GI exams

Question 1

What should you ask the patient before proceeding with any examination?

Answer 1

If they have any pain

Question 2

List two conditions associated with hyperpigmentation of the skin.

Answer 2

Haemochromatosis
Addison’s disease

Question 3

What is palmar erythema associated with?

Answer 3

Chronic liver disease

Question 4

What does koilonychia indicate?

Answer 4

Iron deficiency anaemia

Question 5

What abdominal conditions is finger clubbing associated with?

Answer 5

inflammatory bowel disease
liver cirrhosis
coeliac
liver cirrhosis
GI lymphoma

Question 6

What are 3 possible causes of asterixis?

Answer 6

Hepatic encephalopathy
Uraemia
CO2 retention

Question 7

What does Dupuytren’s contracture involve?

Answer 7

Thickening of the palmar fascia

Question 8

What does acanthosis nigricans indicate?

Answer 8

Insulin resistance or gastrointestinal malignancy

Question 9

What is the significance of Kayser-Fleischer rings?

Answer 9

Associated with Wilson’s disease

Question 10

What does glossitis indicate?

Answer 10

Deficiencies in iron, B12, or folate

Question 11

What is the first clinical sign of metastatic intrabdominal malignancy?

Answer 11

Enlargement of Virchow’s node - L supraclavicular

Question 12

What does Cullen’s sign indicate?

Answer 12

Bruising around umbilicus associated with haemorrhagic pancreatitis

Question 13

Fill in the blank: Caput medusae is associated with _______.

Answer 13

Portal hypertension

Question 14

What does Grey-Turner’s sign indicate?

Answer 14

Bruising in the flanks associated with haemorrhagic pancreatitis

Question 15

What should be assessed if a stoma is present?

Answer 15

Location
Contents
Consistency of stool
Spout presence

Question 16

What does rebound tenderness indicate?

Answer 16

can be associated with peritonitis

Question 17

What does Rovsing’s sign involve?

Answer 17

Palpation of the left iliac fossa causing pain in the right iliac fossa

appendicitis

Question 18

What characteristics should be assessed if a mass is identified during deep palpation?

Answer 18

Location
Size and shape
Consistency
Mobility
Pulsatility

Question 19

What is a palpable liver edge suggestive of?

Answer 19

Gross hepatomegaly

Question 20

List 11 potential causes of hepatomegaly.

Answer 20

Hepatitis
Hepatocellular carcinoma
Hepatic metastases
Wilson’s disease
Haemochromatosis
Leukaemia
Myeloma
Glandular fever
Primary biliary cirrhosis
Tricuspid regurgitation
Haemolytic anaemia

Question 21

What does a palpable gallbladder indicate?

Answer 21

Enlargement due to biliary flow obstruction or infection

Conditions include pancreatic malignancy or cholecystitis.

Question 22

What does Murphy’s sign suggest?

Answer 22

Presence of cholecystitis

Indicated by pain when the patient stops mid-breath during palpation.

Question 23

What are common causes of splenomegaly?

Answer 23

Portal hypertension
Haemolytic anaemia
Congestive heart failure
Splenic metastases
Glandular fever

Question 24

What does a ballotable kidney suggest?

Answer 24

Enlarged kidneys

Question 25

How do you palpate the aorta?

Answer 25

Perform deep palpation just superior to the umbilicus in the midline

Question 26

What indicates a distended bladder during palpation?

Answer 26

Palpation in the suprapubic area arising from behind the pubic symphysis

Question 27

What does dullness to percussion indicate during bladder assessment?

Answer 27

A distended bladder

Question 28

What does an aortic bruit suggest?

Answer 28

Turbulent blood flow Auscultated 1-2 cm superior to the umbilicus may be associated with an abdominal aortic aneurysm.

Question 29

What further assessments are suggested for completeness?

Answer 29

ISHRUG Inguinal lymph nodes Stool sample Hernial orifices Rectal Exam Urine dip Genital Exam

Question 30

where are colostomies typically located?

