then?

Answer 15

GET ON ONE KNEE GO AWAY FROM PAIN
light palpitations to deeper
feeling for guarding, tenderness, masses

Question 16

then

Answer 16

palpate for liver edge from RIF, inspiration feel in for edge then lightly percuss
do the same with the spleen

Question 17

then

Answer 17

ballot kidneys

feel AAA below umbilicus area

Question 18

then

Answer 18

shifting dullness - percuss towards left flank, roll patient towards you and re-percuss

Question 19

then

Answer 19

listen to bowel sounds

then renal bruits (super and lateral to umbilicus) and liver if poss

Question 20

then

Answer 20

check legs for pyoderma gangrenosum -UC
odema -clf
and erythema nodsum - ibd

Question 21

then

Answer 21

cover patient
thank pt
ask if any questions

Question 22

what can I offer examiner?

Answer 22

investigations I would do- resp rate, O2, temp,
Stool sample
Hernia orfices 
Rectal exam
Urine dipstick
Genital exam

Question 23

what is Cullen sign of and where

Answer 23

bruising around umbilicus -sign in ruptured ectopic pregnancy, bleeding, pancreatitis

Question 24

what is grey turner of and where

Answer 24

bruising on on flank - panreatitis

Question 25

three signs that constitute clubbing

Answer 25

(increased nail curvature, loss of the hyponychial angle fluctuance of the nail bed)

Question 26

how long hep flap?

Answer 26

30 seconds

Question 27

how long listen to stomach sounds?

Answer 27

2 minutes

Question 28

what does shifting dullness and fluid thrill test?

Answer 28

ascites