Abdominal Examination MCQ Quiz Questions And Answers

Abdominal pain is indeed one of the most common reasons why people visit a doctor. There are numerous potential causes for abdominal pain, ranging from minor issues like indigestion or gas to more serious conditions like appendicitis or kidney stones. Since abdominal pain can be a symptom of various underlying problems, it is important to seek medical attention to determine the cause and receive appropriate treatment. Therefore, the statement "Abdominal pain is one of the most frequent reasons for a visit to the doctor" is true.

The preferred order for examination of the abdomen is inspection, auscultation, percussion, palpation. Inspection involves visually examining the abdomen for any abnormalities such as scars, distention, or masses. Auscultation is the next step, where the healthcare provider listens to the bowel sounds using a stethoscope to assess for any abnormal sounds or absence of sounds. Percussion involves tapping on the abdomen to assess the density of underlying organs and detect any abnormal fluid or air accumulation. Finally, palpation is done to feel for any tenderness, masses, or organ enlargement. This order allows for a systematic assessment of the abdomen.

Dunphy's sign refers to the presence of increased pain with coughing. It is a clinical sign that suggests inflammation or irritation in the area being examined. When a patient experiences increased pain during coughing, it indicates that there may be an underlying condition or injury causing this symptom. Therefore, Dunphy's sign is a useful diagnostic tool for healthcare professionals to identify the source of the pain and determine appropriate treatment options.

The given scenario describes the palpation of a structure that is located 6 cm below the right costal margin in the midclavicular line during inspiration. This is consistent with the location of the liver edge, as the liver is the largest solid organ in the abdomen and is typically palpable just below the right costal margin. Therefore, the correct answer is the liver edge.

Rovsing's sign is a clinical sign used to assess for appendicitis. It is characterized by pain in the right lower quadrant of the abdomen when pressure is applied to the left lower quadrant. This sign indicates irritation of the peritoneum and is suggestive of appendicitis. The other options, psoas sign, obturator sign, and cutaneous hyperesthesia, are not specific for appendicitis and do not involve the same mechanism of pain referral.

Cutaneous hyperesthesia refers to an increased sensitivity or heightened response to touch or stimuli on the skin. In this scenario, the pain elicited by gently picking up a fold of abdominal skin anteriorly suggests that the individual may have cutaneous hyperesthesia. This condition can occur due to various reasons such as nerve damage, inflammation, or hypersensitivity. It is important to note that the other options listed (liver edge, spleen edge, Rovsing's sign, Psoas sign, and Obutrator sign) are not applicable in this context and do not explain the observed pain.

Based on the symptoms described (N/V, fever, chills, pain upon urination) and the reddish-brown color in the urine, the most likely explanation is renal calculi, also known as kidney stones. Kidney stones can cause urinary tract infections, leading to symptoms such as fever and pain upon urination. The reddish-brown color in the urine could be due to the presence of blood. Appendicitis, pancreatitis, perforation, infarction, esophagitis, and irritable bowel syndrome do not typically present with these specific symptoms and urine color.

The correct answer is spleen edge. During inspiration, if the spleen is palpable deep to the left costal margin, it indicates an enlarged spleen. This can be a sign of various underlying conditions such as liver disease, hematological disorders, or infections. Palpating the spleen edge can help in diagnosing and monitoring these conditions.

The patient's symptoms of severe pain in the side and back just below the ribs, which radiates to the lower abdomen and groin, along with the persistent urge to urinate, are indicative of renal calculi, also known as kidney stones. Kidney stones can cause intense pain as they pass through the urinary tract, and the urge to urinate frequently is a common symptom. The other conditions listed do not typically present with these specific symptoms.

Based on the patient's symptoms of abnormal flatulence, bloating, alternating bouts of diarrhea and constipation, and the fact that she is under a lot of stress, the most likely diagnosis is irritable bowel syndrome (IBS). IBS is a common gastrointestinal disorder characterized by changes in bowel habits, abdominal pain, and bloating. Stress and anxiety can exacerbate the symptoms of IBS. The other options such as cholecystitis, pancreatitis, infarction, esophagitis, dyspepsia, and renal calculi do not align with the patient's symptoms and history.

Rovsing's sign is a clinical finding where palpation of the left lower quadrant of the abdomen causes pain in the right lower quadrant. This suggests inflammation or irritation of the appendix, which is located in the right lower quadrant. This sign is commonly associated with appendicitis, as the appendix can become inflamed and cause pain that is referred to other areas of the abdomen. Therefore, the presence of Rovsing's sign indicates a potential diagnosis of appendicitis.

The given symptoms of a low-grade fever, pain upon movement, involuntary guarding of the lower quadrants of the abdomen, and tenderness at McBurney's point are indicative of appendicitis. Appendicitis is the inflammation of the appendix, which can cause severe abdominal pain and tenderness. The symptoms mentioned align with the classic presentation of appendicitis, making it the most likely diagnosis in this case.

