Term
| In the "4 plus 3" grid, what abdominal structures are located in the right upper grid? |
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Definition
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Term
| In the "4 plus 3" grid, what abdominal structures are located in the epigastric grid? |
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Definition
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Term
| In the "4 plus 3" grid, what abdominal structures are located in the left upper grid? |
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Definition
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Term
| In the "4 plus 3" grid, what abdominal structures are located in the periumbilical grid? |
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Definition
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Term
| In the "4 plus 3" grid, what abdominal structures are located in the right lower grid? |
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Definition
Appendix
Ascending Colon
Ureter
Fallopian Tube |
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Term
| In the "4 plus 3" grid, what abdominal structures are located in the suprapubic grid? |
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Definition
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Term
| In the "4 plus 3" grid, what abdominal structures are located in the left lower grid? |
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Definition
Descending Colon
Ureter
Fallopian tube |
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Term
| When does jaundice become apparent? What other symptoms may accompany jaundice? |
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Definition
| When serum bilirubin levels are >2.5mg/dL; generalized pruritus |
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Term
| What sign is described by bluish periumbilical discoloration? What does this sign mean? |
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Definition
| Cullen's Sign; peritoneal hemorrhage |
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Term
| What sign is described as flank ecchymosis? What does this sign indicate? |
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Definition
| Grey Turner's sign; Retroperitoneal hemorrhage |
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Term
| A pt presents with abdominal wall findings including distended venous collaterals lateral to umbilicus with upward flow for all. In addition the pt has lower extremity edema and scrotal edema, what is your diagnosis? |
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Definition
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Term
| A pt presents with distended venous collaterals with the flow radiating from the umbilicus up or down. The pt also has notable ascites, internal hemorrhoids, small liver and is in ESLD, what is your diagnosis? |
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Definition
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Term
| If a pt presents with grey turner's sign, cullen's sign and back pain and also has associated conditions including hypotension, anemia, and hypocoagulability. What is your diagnosis? |
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Definition
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Term
| If a pt presents with a hx of a PE and has a site of ecchymosis with no skin atrophy, what condition should you suspect? |
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Definition
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Term
| If a pt presents with a hx of a DM and has a site of ecchymosis with skin atrophy, what condition should you suspect? |
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Definition
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Term
| A pt presents with a nodule in the umbilicus, weight loss, early satiety, painless jaundice and hard nodule of troisier. What condition do you suspect? |
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Definition
| Sister Mary Joseph’s nodule which is typically associated with adult cancers of the gastrointestinal tract and ovary |
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Term
| A pt presents with a tender mass in rectus, ecchymosis and cullen's sign. She has a hx of trauma, and tenderness increases with active forward flexion and also increases with passive backward extension. What is the diagnosis? |
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Definition
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Term
| Where is a Pfannenstiel scar located? |
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Definition
| suprapubic or bikini line |
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Term
| What are the potential meanings of a Pfannenstiel scar? |
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Definition
Abdominal hysterectomy
Cesarean section |
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Term
| What is the potential meaning of a right subcostal scar? |
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Definition
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Term
| What is the potential meaning of a left subcostal scar? |
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Definition
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Term
| What is the potential meaning of a midline abdominal scar? |
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Definition
Vascular procedure
Bowel or Gastric resection |
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Term
| What is the potential meaning of a RLQ scar? |
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Definition
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Term
| What is the potential meaning of an inguinal scar? |
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Definition
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Term
| What is the potential meaning of a periumbilical scar? |
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Definition
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Term
| What are hypoactive bowel sounds a sign of? |
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Definition
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Term
| What are high pitched bowel sounds followed by frequent periods of silence indicative of? |
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Definition
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Term
| If bruits are heard in LUQ or RUQ, what condition is suspected? |
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Definition
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Term
| What are the causes of epigastric bruits? (4) |
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Definition
| AAA, Pregnancy, Mesenteric angina, Hepatocellular carcinoma |
