Medicine 💉 Flashcards
(278 cards)
1
Q
why do we take history?
A
History taking is the initial step to reach a diagnosis, and sometimes you can reach a diagnosis by history only.
2
Q
what does history taking need?
A
- good communication skills
- sufficient knowledge.
3
Q
what are items of medical history?
A
- personal history
- Chief complaint
- Present history
- Past history
- Family history
4
Q
what are the items of personal history?
A
Example: Male patient, named XXX, aged 55 year old, from Mansoura, working as a teacher, marned and has 3 offsprings with the youngest one is 6 year old, He is a cigarette smoker with smoking index 400
5
Q
what is somking index?
A
smoking index is a unit for measuring cigarettes consumption over a long period
6
Q
what does smoking index equal?
A
smoking index = Ciggarettes per day × years of tobacco use
7
Q
what are smoking index categories?
A
Smoking index categories are
- non-smoker
- less than 400
- 400-799
- more than 800
8
Q
How to write chief complaint?
A
- In patient own words
- No scientific terms
- Mention the duration of the complaint
Example:
- He started to complain of edema both lower limbs 2 weeks ago ❌
- He started to complain of swelling both lower limbs 2 weeks ago ✅
- He started to complain of dyspnea ❌
- He started to complain of shortness of breath or difficulty in breathing ✅
9
Q
what are the items of present history?
A
- onset, course, and duration
- Analysis of the main complaint
- Symptomatology of the same system
- Symptomatology of other systems
- Investigations & drugs
- D.M. & H.T.N
10
Q
onset & course of complaint
A
Example: complaint Shortness of breath (SOB)
- The condition started with dyspnea 10 days ago of gradual onset and progressive course
11
Q
analysis of the main complaint
A
12
Q
what is chest symptomatology?
A
13
Q
Investigations and drugs in present history
A
- Laboratory
- Radiology (X-ray, C.T, MRI, ..etc)
- Culture
- Other investigations
- Drugs & prescriptions
14
Q
DM and HTN in present history
A
- Duration
- Medications
- controlled or not
- complication
15
Q
what are the items of past historty?
A
16
Q
what are the items of family history?
A
17
Q
Revise the summary
A
…
18
Q
what are the items of general examination?
A
- Appearance
- Built
- Mental status
- Nutrition status
- Decubitus &Gait
- Complexion
- Vital signs
- Head and neck
- Hand examination
- Lower limb examination
19
Q
examination of general appearance
A
- Well
- ill
- Cachectic “wasting of face muscle & fat”
- Infantile
- Toxic
20
Q
examination of mental status
A
- Consciousness
- Orientation (time, person, place)
- Memory
- Mood
- Intelligence
- Co-operative
21
Q
what is the definition of built?
A
It is either (average built- overbuilt- under built)
22
Q
how is built determind?
A
By body mass index (BMI) & skeletal proportions in relation to age, sex & race.
23
Q
BMI
A
24
Q
waist circumference
A
25
how is nutritional status examined?
- Body Mass Index (BMI)
- Fat fold measurement
- Muscle wasting
- Signs of vitamin deficiency
26
Fat fold measurement
**Indirect measurement of fat mass:**
- skin fold thickness
**Sites:**
- Biceps
- Triceps
- Subscapular
- Suprailliac
- Mid-thigh
- Mid-calf
- Abdomen
27
muscle wasting
28
signs of vitamin deficiency
29
decubitus
Position adopted by the patient during lying in the bed
30
Gait
31
examination of complexion
- Pallor
- Cyanosis
- Jaundice
32
what are the sites of pallor?
- Mucous membranes in the lips & conjunctiva
- Palmar crease, (Pale palmer crease = Hb < 6-7)
- Skin, Nail ,Tongue
33
what Is the definition of jaundice?
Yellowish discoloration of the sclera, mucous membranes and skin due to hyperbilirubinemia (2 - 3 mg/dl).
34
what are the types of jaundice?
**Hepatocellular:** liver diseases
**Hemolytic:** excess RBCs destruction
**Obstructive:** obstruction in biliary system
35
what is the definition of cyanosis?
Bluish discoloration of the skin and/or mucous membranes due to increase level of reduced Hb ≥ 5 gm/dl in capillary blood. (Normally reduced Hb not exceed 2.5 gm/dl)
36
what are the types of cyanosis?
