GI PE IM PLAT

Question 1

Skin

Note for

Answer 1

Presence of scars, striae, rashes, ecchymoses

Dilated veins

Question 2

Umbilicus

Answer 2

Observe contour

Location

Question 3

Abdominal contour

Answer 3

Round
Flat
Scaphoid
Protuberant

Local bulges
Asymmetry

Question 4

Violaceous striae is associated

Answer 4

Cushing’s syndrome

Question 5

Umbilical bulge is seen in

Answer 5

Ventral hernia

Question 6

Dilated veins is seen in

Answer 6

Portal hypertension and inferior vena caval obstruction

Question 7

Bulging flanks is associated with

Answer 7

Ascites

Question 8

Normal auscultation findings on the abdomen

Answer 8

Clicks and gurgles 5-34 per min

Question 9

High-pitched rumbling sounds of hyperperistalsis that correspond with crampy abdominal pain

Answer 9

Borborygmi

Question 10

For auscultation check fr

Answer 10

Borborygmi
Bruits
Friction rubs

Question 11

Percussion

Answer 11

Percuss the abdomen lightly in all 4 quadrants
Assess distribution in the abdomen, characteristics of palpable masses ( fluid-filled, solid) and size of liver and spleen

Question 12

Prominent peristaltic waves may be seen in

Answer 12

Intestinal obstruction

Thin individuals

Question 13

Liver percussion

Answer 13

Lower border of liver dullness - start at level of umbilicus, right midclavicular line, percuss cranially until dullness is noted
Upper border of liver dullness- nipple line, right midclavicular line, percuss from lung resonance down to liver dullness

Question 14

Normal liver span

Answer 14

Right midclavicular line 6-12 cm

Midsternal line 4-8 cm

Question 15

How does the spleen expand

Answer 15

It expands anteriorly, downward and medially and replaces the general tympanitic tone with dullness

Question 16

How to percuss the spleen

Answer 16

Percuss the left lower anterior chest wall
From border of cardiac dullness at the 6th rib -> anterior axillary line -> down to the costal margin

Tympany is prominent -> splenomegaly unlikel

Question 17

Obliterated Traube’s space signifies

Answer 17

Splenomegaly

Or presence of fluids /solids in the stomach or colon

Question 18

Splenic percussion sign

Answer 18

Change in percussion note from tympany to dullness on inspiration

Question 19

Predominant percussion tone

Due to gass in the abdomen

Answer 19

Tympany

Question 20

Signifies presence of underlying mass/organ, fluid or feces

Answer 20

Dullness

Question 21

Used to elicit tenderness, muscular resistance and presence of superficial organs and masses

Answer 21

Light palpation

Question 22

How to differentiate voluntary guarding from involuntary muscular spasms by

Answer 22

Asking patient to relax

ask patient to mouth-breathe with jaw dropped open

Question 23

How to position hands when palpating for liver dullness

Answer 23

Left hand -> behind he patient at the level of right 11 and 12th ribs

Right hand-> right abdomen lateral to the rectus muscle with finger tips below the lower border of liver dullness

ask patient to breathe deeply, then try to feel the liver edge as it comes in contact: note consistency, presence of contour irregularity, and any tenderness

Question 24

Splenic palpation

Answer 24

At the patient’s right side, reach over and around the patient using the left hand to support and press forward the left
right hand -> press below the left costal margin and press in toward the spleen contour and presence of any tenderness
Ask patient to take a deep breath, feel the splenic edge, note contour and presence of any tenderness
Measure the distance between the spleen’s lowest point and left costal margin
Repeat procedure but with patient assuming a right decubitus position

Question 25

Why right decubitus position in spleen palpation

Answer 25

Places the spleen forward and to the right and makes it more accessible to palpation

Question 26

Shifting dullness is seen in

Answer 26

Ascites

Question 27

Dullness shifting to more dependent side

Answer 27

Shifting dullness

Question 28

Palpable impulse on the side opposite the pressure (with hands pressed firmly on the midline of the abdomen)

Answer 28

Fluid wave

Question 29

Pain in the RLQ during left sided pressure | Also associated with referred rebound tenderness - RLQ pain on withdrawal of pressure on left side

Answer 29

Rovsing's sign

Question 30

Abdominal pain on hip flexion and or extension

Answer 30

Psoas sin

Question 31

Right hypogastric pain on internal rotation of the right hip

Answer 31

Obturator sign

Question 32

Extreme pain on light touch over the area bound by the umbilicus, pubic tubercle and anterior superior iliac spine

Answer 32

Cutaneous hyperesthesia

Question 33

Sharp increase in RUQ tenderness with a sudden stop in inspiratory effort while pressure is applied under the costal margin lateral oto the border of the rectus muscle

Answer 33

Murphy's sign

Question 34

Proper positioning for DRE

Answer 34

Ask patient to lie on his/her left side,flexing his/here knees, wit buttocks close to the edge of the examination table

Question 35

DRE STEPS

Answer 35

``` Proper position of patient 1. With gloved hands, spread buttocks apart and inspect immediate area for A. Skin lesions B. Ulcers C. Masses D. Inflammation ```

Question 36

Sphincter tightness may be noted in

Answer 36

Anxiety Inflammation Scarring

Question 37

Sphincter laxity may be noted in

Answer 37

Some neurologic diseases

Question 38

Induration may be noted due to

Answer 38

Inflammation, scarring or malignancy

Question 39

Local hardening of soft tissue, firm, but not as hard as bone

Answer 39

Induration

Question 40

Soft, pliable tags of redundant skin at anal margin | Usually seen in most individuals

Answer 40

Skin tags

Question 41

Also known as semilunar space

Answer 41

Traube's space

Question 42

Is an anatomic space Crescent shaped space Encompassed by the lower edge of the left lung, anterior border of the spleen. And left costal margin and inferior margin of the left lobe of the liver

Answer 42

Traube's space

Question 43

Surface markings of traube's space

Answer 43

Left sixth rib - superiorly Left mid axillary line - laterally Left costal margin inferiorly

Question 44

Obliteration of Traube's space may indicate | Dullness instead of tympany

Answer 44

Splenomegaly (Sensitivity of 62% and specificity of 72%) Higher specificity if patient has not eaten in the last 2 hours Normal finding after a meal Left pleural effusion