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Term
| A pt has an epigastric, femoral and carotid bruit, an epigastric pulsation and a popliteal aneurysm. What condition is suspected? |
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Definition
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Term
| A pt presents with high pitched sounds, tinkling and rushes mixed with silence on auscultation as well as abdominal distention, tympany and diffuse tenderness. What condition do you suspect? |
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Definition
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Term
| A pt post-surgical pt presents with absent bowel sounds. What condition should you suspect? |
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Definition
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Term
| A pt presents with flank bruits, HTN and hypokalemia. What condition should you suspect? |
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Definition
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Term
| A pt presents with an epigastric bruit, bruits over other arteries and postprandial pain. What condition should you suspect? |
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Definition
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Term
| A pt presents with a RUQ bruit on auscultation, hepatomegaly and nodules. What condition should you suspect? |
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Definition
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Term
| What is the liver span along the midsternal line? along the midclavicular line? |
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Definition
midsternal line: 4 - 8 cm
midclavicular line: 6 - 12cm |
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Term
| What is the difference between the tympany of the gastric bubble and the tympany of the intestine? |
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Definition
| The tympany of the gastric bubble is lower than the tympany of the intestine |
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Term
| What is a positive fluid wave test? What does it mean? |
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Definition
| Fluid wave = Succession splash -> Ascites |
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Term
| What is a positive shifting dullness test? What does a positive test indicate? |
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Definition
| If the dullness has shifted to areas of prior tympany, the patient may have excess peritoneal fluid (ascites) |
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Term
| What is rebound tenderness indicative of? |
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Definition
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Term
| A pt presents with pain starting around the periumbilical area, resolves for 4 hours than returns with great intensity in their RLQ, then after 24 hours the pain disseminates throughout the abdomen. What condition is suspected? |
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Definition
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Term
| What does involuntary guarding and rigidity of the abdominal muscles suggest? |
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Definition
| Diagnostic for acute abdomen or surgical abdomen b/c signifies advanced peritonitis |
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Term
| What is the scratch test used for? |
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Definition
| Excellent first-line assessment of liver size and span |
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Term
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Definition
| Yellow discoloration of the sclera |
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Term
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Definition
| Yellow discoloration of the skin |
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Term
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Definition
| Golden-brown coloration of the urine |
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Term
| Breast development, spider angiomatas (on the upper chest), lower extremity edema and testicular atrophy are signs of what? |
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Definition
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Term
| What is the cause of lower extremity pitting edema in liver disease? |
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Definition
| Impaired synthesis of albumin leads to lower oncotic pressure resulting in leakage of fluid into soft tissue |
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Term
| What are Caput Medusae? What veins are involved? What condition is this seen in? |
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Definition
They are dilated superficial veins
The blood is redirected into recanalizations of the umbilical vein
Seen in Liver disease |
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Term
| What are the most common varices associated with liver disease? Which veins are involved? What is the worst complication of these varices? |
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Definition
Esophageal varices
Splenic and short gastric veins (which pass through the esophageal venous plexus en route to the SVC)
These esophageal varices can bleed profoundly. |
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Term
| If a pt presents with spider angiomas, gynecomastia, small testes, small liver span, icterus, caput medusa and ascites, what condition do you suspect? |
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Definition
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Term
| Where is the spleen located? |
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Definition
| Under the 6 & 7 rib lateral left abdomen |
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Term
| What is castell's point? Where is the normal spleen located in reference to Castell's point? |
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Definition
Point intersection of L subcostal margin and AAL (Anterior Axial Line)
Normal spleen located proximal to Castell's point |
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Term
| A pt has tympany to percussion just proximal to Castell's point and a scar at the L subcostal area. What is your dx? |
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Definition
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Term
| A pt has dullness to percussion at Castell's point with expiration and inspiration. They also have dullness to percussion at Traube's space. What are the 3 possible dx? |
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Definition
Moderate Splenomegaly
Large Pleural Effusion
Cardiomegaly |
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Term