Central & peripheral
37
what is the definition of central Cyanosis?
Reduction in the oxygen saturation of arterial blood below 80-85% eg: cyanotic heart disease
38
what causes peripheral cyanosis?
- Due to stagnation of blood in peripheral circulation or vasoconstriction through the peripheral vascular bed with excessive O2 extraction from capillary blood. the arterial O2 saturation is normal unless cardiopulmonary disease is also present eg : PVD, cold weather
39
examination of vital signs
- Temperature
- Blood pressure
- Pulse
- Respiratory rate
40
what are the site of temperature measuring?
mouth ,axilla ,rectal
41
duration of temperature measurement
1 min
42
what is the normal body temperature?
- Normal 36.6 – 37.2 0C
- In axilla add 1⁄2 C
- In rectum subtract 1⁄2 C
43
what does fever, hypothermia & hyper pyrexia mean?
- Fever means temperature> 37.2°C
- Hypothermia means temperature ≤35 C. (rectal)
- Hyperpyrexia means temperature ≥ 41°C
44
pulse (heart rate) examination
45
Respiratory rate examination
- Normal RR: 12- 18 cycle/min, regular in rhythm
- Tachypnea: RR > 18
- Bradypnea: RR < 12
46
what is the normal systolic blood pressure?
(90 -120 mmHg) which is the pressure exerted by blood (from left ventricle) on the arterial wall during systole “depends on LV contraction”.
47
what is the normal diastolic blood pressure?
(60 - 80 mmHg) which is the pressure exerted on the arterial wall as result of elastic recoil of the aorta “ depends mainly on the peripheral resistance”
48
what are the steps of measuring of blood pressure?
- The patient better to be flat with arm & sphygmomanometer at the level of the heart
- Remove any restrictive clothes & choose the appropriate size cuff
- Put the cuff around the upper arm with its lower edge 3 cm above the elbow.
- Palpate brachial pulse before applying stethoscope.
- Inflate cuff until radial pulse is impalpable, check systolic pressure by auscultation, deflate slowly until diastolic pressure is reached
49
what are facies?
peculiar and unusual facial features that often are pathognomonic of a particular disease.
50
Neck examination
- LN
- Trachea
- Neck rigidity
- Neck vessels
- Thyroid Gland
51
lymph node examination
52
examination of trachea
53
Neck vessels examination
54
what is the difference between internal jugular vein pulsation and internal carotid artery pulsation?
55
thyroid examination
56
hand examination
57
lower limb examination
- Oedema
- Foot deformities
- Ulcer
- Varicose veins
58
what are the parts of examination?
59
what does inspection include?
60
abnormalities of the shape of the chest
61
compare between normal symmetric chest, barrel shaped (emphysematous) chest & Chest alar (Flat chest) in terms of:
- Description
- Diameters
- Subcostal angle
- Ribs
- Intercostal spaces
- Moving with respiration
- others
- figure
62
Compare between Funnel shaped chest (Pectus excavatum), Pigeon shaped chest (Pectus carinatum) & Kyphoscoliosis in terms of:
- Description
- Etiology
- Effects
- Figure
63
what are the characteristcs of Rachitic chest?
64
what does a normal chest look like (Regarding symmetry)?
Both halves are symmetrical.
65
what is the etiology of unilateral bulge of the chest?
- Something Pushing
**Pleural causes:**
- Massive pleural effusion.
- Tension pneumothorax.
- Hydropneumothorax.
**Lung causes:**
- Unilateral emphysema.
**Cardiac causes:**
- Precordial bulge.
**Chest wall causes:**
- Abscess.
- Lipoma.
66
what is the etiology of Unilateral retraction of the chest?
- Something Pulling
1. Lung collapse.
2. Lung fibrosis.
67
what is expansion of the chest differentiated by?
- Normal part: moves freely with respiration.
- Disease part: moves less.
68
Comment of respiratory movements
- Respiratory rate
- Rhythm
- Type of breathing
- Degree of chest expansion
69
Method of examination of respiratory rate
70
Rythm of respiratiory rate
Normally: Regular (Inspiration, Expiration then Pause).
71
what are types of breathing in males and females?
