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154 Cards in this Set
- Front
- Back
Visceral pain in the right upper quadrant may result from what
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liver distention against its capsule in alcoholic hepatitis
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Visceral periumbilical pain may signify the early stages of this
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Acute appendicitis from distention of an inflamed appendix
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Visceral periumbilical pain from early appendicitis gradually changes to which type of pain
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parietal pain in the right lower quadrant
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Pain in the duodenum or pancreas is found where
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refereed back pain from the biliary tree to the right shoulder or right posterior chest
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Where would pain from pleurisy or acute MI be referred to
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Epigastric area
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These mediate interconnected symptoms of pain, bowel dysfunction and stress
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Neuropeptides (5-hydroxytryptophan and substance P)
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A pt who is doubling over with cramping colicky pain indicates what
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Renal stone
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Sudden knife like epigastric pain occurs when
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gallstone pancreatisis
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Epigastric pain occurs with what
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Gastitis or GERD
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What does right upper quadrant pain and upper abdominal pain signify
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Cholecystitis
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This can present as indigestion but is precipitated by exertion and relieved by rest
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Angina
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These can cause bloating
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inflammatory bowel disease
belching from aerophagia swallowing air |
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These can cause upper abdominal discomfort or pain which can last over 3 months
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Delayed gastric emptying
Gastritis Peptic ulcer disease psychosocial factors |
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What are the symptoms for GERD
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Chronic upper abdominal pain discomfort
Heartburn acid reflux regurgitation |
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What are the risk factors for GERD
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reduced salivary flow, prolonged acid clearance, delayed gastric emptying, selected medications, hiatal hernia
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Angina from inferior wall coronary ischemia along the diaphragm may present as what
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heartburn
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Patients with uncomplicated GERD who do not respond to empiric therapy, pts older than 55, pts with alarm symptoms all warrant what procedure
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endoscopy
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Endoscopy is used to detect what diseases
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esophagitis, peptic strictures, barrett's esophagus (30-fold increase risk of cancer),
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Approx what percent of GERD patients who have a endoscopy exam will have a disease detected
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50%
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Dysphagia, odyophagia, recurrent vomiting, evidence of gastrointestinal bleeding, weight loss, anemia, or risk factors for gastric cancer are what type of symptoms
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alarm symptoms
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Right lower quadrant pain or pain that migrates from the periumbilical region combined with abdominal wall regidity is most likely this disease
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Appendicitis
In females could also be PID, ruptured ovarian follicle, and ectopic pregnancy |
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This usually is the cause of cramping radiating to the right or left lower quadrant
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renal stone
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Left lower quadrant pain with a palpable mass may be this
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diverticulitis
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Diffuse abdominal pain with absent bowel sounds and firmness, guarding, or rebound pain indicates this
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small or large bowel obstruction
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Change in bowel habits with mass lesion indicates this
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bowel cancer
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Intermittent pain for 12 weeks of the preceding 12 months with relief from defecation change in frequency of bowel movements, or change in form of stool without structural or biochemical abnormalities is usually what
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irritable bowel syndrome
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Regurgitation occurs in these diseases
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GERD, esophageal strictures, and esophageal cancer
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Vomiting and pain indicates this
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small bowel obstruction
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Fecal odor occurs with these diseases
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small bowel obstruction or gastrocolic fistula
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Hematemesis may accompany these diseases
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esophageal or gastric varices, gastritis, peptic ulcer disease
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Pt who complain of unpleasant abdominal fullness after light or moderate meals, early satiety, inability to eat a full meal usually suffer from this
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diabetic gastroparesis, anticholinergic medication, gastric outlet obstruction, gastric cancer, early satiety in hepatitis
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Gurgling or regurgitation of undigested food occur in this structural condition
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zenker's diverticulum
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Drooling, nasopharyngeal regurgitation, cough from aspiration in muscular or neurologic disorders affecting motility are indicators of what
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oropharyngeal dysphagia
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Pointing to below the sternoclavicular notch indicates what
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esophageal dysphagia
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If solid foods provoke symptoms what should you consider
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esophogeal conditions including stricture, schaztki's ring, web ring, neoplasm
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if both solids and liquids provoke symptoms what should you consider
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motility disorder
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esophogeal ulceration from radiation, caustic ingestion, infection from candida, cytomegalovirus, herpes simplex, or hiv can cause this symptom