Answer 30

LIF

Question 31

where are ileostomies and urostomies typically located?

Answer 31

RIF

Question 32

what is the association with number of lumens in stoma and purpose?

Answer 32

1 lumen in RIF - end ileostomy/urostomy 1 lumen in LIF - end colostomy 2 lumens in RIF - loop ileostomy 2 lumens in LIF - loop colostomy

Question 33

what does a spouted stoma mean?

Answer 33

presence of spout = ileostomy/urostomy - as cause skin irritation no spout = colostomy

Question 34

what kind of output comes from colostomies?

Answer 34

solid/semisolid faeces

Question 35

what kind of output comes from ileostomies?

Answer 35

liquid or mushy bowel contents

Question 36

what are 5 complications of stomas?

Answer 36

parastomal hernia stoma prolapse stoma retraction stoma haemorrhage stoma ischaemia/infarction

Question 37

what are 4 features of parastomal hernia?

Answer 37

enlarged stoma bulging of area behind stoma increased size on coughing or sneezing reducible mass

Question 38

what does a stoma prolapse appear like?

Answer 38

elongation when patient stands, coughs or strains and reduction when lying

Question 39

what is a complication of stoma retraction?

Answer 39

poor stoma bag attachment and frequent peristomal skin complications

Question 40

what does stoma ischaemia appear like?

Answer 40

pain at stoma site necrosis of stoma

Question 41

how do hernias typically present on examination?

Answer 41

Single lump in the inguinal region Positive cough impulse (unless incarcerated) Soft on palpation Reducible (unless incarcerated) Unable to get above the lump during palpation Painless (unless incarcerated) Bowel sounds on auscultation (may be absent if incarcerated

Question 42

where are inguinal hernias located?

Answer 42

above and medial to pubic tubercle and inguinal ligament

Question 43

where are femoral hernias located?

Answer 43

below and lateral to pubic tubercle and inguinal ligament

Question 44

what examination needs to be done with inguinal hernias?

Answer 44

scrotal examination - hernia may extend into scrotum

Question 45

what is being examined for externally in PR exam?

Answer 45

skin excoriation skin tags - associated with crohns haemorrhoids anal fissure external bleeding anal fistula irregular growths - warts, cancer Cough - rectal prolapse, internal haemorrhoids

Question 46

what may be seen on general inspection in lymphoreticular examination?

Answer 46

Bleeding/bruising/petechiae - thrombocytopenia abdo distention pallor cachexia

Question 47

what characteristics should be assessed in an enlarged lymph node?

Answer 47

size site shape consistency tenderness mobility overlying skin changes

Question 48

what are the characteristics of a benign lymph node?

Answer 48

<1cm, smooth round, non tender, mobile

Question 49

what are the characteristics of a reactive lymph node?

Answer 49

smooth, round, tender, mobile, associated infective symptoms

Question 50

what are the characteristics of lymphadenopathy due to haematological malignancy?

Answer 50

widespread, enlarged, rubbery lymph nodes

Question 51

what are the characteristics of lymphadenopathy due to metastasis?

Answer 51

Hard, firm, irregular and tethered nodes

Question 52

what areas need to be examined in a lymph node exam?

Answer 52

Cervical node Axillary nodes epitrochlear nodes - elbow Inguinal nodes Full Abdomen - for hepatomegally/splenomegally

Question 53

what further assessments are required with lymph node exam?

Answer 53

FBC, blood film, US node Biopsy of suspect node Examination of relevant organ if mets are suspected

Question 54

How do you measure insertion length of NG tube?

Answer 54

Tip of nose to tragus to xiphisternum

Question 55

what pH suggests correct NG placement?

Answer 55

<4

Question 56

what are some risks of NG insertion?

Answer 56

aspiration pneumonia Trauma and bleeding Tube dislodgement Nosebleed sore throat