Normally:
* In females: Thoraco-abdominal respiration.
* In males: Abdomino-thoracic respiration.
72
Degree of chest expansion
73
Pulsations in (Chest examination)
**Epigastric pulsation:** as discussed in "Abdominal examination"
- To detect right Ventricular Enlargement (As in cor-pulmonale).
**Other Pulsations:** Will be discussed in "Cardiac examination" lecture.
74
How to comment in skin (In chest examination)
1. Dilated veins.
2. Pigmentation.
3. Sinuses - Fistula.
4. Nodules.
5. Scars of previous operations.
6. Skin rashes.
75
what are the most common causes of chest wall sinuses?
1. T.B.
2. Actinomycosis with characteristic sinus discharging sulphur granules.
76
Normal trachea
- Trachea is central.
- With both tendon of sternomastoid is symmetrical in shape & position
77
Abnormal trachea (In chest examination)
**Trail's sign:**
- Unilateral bulge of Sternomastoid tendon on side of tracheal shift.
- Due to displacement of trachea behind the tendon.
78
what does **Palpation** include?
1. Superficial palpation.
2. Palpation of the trachea.
3. Confirmation of chest movement.
4. Tactile vocal fremitus (TVF).
5. Palpable rhonchi or pleural rub.
6. Confirmation of the origin of pulsations.
79
what are the causes of chest wall tenderness?
80
what are the methods of palpation of the trachea?
81
Findings on palpation of the trachea
**Normal:**
- Upper part: Central.
- Lower part: slightly deviated to the right.
**Abnormal:**
- Shifted: unequal distance being narrow at the side of tracheal isgist deviation.
82
what are the causes of tracheal shift?
**Tracheal shift to the same side:**
1. Lung collapse.
2. Lung fibrosis.
3. Lung agenesis.
4. Pneumonectomy.
**Tracheal shift to the other side:**
1. Pneumothorax.
2. Massive pleural effusion.
3. Tumors:
- Any large mass of the bronchi, lung or pleural cavity (including a benign or malignant tumor) may result in tracheal deviation.
83
Confirmation of chest movement
**Accurate Method:** Tap Test
**Other method:**
- Upper chest expansion
- Lower chest expansion
- Apical chest expansion
- Lower chest expansion of the back
84
what does Tactile Vocal Fremitus mean?
85
Method of TVF
86
what causes increased TVF?
1. Consolidation.
2. Cavitation: Cavity must be:
* Big.
* Superficial.
* Around it an area of consolidation.
3. Collapse with Patent main bronchus.
87
what causes decreased TVF?
1. Thick chest wall.
2. Pleural effusion or pleural fibrosis.
3. Pneumothorax.
4. Emphysema.
5. Collapse with obstructed main bronchus.
88
Pulsations in (Chest examination)
89
Palpable adventitious sounds
90
what are other items in paplation during chest examination?
91
How to count the ribs?
92
Compare between types of percussion sounds
93
Fingers & movement in percussion
94
where to start percussion?
95
Percussion in chest
96
Last step in percussion
- Whenever dullness is confirmed: its topography should be delineated.
- Whenever flat stony dullness is present: shifting dullness should be elicited.
97
what are the types of percussion?
98
Percussion of anterior and posterior chest
99
Preparation for auscultation
100
Instructions for the patient during ausculatation
101
what to do during auscultation?
102
what do we report on during chest ausculatation?
- Breath Sounds.
* Intensity of breath sounds.
* Type of breath sounds.
- Vocal resonance.
- Adventitious sounds.
103
Comments on breath sounds
- Intensity
- Type
104
Normal Intensity of breath sounds
Bilaterally equal.
105
what causes diminshing in intensity of Breath sounds?
- Pneumothorax.
- Lung collapse / Fibrosis.
- Emphysema.
106
what causes abscence of Breath sounds?
Pleural effusion
107
what causes Increase in intensity of Breath sounds?
Children, Due to thin chest wall.
108
what are the types of Breath sounds?
109
Compare between Vesicular breath sound (Normal) & Bronchial breath sound
110
what is **Vocal resonance**?
- It is the audible (by stethoscope) vibration of the vocal cords transmitted through respiratory passages to the chest wall..
- When the patient says 4,4 in Arabic or 99 in English.
