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In collaboration with the Warwick Medical School’s very own Clinical Skills Society, MedGuide proudly presents the first OSCE-like quiz.  Best of luck! 

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  • Introduce, explain and consent a patient to undergo a full abdominal examination
  • Perform a structured general inspection and examination relevant to the abdominal exam 
  • Perform a structured inspection, palpation, percussion and auscultation relevant to the abdominal exam 
  • Note any further tests that would be undertaken in a patient who has had an abdominal examination 

Clinical Skills - Introduction to the Abdominal Examination

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Question 1
Facial jaundice should be first observed in which part of the structured abdominal examination?
A
General inspection
B
General examination
C
Inspection
D
Palpation
E
Percussion
Question 2
Which of the following is the strongest indicator of pregnancy?
A
Clubbing
B
Leukonychia
C
Koilonychia
D
Dupuytren's contracture
E
Palmar erythema
Question 3
A patient tests positive for asterixis during the general abdominal examination sequence. Which of the following profiles best matches this finding?
A
Trauma to the ulnar nerve
B
Shifting dullness noting visible ascites
C
Parkinsonian findings
D
Foregut metastatic disease
E
Chronic alcohol disease
Question 3 Explanation: 
As the liver function deteriorates, ammonia is increasingly lacking conversion to less toxic ammonium. Thus the former ammonia deposits in the motor cortices of the cerebrum, causing an "hepatic flap", or asterixis sign
Question 4
Which of the following signs are most associated with family history?
A
White spots in the nailbed
B
Spooning of the nails
C
Loss of Schamroth's window
D
Passive flexion of the fourth and fifth digit at the proximal digit joints
E
Shaking of the extended upper limb when hands are dorsiflexed.
Question 5
A patient is noted to have central obesity, a fatty diet and can be seen to have marked excoriations on the flexor surface of their upper limbs bilaterally.  Which is the most likely cause of this finding?
A
Cholestasis
B
Cholecystectomy
C
Hepatic encephalopathy
D
Gastro-oesophageal reflux disease
E
Peptic ulcer perforation
Question 6
Study the following image

Which of the following is the most likely diagnosis as a result of this sign?
A
Gastric metastatic disease
B
Anaemia of chronic disease
C
Malnourishment
D
Malignant melanoma
E
Dehydration
Question 7
About the lateral angles of the mouth (canthi), there is marked erythema.  What is the most likely diagnosis?
A
B6 deficiency
B
B9 deficiency
C
B10 deficiency
D
B11 deficiency
E
B12 deficiency
Question 7 Explanation: 
This can also be a marker of iron deficiency. The sign is termed "angular stomatitis".
Question 8
Which of the following is not a node palpated in the head and neck lymphatic assessment during the abdominal examination?
A
Preauricular
B
Posterior occipital
C
Posterior auricular
D
Supraclavicular
E
Submental
Question 9
Grey-turner's sign is best described as?
A
9th costal cartilage, midclavicular line guarding pain
B
A positive finding of nephroptosis
C
A positive finding of shifting dullness
D
The consequence of overprescription of spironolactone
E
Indicative of retroperitoneal bleeding
Question 10
On abdominal examination a Pfannenstiel scar is noted. This suggests the patient has had previous surgery of which type?
A
C-section
B
Removal of the gallbladder
C
Operation to remove colic obstruction
D
Urostomy bag insertion
E
Ablated appendix
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