| A pt presents with c/o early satiety, nausea and postprandial vomiting. On PE you find dullness to percussion at Castell’s point on expiration and inspiration and also dullness to percussion at Traube’s space. What condition does this pt have? What else might you find on PE on palpation? |
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Definition
Marked or Massive Spleenomegaly
Palpable Spleen at LUQ in R Lat decubitus and supine positions |
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Term
| A pt presents with c/o early satiety, nausea and postprandial vomiting. On PE you find dullness to percussion at Castell’s point on expiration and inspiration and also dullness to percussion at Traube’s space. What condition does this pt have? What else might you find on PE on palpation? |
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Definition
Marked or Massive Spleenomegaly
Palpable Spleen at LUQ in R Lat decubitus and supine positions |
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Term
| What is the best FIRST exam technique for the spleen eval? |
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Definition
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Term
| What is the best FIRST exam technique for the liver? |
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Definition
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Term
| As far as spleen size, what does tympany at Castell's pt mean? |
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Definition
| Pt unlikely to have spleenomegaly |
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Term
| What is the Lateral border of Traube's Triangle? What is the superior border of Traube's triangle? What is the inferior border of Traube's triangle? |
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Definition
Lateral = AAL
Superior = 6th rib
Inferior = Subcostal margin |
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Term
| In what direction is the umbilical hernia seen in pregnancy? |
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Definition
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Term
| In what direction is the umbilical hernia seen in ascites? |
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Definition
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Term
| In which two populations of pts is there a higher risk of an incisional hernia? |
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Definition
Uncontrolled DM
High dose steroid users |
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Term
| Which type of hernia is seen at a surgical scar? |
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Definition
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Term
| Which type of hernia is a palpable and visible nodule or mass often replacing the umbilicus? |
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Definition
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Term
| Which type of hernia is a palpable or visible mass in the lower medial abdomen that is nontender and reducable? What is the term for the same location of hernia but it is tender and nonreducible? |
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Definition
Inguinal hernia
Incarcerated Inguinal Hernia |
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Term
| A pt with hx of longstanding HTN presents with diminished pulses in extremities and a pulsatile mass in both popliteal fossa as well as a midline pulsatile mass in the epigastric region. What is your dx? |
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Definition
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Term
| Which sign is described as a palpable nontender mass in the RUQ, near Murphy's Point? |
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Definition
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Term
| A pt presents with Courvoisier’s sign, jaundice, clay-colored stool and darkened urine. What condition do you suspect? |
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Definition
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Term
| What is a sub-q fleshy nodule that remains present with contraction of abdominal mms? |
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Definition
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Term
| At what measurement along the MCL is Hepatomegaly? |
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Definition
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Term
| A pt presents with abdominal discomfort and on inspection, you see a fullness in the suprapubic area, there is dullness to percussion in that area as well. What condition do you suspect? What is a common cause of this condition in men? |
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Definition
Distended urinary bladder
Enlarged Prostate (felt on DRE) causing Bladder outlet obstruction |
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Term
| What is the difference btwn a mass and a nodule? |
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Definition
Mass = > 4cm
Nodule = < 4cm |
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Term
| Which type of hernia is described as tender and non-reducible and is surgically urgent? |
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Definition
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Term
| Which type of hernia is described as non-tender and non-reducible and is a surgical emergency? |
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Definition
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Term
| What are three possible dx for a suprapubic mass? |
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Definition
1 - Distended Urinary Bladder
2 - Uterine Fibroid
3 - Gravid Uterus |
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Term
| With the rare finding of a palpable gallbladder, what condition MUST be considered? |
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Definition
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Term
| What is one of the MC causes of nodules found on abdominal examination? |
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Definition
|
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Term
| Is a PE diagnostic for a AAA? |
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Definition
| NO it requires imaging techniques to properly eval |
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Term
| A pt describes their abdominal pain as "burning", what do you suspect? |
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Definition
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Term
| A pt describes their abdominal pain as "tearing", what do you suspect? |
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Definition
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Term