111
what are the causes of increased or decreased vocal resonance?
Causes of increased or decreased Vocal Resonance are same as TVF.
112
Compare between Rhonchi & Crackles
113
what is pleural rub?
A scratching (To and Fro) sound heard due to friction between the two inflamed pleural surfaces against each other.
114
what are the characters of pleaural rub?
1. Leathery sound.
2. Heard during inspiration and expiration.
3. Localised over area affected by pleurisy.
115
what increases pleural rub?
- Increased by:
* Deep inspiration.
* Pressure of stethoscope.
116
what decreases pleural rub?
- Decreased on:
* Stoppage of breathing.
* Absent by effusion.
117
Auscultation of the trachea
- Normal breath sound heard over the trachea is called tracheal breath sound.
- Auscultation of the trachea allows recognition of stridor.
118
what is **Stridor**?
a wheeze found only in inspiration
119
Positioning of patients during cardiac examination
120
what is the precordium?
The region on the chest wall that overlays the heart area.
121
what is the pericardium?
The fibrous sac that encloses the heart and the heart area & great vessels
122
what are examples of chest wall abnormalities?
- Precordial bulge
- pectus excavatum (Funnel-shaped chest)
- Pectus carinatum (Pigeon chest)
123
Method of inspection of Precordial bulge
124
what may cause precordial bulge?
125
what are examples of scars you might see during cardiac examination?
126
Dilated veins during cardiac examination
127
Items palpated during cardiac examination
- Apex & other pulsations
- Thrill & palpable sounds
128
what is the **apex**?
Outermost & Lowermost visible & strongest palpable point of cardiac pulsation (Point of Maximum Apical Impulse "PMI").
129
Comment on apex beat
130
what should you do when the apex isn't palpable?
Ask patient to lean in left lateral position.
131
what is the definition of **Absent apex**?
Not visible neither palpable apex even on left lateral position
132
what are the causes of **Absent apex**?
133
abnormal sites of apex
134
what are the characters of normal apex impulses?
A normal apical impulse: briefly lifts your fingers & is localized.
135
what are the characters of abnormal apex impulses?
- Diffuse, sustained and more forceful thrust -» indicates: Left ventricular hypertrophy OR hyperkinetic circulation.
- A "tapping" apex beat: may be seen in mitral stenosis.
136
what are areas of pulsation?
137
what are basal pulsations?
Aortic & Pulmonary.
138
what is **Parasernal heave**?
A heaving motion felt over the left parasternal area.
139
How to palpate parasternal heave?
With the ulnar border of your hand.
140
what is the medical significane of parasternal heave?
* If present ---> Suggests Right Ventricular Hypertrophy.
141
Thrill and palpale sounds in cardiac examination
142
what are sites of auscultation?
143
what are the sounds that may be auscultated?
144
what are the parts of stethoscope used in cardiac examination?
145
Timing of auscultation
146
Compare between normal heart sounds
147
What to comment on during auscultation?
148
what are additional sounds that may be auscultated?
149
what are **Murmurs**?
audible series of vibrations due to turbulent blood flow
150
what are synonyms of murmurs?
151
what are types of murmurs?
- Organic
- Functional
- Innocent
152
what causes organic murmur?
153
what causes functional murmur?
154
what causes innocent murmur?
155
Comment on murmurs
156
Items inspected during cardiac examination
- Chest wall (Skeletal) abnormalities
- Scars
- Dilated & Engorged veins
- Apex & other pulsations
157
Items auscultated during cardiac examination
- Heart sounds
- Additional sounds
- Murmurs
158
what is the abdomen divided into?
- 4 Abdominal Quadrants
- 9 Abdominal Regions
159
what is the abdomen divided by? (Into 4 abdominal quarters)
- Vertical median plane.
- Horizontal trans umbilical plane.
**(Both passes through the umbilicus)**
160
what is the abdomen divided by? (Into 9 abdominal regions)
**2 Vertical lines:**
- Midclavicular sagittal plane on each side
**2 Horizontal lines:**
- Subcostal plane
- Intertubercular planes
161
what is **Subcostal plane**?
A transverse plane passing through
the inferior limits of costal margin.
162
what is **Intertubercular plane**?