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Pain on swallowing (odynophagia)
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What would cause increased passing of excess gas
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aerophagia, legumes or other gas producing foods, intestinal lactase deficiency, irritable bowel syndrome
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What is the main cause for acute diarrhea
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infection
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This is usually noninfectious in origin. Two examples are Crohn's disease and ulcerative collitis
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Chronic diarrhea
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What is the origin of high-volume, frequent watery stools
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small intestine
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Small-volume stools with tenesmus, or diarrhea with mucus, pus, or blood occur in this condition
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rectal inflammatory condition
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This usually has pathologic significance
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nocturnal diarrhea
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Oily residue, sometimes frothy or floating occurs with this
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steatorrhea
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Fatty diarrheal stools occur from this
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malabsorption in celiac spure, pancreatic insufficiency, and small bowel bacterial overgrowth
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Medications such as penicillins, macrolides, magnesium-based antacids, metformin, and herbal alternative medicines all can cause this
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diarrhea
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Thin, pencil like stool occurs in this
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obstructing "apple core" lesion of the sigmoid colon
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Diabetes, hypothyroidism, hypercalcemia, multiple sclerosis, parkinson's disease, and systemic sclerosis all can cause this
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Constipation
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This is a condition of extreme and persistent constipation caused by obstruction in the intestinal system
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obstipation
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this signifies intestinal obstruction
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obstipation
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this is the passage of black tarlike stools containing blood that has been acted on by the intestinal juices
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melena
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The presence of as little as 100ml of blood in the upper gastrointestinal area can cause this
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melena
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If more than 1000ml of blood is present in the lower gastrointestinal area this can occur
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Hematochezia
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Blood on the surface of toilet paper is a sign of this
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hemorrhoids
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Impaired excretion of conjugated biliruben occurs with what diseases
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viral hepatitis, cirrhosis, primary biliary cirrhosis, drug-induced cholestasis
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These may obstruct the common bile duct
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Gallstones or pancreatic carcinoma
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Dark urine from bilirubin indicates this
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impaired excretion of bilirubin into the gastrointestinal tract
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Acholic (putty colored, lack of bile) stools may occur briefly in this disease
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viral hepatitis as well as obstructive jaundice
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Itching may indicates this
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cholestatic or obstructive jaundice
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Skin Pain may signify this
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a distended liver capsule, biliary cholic or pancreatic cancer
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Involuntary voiding or lack of awareness suggests this
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cognitive or neurosensory deficits
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This arises from decreased intraurethral pressure
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stress incontinence
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Trouble starting urine stream, weak flow and force, hesitation, dribbling are all common in men with this
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partial bladder outlet obstruction due to BPH and urethral stricture
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Pain of sudden overdisention accompanies this
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acute urinary retention
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Painful urination accompanies this
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cystitis or urethritis
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This symptom is found in bladder stones, foreign bodies, tumors, and acute prostitis
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Dysuria
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In women Internal burning occurs due to this
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urethritis and vulvovaginitis
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Urgency to urinate suggests this
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bladder infection or irritation
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In men painful urination without frequency or urgency suggests this
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urethritis
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Abnormal high renal production of urine suggests this
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polyuria
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frequency without polyuria during the day or night suggests this
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bladder disorder or impairment to flow at or below the bladder neck
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urination with increased intra-abdominal pressure suggests decreased contractility of urethral sphincter or poor bladder neck and is called this
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stress incontinence
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This is the inability to hold the urine and is a sign of detrusor overactivity
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urge incontinence
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type of incontinence where the bladder cannot be emptied until bladder pressure exceeds urethral pressure, this indicates anatomical obstruction by prostatic hypertrophy or stricture or neurogenic abnormalities
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over flow incontinence
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This may arise from impaired cognition, musculoskeletal problems, or immobility
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Functional incontinence
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Signs and symptoms such as fever, pain, chills occur during this
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kidney pain
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This is caused by sudden obstruction of a ureter (urinary stones, blood clots)