| A pt describes their abdominal pain as "gripping", what do you suspect? |
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Definition
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Term
| A pt describes their abdominal pain as "dull, aching", what do you suspect? |
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Definition
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Term
| A pt describes their abdominal pain as "crampy, constricting", what do you suspect? |
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Definition
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Term
| What type of condition has referred pain to the R shoulder? |
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Definition
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Term
| What type of condition has referred pain to the testicles? |
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Definition
| Renal Colic or appendicitis |
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Term
| Which type of condition has referred pain to the mid-lumbar region of the back? |
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Definition
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|
Term
| Which condition has referred pain to the left posterior shoulder (trap area)? |
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Definition
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Term
| Which condition may have referred pain to the right posterior shoulder (trap region)? |
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Definition
| Perforated Duodenal Ulcer |
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Term
| Periodic epigastric pain occuring 1/2 to 1 hr AFTER eating is a classic symptom of what condition? |
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Definition
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Term
| Pts with pain 2 - 3hrs post-prandial likely have which condition? |
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Definition
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Term
| With a duodenal ulcer what does food do to the pain? |
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Definition
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Term
| With which type of ulcer is nocturnal pain common? |
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Definition
| Duodenal Ulcer (think no food=greater pain) |
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Term
| In addition to a Gastric ulcer, what may pain after eating be associated with? |
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Definition
| Vascular dz of the abdominal viscera |
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Term
| Where does pain from the large bowel begin? (hint - think embryologically) |
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Definition
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Term
| Where does pain from the small bowel (appendix) begin? |
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Definition
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Term
| What does the color green suggest? |
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Definition
| bile duct or gallbladder rupture |
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Term
| What does a purple color represent? |
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Definition
| Ecchymosis or a vessel rupture |
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|
Term
| What does blue in the extremities suggest? |
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Definition
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Term
| What does yellow (in the skin, eyes or dark urine) suggest? |
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Definition
| obstructed bile duct or liver disease |
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|
Term
| What does black tarry stool suggest? |
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Definition
| An UPPER GI bleed (melana) |
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|
Term
What does red suggest?
What does dark red mean?
What does bright red mean? |
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Definition
BRBPR suggests a bleed in the LOWER GI tract (or a brisk upper GI bleed, aka peptic ulcer)
Dark Red = R Colon (ascending)
Bright Red = L Colon (decending) or hemorrhoids |
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Term
| What do silver stools represent? |
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Definition
| Melena w/out bile (tumor obstructing the bile duct that is bleeding into the duodenum) |
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|
Term
| Which diseases can cause referred pain to the abdomen? |
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Definition
P = Porphyria
M = Mediterranean Fever
B = Black Widow Bite
A = Addison's Dz
D = Diabetic Ketoacidosis
L = Lead Poisoning
U = Uremia (kidney failure)
N = Narrow Angle Glaucoma
C = Calcium (Hypercalcemia); Chronic Constipation
H = Herpes Zoster |
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Term
| What are the 3 signs of peritonitis? |
|
Definition
Gaurding
Rebound Tenderness (Cross-Palpation tenderness)
Completely Lying Still (late sign) |
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|
Term
| What are "tinkling and rushes" characteristic of? |
|
Definition
|
|
Term
| What 2 physical signs are associated with pancreas disorder? |
|
Definition
|
|
Term
| What is a positive Murphy's test? What does it indicate? |
|
Definition
Pos Test = Pain on inhalation
Indicative of Cholecystitis |
|
|
Term
| What is a positive psoas sign? |
|
Definition
| Pos = Increased abdominal pain with flexion |
|
|
Term
| What is a positive obturator sign? |
|
Definition
| Pain with internal rotation |
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Term
| What is the name of the test described as at a series of points down the abdomen, gently pick up a fold of skin between your thumb and index finger without pinching it? What is a positive test, what does it indicate? |
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Definition
Cutaneous Hyperesthesia Test
Pos = localized pain with the maneuver in the RLQ
Indicates Appendicitis |
|
|
Term
| Where is McBurney's point? Why is it important? |
|
Definition
Located 2/3rds of the way btwn the umbilicus and the ASIS.
Tenderness at this point is indicative of appendicitus |
|
|
Term
| What does rebound tenderness suggest? |
|
Definition
|
|
Term
| What is a pos Rovsing's sign? |
|
Definition
Pain in the RLQ with deep palpation and release in the LLQ
Suggestive of Appendicitis |
|
|
Term
| What symptoms does obstruction (SBO or appendicitis) begin with? |
|
Definition
| Anorexia (the body is trying to keep any additional food from entering the body) |
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