Transverse plane passing through
the iliac tubercles.
163
what are the contents of the four abdominal quarters?
164
scheme for inspection of abdomen
165
General considerations during examination of the abdomen
- The patient must be exposed from the lower chest to the symphsis pubis.
- The patient's position:
1. Hand should remain at his sides.
2. Head resting on a pillow.
3. Flexion on the knees may relax the abdomen.
- The patient should have an empty bladder.
- Warm room & adequate light must be provided.
- For easy localization of any abnormalities: It is useful to divide the abdomen in 4 quadrants or 9 segments as before.
- Watch the patient's face for signs of discomfort during the examination.
166
Steps of examination of shape of the abdomen (contour)
167
aim of examination of the shape of the Abdomen (contour)
- Describes the nutritional state.
- Differential diagnosis for some conditions.
168
what to comment on During examination of shape of the abdomen (contour)?
- Ranges
- Normal contour
- abnormal contour
169
ranges of abdomen
170
normal contour of abdomen
- Slightly scaphoid (convex) from up downwards.
- Preserved waist (Convex) from side to side
- With empty flanks.
171
what does abnormal contour of the abdomen look like?
- Marked Retraction (Scaphoid): Starvation + Wasting diseases "Malignancy"
- Bulging (distention):
172
what causes diffuse abdominal enlargement?
- Free fluid (Ascites).
- Fat (Obesity).
- Flatus.
- Fetus (in Female).
- Fatal tumor growth.
- Full urinary bladder.
- Fluid in ovarian cyst.
173
what causes localized abdominal enlargement?
174
how to differentiate between ascitis and obesity?
175
method of examination of respiratory movements during abdominal examination
Count respiratory rate while you are simulating counting the pulse rate to distract the attention of the patient.
176
what to comment on during Examination of respiratory movements during abdominal examination?
- Rate
- Rhythm
- Depth
- Type
177
what is the type of respiratory movements in males?
**in males:** Mainly abdominal
178
what is the type of respiratory movements in females?
**in females:** Mainly thoracic
179
what causes abnormal types of respiratory movements?
- Tense ascitis
- peritonitis
180
types of breathing in patient of tense ascitis
- orthopenic
- Thoraco-abdominal breath
181
type of breathing in patient of peritonitis
- Has a rigid dorsal decubitus
- Has absolutely thoracic breathing
182
abdominal movements during respiratory movements
- Normally abdomen moves freely with respiration (bulge during inspiration & retract during expiration).
- This movement (Limited in tense ascites - Absent in peritonitis).
183
what technique is used in measuring subcostal angle?
Thumb test at xiphi-sternal junction.
184
what is the normal subcostal angle?
Acute to right (90° +- 20)
185
why does the subcostal angle range between 70 and 110?
Tall & thin has more acute angle than obese one.
186
abnormal subcostal angle
- Narrow or obtuse
187
what causes Narrow subcostal angle?
- Flat chest.
- Pigeon chest.
188
what causes obtuse subcostal angle?
**Chronic Increased Intra-abdominal pressure as in:**
- Upper abdominal swelling:
1. Hepatosplenomegaly (HSM).
2. Ascites.
**Chronic increased intra-thoracic pressure as in:**
- Barrel shaped chest in COPD (Chronic obstructive pulmonary disease)
189
what to comment on during examination of umbilicus?
4S + 2D
- Site
- Shape
- Swelling
- Skin pigmentation
- Discharge
- Dilated veins
190
what is the normal site of umbilicus?
Midway between symphysis pubis & xinhisternum.
191
abnormal side of Umbilicus and its causes
**Shifted downwards:**
- Ascites.
- Upper abdominal swelling as hepatic & splenic enlargement.
**Shifted upwards:**
- in pelvi-abdominal masses.
192
normal shape of umbilicus
- Inverted (Attached to umbilical ligament)
193
abnormal shape of umbilicus and its causes
- Everted umbilicus: Due to chronic increase of intra-abdominal pressure (Ascites - Hepatosplenomegaly "HSM").
194
normal umbilicus concerning swelling, skin pigmentation, discharge & dilated veins
Normally absent
195
Abnormal umbilicus concerning swelling, skin pigmentation, discharge & dilated veins
196
what is the definition of **Divarication of recti**?