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Renal or ureteral colic
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These are all classic findings of alcohol abuse
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spider angiomas, palmar erythema, peripheral edema
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this thrusts the abdomen foward and tightens the ab muscles
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arched back
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Pink-purple striae is a observed in this
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cushing's syndrome
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Dilated veins that can be observed on the abdominal exam are due to these diseases
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hepatic cirrhosis, inferior vena cava obstruction
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This can be a cause of bulging flanks
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ascites
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this can be a cause of supra pubic bulge
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distended bladder or pregnant uterus, hernias
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What can cause asymmetry of the abdomen
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enlarged organs or a mass
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What are some causes for lower abdominal masses
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ovarian/uterine tumor
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This can cause increased peristaltic waves
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intestinal obstruction
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These are causes of pulsations in the abdomen
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aortic aneurysm, increased pulse pressure
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Bruits heard in the abdomen suggests this
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vascular occlusive disease
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When might bowel sounds be altered
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diarrhea, intestinal obstruction, paralytic ileus, and peritonitis
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A bruit that is detected in an area with both systolic and diastolic components suggests
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renal artery stenosis which causes hypertension
also turbulent blood flow of partial aterial occlusion or arterial insufficiency |
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Friction rubs heard while auscultating the liver are a sign of
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liver tumors, gonococcal infection around the liver, splenic infarction
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A protuberant abdomen that is tympanitic throughout suggests what
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interstinal obstruction
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Large dull areas on percussion can be due to
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pregnant uterus, ovarian tumor, distended bladder, large liver or spleen
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Dullness in both flanks may be a sign of this
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ascites
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This is a disease where the organs are reversed resulting in an air bubble on the right and liver dullness on the left
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Situs inversus
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Involuntary rigidity typically persists despite maneuvers to relax the abdominals this is causes by
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peritoneal inflammation
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This is an example of a physiologic abdominal mass
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pregnant uterus
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this is an example of a inflammatory mass
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divericulitis of the colon
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This is an example of a vascular abdominal mass
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abdominal aortic aneurysm
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This is an example of a neoplastic abdominal mass
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carcinoma of the colon
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this is an example of a obstructive abdominal mass
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distended bladder or dilated loop of bowel
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Abdominal pain with coughing or light percussion suggests this
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peritoneal inflammation
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Rebound tenderness suggests this
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peritoneal inflamation
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When is liver dullness increased
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when the liver is enlarged
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When is the span of liver dullness decreased
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when the liver is small or when free air is present below the diaphragm (perforated hallow viscus)
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Serial observations may show a decreasing span of dullness with what
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with resolution of hepatitis or congestive heart failure or fulminant hepatitis
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This is a cause of liver displacement downward by the lower diaphragm
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chronic obstructive pulmonary disease
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dullness of a right pleural effusion or consolidated lung if adjacent to liver dullness may falsely cause this
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increase the estimate of liver size
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Gas in the colon may produce this in the RUQ
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tympany
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Tympany in the RUQ, obscure liver dullness due to gas in the colon can lead to this
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underestimation of liver size
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When the edge of the liver is palpable this can lead to what
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a doubled likelihood of hepatomegaly
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Firmness or hardness of the liver, bluntness or rounding of its edge, and irregularity of its contour suggests what
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abnormality of the liver
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This forms an oval mass below the edge of the liver and is dull to percussion
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obstructed, distended gall bladder
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What does Tenderness over the liver suggest
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inflammation, hepatitis, congestion as in heart failure
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If percussion dullness is present palpation correctly detects this more than 80% of the time
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splenomegaly
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Fluids or solids in the stomach or colon may cause dullness in this space
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traube's space
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What is suggested when you appreciate a change in spleen percussion from tympany to dullness on inspiration
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splenic enlargement (this is a positive splenic percussion sign