The obturator sign refers to pain experienced when the right thigh is internally rotated. This sign is indicative of irritation or inflammation of the obturator muscle or the obturator nerve. It is often associated with conditions such as appendicitis, pelvic abscess, or ovarian cysts. The presence of pain during internal rotation of the right thigh suggests that there may be an issue with the structures in the pelvic region on the right side.

Murphy's sign is a physical examination finding that increases suspicion of cholecystitis. It is elicited by palpating the right upper quadrant of the abdomen while the patient takes a deep breath. If the patient stops breathing or experiences increased pain upon inspiration, it suggests inflammation of the gallbladder. This sign is indicative of cholecystitis because the gallbladder is typically tender and inflamed in this condition, and the patient's symptoms of abdominal pain worse after eating, particularly with spicy or fatty meals. The other signs mentioned, such as the psoas sign, Rovsing's sign, and Grey Turner's sign, are not specifically associated with cholecystitis.

Based on the given scenario, the most likely explanation for the PA student's symptoms is esophagitis. Esophagitis is the inflammation of the esophagus, which can cause pain and difficulty swallowing. It can also lead to food getting stuck in the esophagus, resulting in choking episodes. The student's complaint of pain while swallowing and the recurring episodes of food getting stuck support this diagnosis. Pancreatitis, perforation, obstruction, infarction, peptic ulcer disease, and renal calculi are less likely explanations based on the information provided.

The Obturator sign is a clinical test used to assess for inflammation or irritation of the obturator internus muscle or the obturator nerve. It involves flexing the patient's right thigh at the hip with the knee bent, and then internally rotating the leg at the hip. If the patient experiences pain during this maneuver, it suggests inflammation or irritation of the obturator structures. This sign can be indicative of conditions such as appendicitis or pelvic inflammatory disease.

The psoas sign refers to pain experienced when the right thigh is extended, which suggests irritation or inflammation of the psoas muscle. In this case, the pain on extension of the right thigh indicates that the retroperitoneal retrocecal appendix is likely causing the discomfort. The psoas muscle runs along the front of the hip joint and can become irritated when there is inflammation in the nearby appendix. Therefore, the presence of the psoas sign supports the diagnosis of a retroperitoneal retrocecal appendix.

The most likely sign expected in this scenario is CVA tenderness. Flank pain, dysuria, nausea, and fever are suggestive of a urinary tract infection (UTI). The positive leukocyte esterase on the urine dipstick further supports this diagnosis. CVA tenderness refers to tenderness over the costovertebral angle, which is located over the kidneys. In a patient with a UTI, inflammation of the kidneys can cause pain and tenderness in this area. Therefore, CVA tenderness is the most likely sign to be expected in this case.

In a patient with acute hepatitis, the liver is typically enlarged and tender. The tenderness is due to inflammation and swelling of the liver. The liver edge is also expected to be palpable and may be felt below the right costal margin (RCM). The distance between the liver edge and the RCM is often described in terms of finger breadths. In this case, a liver edge that is tender and 4-5 finger breadths below the RCM is consistent with the diagnosis of acute hepatitis.

The Psoas sign is a physical examination maneuver used to assess for inflammation or irritation of the psoas muscle. In this maneuver, the examiner places their hand on the patient's right knee and asks the patient to raise their right thigh against the examiner's hand. If the patient experiences pain in the right lower quadrant of the abdomen during this maneuver, it may indicate inflammation of the psoas muscle, which can be seen in conditions such as appendicitis. Therefore, the Psoas sign is the most appropriate answer in this scenario.

The patient's symptoms of hunger and an empty feeling in the stomach after eating, along with abdominal pain that is relieved with vomiting, suggest peptic ulcer disease. Peptic ulcers are open sores that develop on the lining of the stomach or the upper part of the small intestine. These ulcers can cause pain and discomfort, especially after eating. The patient's symptoms of nausea and waking up at night with abdominal pain further support this diagnosis. Appendicitis, diverticulitis, pancreatitis, perforation, obstruction, and dyspepsia do not typically present with the specific symptoms described by the patient.

Based on the patient's symptoms of not farting or pooping for days, along with moderate cramping around the umbilicus, the most likely explanation for this patient's condition is obstruction. Obstruction refers to a blockage in the gastrointestinal tract that prevents the normal passage of stool and gas. This can lead to symptoms such as constipation, abdominal pain, and bloating. Given that the patient is post-op, it is possible that adhesions or scar tissue from the surgery are causing the obstruction. Other potential causes of obstruction include tumors, strictures, or hernias.