Separation of rectus abdominis muscles.
197
how to examine **Divarication of recti**?
198
what causes **Divarication of recti**?
Chronic increase of the intra abdominal pressure (HSM - Ascites) + hypoproteinemia
199
what are the signs of chronic increased intra-abdominal pressure?
- Wide subcostal angle
- Divarication of the recti
- **Umbilicus:** Everted, shifted downwards +- umbilical hernia
200
what is the normal arrangement of suprapubic hair?
**In males:** Triangular with apex directed upward toward the umbilicus.
**In females:** Triangular with upper horizontal line
201
abnormal distribution of supra pubic hair in males and its causes
- Feminine distribution as in LCF: Due to lack of destruction of estrogen by liver.
202
what could lost hair in males and females indicate?
hypogonadism
203
how to examine epigastric pulsation?
- Ask the patient to hold respiration.
- Looking tangential to abdomen.
- You can also palpate: Place our hand longitudinal in the subcostal angle.
204
compare between epigastric pulsations
205
what causes visible peristalisis?
**Normal:** in thin person or in emaciated person.
**Abnormal:** Pyloric obstruction & Intestinal obstruction
206
what are the characters of prestalitic wave?
- Slow.
- From the left rib margin to the right.
- Exaggerated by:
1. Massage.
2. Gentle tapping.
3. Drinking soda.
207
how are peristaltic waves Confirmed?
Succussion splash.
208
intestinal obstruction on x-ray
Step ladder pattern on x-ray
209
what does hernia indicate?
Increased intraabdominal pressure + weak abdominal wall.
210
what characterizes hernia?
Expansible impulses with cough.
211
patient position during palpation of hernial orifices
Preferred in standing patient.
212
what are types of hernia?
- epigastric
- Umbilical
- Incisional (Old scar)
- Abdominal
- Inguinal (direct or indirect)
213
epigastric hernia
- **Size:** small.
- **Site:** midline through a defect in the linea alba "Between the xiphoid process & umbilicus"
214
umbilical hernia
- Bulging defect at umbilicus
215
incisional (Old scar) hernia
**Cause:** Defect in abdomen muscles after
surgical incision.
- Must palpate the size of the defect.
216
abdominal hernia
Hernia through the abdominal wall
217
What is the difference between visible and dilated veins?
**Visible veins:** Straight - Narrow - Not raised.
**Dilated veins:** Tortuous - Wide - Raised above the level of the skin.
218
what does dilatation of veins mean?
- Prominent, dilated veins may represent collateral circulation through the abdominal wall that has developed to compensate for obstruction of either the inferior vena cava or increase portal vein pressure.
219
compare between Caput Medusa and IVC obstruction
220
what is the aim of milking test?
Determine the direction of blood flow in the veins of the anterior abdominal wall, Which is important in differentiating portal from systemic veins obstruction.
221
steps of milking test
222
pigmentations observed during abdominal examination
223
compare between Cullen's sign & Grey turner's sign in terms of:
- definition
- Indication
224
what does scratch marking indicate?
- Denotes pruritus usually with obstructive jaundice.
225
characters of scratch marking
- Multiple.
- Parallel.
- Superficial.
- In accessible area.
226
what are the types of scars?
1. Surgical scar
* Name
* Healing: 1ry or 2ry intention
* Complications.
2. Traumatic.
3. Cautery.
227
Etiology of stria
Due to rapid stretching of abdominal wall with rupture of elastic fibers.
228
what are the types of stria? and when are they seen?
229
subcutaneous hemorrhage
230
General rules for patient during palpation (In abdominal examination)
231
General rules for the doctor during palpation (In abdominal examination)
1. Warm your hands.
2. Ask patient if any part is tender -> examine that last.
3. Superficial palpation, then deep palpation.
232
what are types of abdominal palpation?
- Superficial palpation.
- Deep Palpation.
- Per Rectal (PR).
- Per Vaginal (PV).
233
what is the aim of superficial palpation?
- Gain patient's confidence.
———
Detect:
* Tenderness.
* Hyperesthesia.
* Temperature.
* Tone (Guarding & Rigidity).
* Superficial swellings e.g., lipoma, Varicosities & hernia
234
what is the aim of deep palpation?