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Splenic percussion sign may be positive when the spleen is what
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normal
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What are causes of splenomegaly
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portal hypertension, hematologic malignancies, hiv, infection, and splenic infart or hematoma
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When is splenomegaly eight times more likely to occur
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when the spleen is palpable
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Where is the spleen tip just palpable
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left costal margin
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What might left flank mass represent
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marked splenomegaly or an enlarged kidney
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When might you suspect splenomegaly
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if a notch is palpated on medial border,
the edge extends beyond the midline, percussion is dull, fingers can probe deep to the medial and lateral borders but not between the mass and the costal margin |
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What attributes favor an enlarged kidney over an enlarged spleen
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preservation of normal tympany in LUQ,
ability to probe your fingers between the mass and the costal margin but not deep to its medial or lateral borders |
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Where is an enlarged spleen palpable
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2cm below the left costal margin on deep inspiration
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What are causes of kidney enlargement
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hydroenphrosis, cysts, tumors
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what does bilateral enlargment suggest
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polycystic kidney disease
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What does pain with pressure or fist percussion of the kidneys suggest
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pyelonephritis or may be musuloskeletal
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What can cause bladder distention
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outlet obstruction due to urethral stricture, prostatic hyperplasia, medications neurological disorders
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This is the main symptom of bladder infection
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suprapubic tenderness
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The following are risk factors for what disease.
age 65 years or older, history of smoking, male gender, and a first degree relative with this disease |
Abdominal aortic aneurysm
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Whar do periumbilical or upper abdominal mass with expansile pulsations that are 3cm or more wide suggest
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AAA
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Screening by palpation followed by ultrasound decreases mortality for this disease
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AAA
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Rupture is 15 times more likely to occur in AAA that are this size
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>4cm
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What are the causes of ascites
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hydrostatic pressure in cirrhosis, congestive heart failure, constrictive heart failure, constrictive pericaritis, inferior vena cava/ hepatic vein obstruction,decreased osmotic pressure in nephrotic syndrome, malnutrition, ovarian cancer
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When does dullness shift to the more dependent side whereas tympany shifts to the top
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ascites
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A positive fluid wave, shifting dullness, peripheral edema help make a positive diagnosis for what
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ascites
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An easily palpable impulse in the abdomen suggests what
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ascites
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Where does the pain of appendicitis classically begin
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umbilicus
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During appendicitis pain originates around the umbilicus and then shifts to which abdomanal area
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RLQ
increased by coughing not as common to occur in older patients |
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Localized tenderness anywhere in the right lower quadrant even the right flank indicates what
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appendicitis
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Early voluntary guarding during appendicitis may be replaced with what
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involuntary muscular rigidity
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Right sided rectal tenderness may be caused by this
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inflammed andex or inflammed seminal vesicle
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What does rebound tenderness suggest
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peritoneal inflammation in appendicitis
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What does pain in the right lower quadrant during left pressure suggest
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appendicitis (this is a positive rovsing's sign)
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What does right lower quadrant pain on quick withdrawal indicate
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appendicitis (referred rebound tenderness)
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This test involves you placing your hand above the patient's right knee and asking them the raise that thigh against your hand. Then the patient will turn onto the left side and extend the right leg at the hip.
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psoas sign for appendicitis
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This test involves flextion of the patient's right thigh at the hip with the knee bent and the let rotating internally at the hip.
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Obturator sign for appendicitis
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This test involves you picking up a fold of skin along a series of points along the abdomen
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cutaneous hyperesthesia
localized pain with this maneuver in all or part of the RLQ is a sign of appendicitis |
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What does a sharp increase in tenderness with a sudden stop in inspiratory effort indicate
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positive murphy's sign of acute cholecystitis
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How do you expose a bulge of a hernia in a supine patient
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have them raise their head and shoulders off of the table
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What is the reason why intestinal obstruction or peritonitis causation may be missed
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overlooking a strangulated femoral hernia as a possible cause
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A mass in the abdominal wall can be palpable true or false
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true
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an intraabdominal mass is obscured by what
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muscular contraction
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