The patient's symptoms of severe RUQ pain that worsens upon respiration, discomfort after eating, and nausea, along with the grayish clay color of their last bowel movements, are indicative of cholecystitis. Cholecystitis is inflammation of the gallbladder, which can be caused by gallstones blocking the cystic duct. This blockage leads to the accumulation of bile, causing pain and discomfort. The association of symptoms with eating and the presence of grayish clay-colored stools suggest a problem with bile flow, supporting the diagnosis of cholecystitis.

Involuntary guarding refers to the tightening or contraction of muscles in response to pain or injury. It is an automatic reflex that occurs before the doctor actually makes contact. This reflexive muscle contraction is the body's way of protecting the injured area from further harm. It is different from voluntary guarding, which is a conscious effort to protect the injured area by contracting the muscles.

Voluntary guarding refers to the intentional contraction of the abdominal muscles by the patient in response to pain or discomfort. It is a conscious and deliberate action taken by the patient to protect the abdomen from further injury or pain. In this case, when the doctor's hand touches the abdomen, the patient may instinctively contract their abdominal muscles to guard against the potential pain or discomfort caused by the examination.

The patient's symptoms of nausea, loss of appetite, irregular bowel movements, and painful bloating in the abdomen, along with severe pain in the lower left side of the abdomen upon palpation, are indicative of diverticulitis. Diverticulitis is the inflammation or infection of small pouches called diverticula that can develop along the walls of the colon. The symptoms and location of pain align with diverticulitis, making it the most likely diagnosis in this case.

Abdominal pain accounts for about 8 percent of all emergency room visits.

Voluntary guarding is not a peritoneal sign because it is a protective mechanism where the patient voluntarily tenses the abdominal muscles to protect the underlying structures. Peritoneal signs, on the other hand, are indicative of inflammation or irritation of the peritoneum and include rebound tenderness, involuntary guarding, and rigidity of the abdomen.

Guarding refers to the involuntary tensing of the abdominal muscles by a patient during a medical examination. This response is typically subconscious and occurs as a protective mechanism to prevent further pain or injury in the abdominal area. It can be a sign of underlying pathology of inflammation in the abdomen. Guarding can be differentiated into voluntary or involuntary based on the patient's level of control over the muscle tension.

The patient's symptoms of upper abdominal pain that radiates into the back, worsens when lying supine and after eating, along with a recorded heart rate of 130 bpm, are consistent with pancreatitis. Pancreatitis is inflammation of the pancreas, which can cause severe abdominal pain that may radiate to the back. The pain is typically worsened by lying flat and after eating. The elevated heart rate could be a result of the body's response to inflammation and pain. Therefore, pancreatitis is the most likely diagnosis for this patient.

In this scenario, the absence of bowel sounds suggests a complication related to the gastrointestinal tract. Perforation refers to a hole or tear in the wall of the gastrointestinal tract, which can occur as a complication of surgery. This can lead to severe abdominal pain and nausea/vomiting, as seen in the patient's chief complaint.

Based on the patient's description of gnawing and burning pain in the upper middle part of the stomach, along with symptoms of vomiting and unusual burping, the most likely diagnosis is dyspepsia. Dyspepsia, also known as indigestion, is a common condition characterized by discomfort or pain in the upper abdomen. It can be caused by various factors such as overeating, eating too quickly, certain medications, or underlying conditions like gastroesophageal reflux disease (GERD) or peptic ulcer disease. The symptoms described by the patient align with the typical presentation of dyspepsia.

Based on the given information, the patient's severe, colicky, continuous abdominal pain suggests a lack of blood supply to a specific organ, which is known as infarction. This can occur due to a blockage in the blood vessels supplying the organ. The absence of rebound tenderness, ruling out cholelithiasis, nephrolithiasis, and ulcers, further supports the possibility of infarction. Appendicitis, pancreatitis, perforation, obstruction, peptic ulcer disease, and irritable bowel syndrome are less likely based on the given symptoms and findings.

The given answer includes appendicitis, cholecystitis, pancreatitis, perforation, and obstruction. These conditions are considered acute abdominal pain syndromes because they all involve sudden and severe abdominal pain. Appendicitis refers to inflammation of the appendix, cholecystitis is inflammation of the gallbladder, pancreatitis is inflammation of the pancreas, perforation refers to a hole or tear in the gastrointestinal tract, and obstruction refers to blockage of the intestines. These conditions can all cause acute abdominal pain and require medical attention.

The correct answer includes esophagitis, peptic ulcer disease, dyspepsia, and IBS. These conditions are all considered chronic abdominal pain syndromes. Esophagitis refers to inflammation of the esophagus, which can cause abdominal pain. Peptic ulcer disease is characterized by open sores in the lining of the stomach or small intestine, leading to abdominal pain. Dyspepsia is a term used to describe recurring or persistent indigestion, which can cause abdominal discomfort. IBS, or irritable bowel syndrome, is a chronic gastrointestinal disorder that can cause abdominal pain, bloating, and changes in bowel habits.