Localize:
- Abdominal organs (e.g., for organomegaly).
- Deep abdominal masses.
235
Method of superficial palpation
236
How to differentiate between Abdominal wall mass & Intra abdominal mass?
237
Assessment of muscle tone
**There are 3 reactions that indicate pathology:**
- **Guarding:** Muscles contract as pressure is applied.
- **Rigidity:** Rigid abdominal wall indicates peritoneal inflammation.
- **Rebound tenderness:** Release of pressure -> pain.
238
what to comment on during paplation of abdominal swelling?
For any abdominal swelling comment on:
- Intra or extra-abdominal.
- 4 S: Site - Shape - Size - Skin over.
- Edge.
- Pulsations.
- Movement with respiration.
- Consistency.
- Tenderness.
- Regional LN.
239
what is teh surface anatomy of the liver?
240
Methods of palpation of the liver
241
what are the techniques used to palpate the lower border of the liver?
- Ordinary method
- Tip of hands (Hutchinson's) method
- Bimanual method
- Hooking method
- Dipping method
- Auscultatory method
242
Ordinary method of liver palpation
243
Tip of hands (Hutchinson's) method of liver palpation
244
Bimanual method of liver palpation
245
Hooking method of liver palpation
246
Dipping method of liver palpation
247
Ausculatatory method (Macleod) of liver palpation
248
what is the surface anatomy of the spleen?
249
what are methods of palpation of the spleen?
250
Comment on liver & spleen
251
Give example for a comment on liver
Intra-abdominal swelling, moves up & down with respiration, in Rt. hypochondrium, 3 fingers below costal margin, not tender, not pulsating, sharp edge, firm in consistency, smooth surface, mostly it's Rt lobe of liver.
252
Give example for a comment on spleen
- Intra-abdominal swelling moves up & down with respiration, oblong in shape in left hypochondrium, Extending to ... cm (or ... finger breadth) below left costal margin in left mid clavicular line (or Huge), Not warm, not tender, not pulsatile, Firm in consistency, sharp anterior border with smooth, surface.
- Hand can't reach the upper pole as you can't insinuate fingers between costal margin.
253
Size (Dimensions) of the kidney
12 * 6 * 3 cm
254
Position of the kidney
255
Surface anatomy of the kidney
256
what are the methods of palaption of the kidney?
- bimanual & ballotment
257
Bimanual technique in palpation of kidney
258
Ballotment method in palpation of kidney
259
What to commen on if kidney is identifiable?
260
Can kidneys be palpated in normal cases?
Yes, In thin persons
261
what is the difference between kidney & spleen?
262
what is tyhe surface anatomy of gall bladder?
263
methods of palpation of gall bladder
264
Method of palpation of the colon
265
Abdominal percussion
1. Ascites.
2. Liver borders: for liver span.
3. Spleen: for splenomegaly.
4. Kidneys.
5. Bladder: for enlarged bladder or pelvic mass.
6. Masses.
266
what are types of ascitis? and fluid volume in each
267
Technique of percussion in case of mild ascitis
268
Technique of percussion in case of severe (tense) ascitis
269
Technique of percussion in case of moderate ascitis
270
Auscultation of the abdomen
- Intestinal sounds
- Vascular sounds
- Scratch test
- Succession splash
- Puddle sign
- Friction rubs
271
what is another name of **Intestinal sounds**?
Also called "Borborygmi"
272
what are vascular sounds?
- Venous Hum.
- Arterial Bruit.
273
Technique of scratch test
- Place the diaphragm over the area of liver/spleen.
- Then scratch parallel to the costal margin until the sound intensity drops of marking the edge of the liver.
274
Succession splash
- Auscultaion of stomach.
- Detected in gastric outlet obstruction e.g., pylori ulcer or neoplasm.
275
Technique of succession splash
**Technique:**
- Place the stethoscope on the epigastrium.
- Then shake both iliac crests.
- While shaking, listen to splash from retained fluid.
276
puddle sign
- Auscultaion in knee elbow position.
- For detecting small amounts of ascites as small as 120 ml.
277
Friction rubs
- In Rt. & Lt. upper quadrant.
- Grating sound with respiratory movement.
- Indicates inflammation of peritoneal surface of an organ.
278
Comment on case of tense ascitis
