jom cabar minda kita!!
1. Which of the following is the proper sequence for examination of the abdomen?
a. Auscultation, percussion, inspection, palpation
b. Auscultation, inspection, palpation, percussion
c. Inspection, percussion, auscultation, palpation
d. Inspection, auscultation, percussion, palpation
e. Inspection, percussion, palpation, auscultation
ANSWER:(d)- It is necessary to auscultate the abdomen prior to percussion and palpation because percussion may alter the frequency and the intensity of bowel sounds.
2. A 40-year-old man presents to the emergency room complaining of severe abdominal pain that radiates to his back accompanied by several episodes of vomiting.He drinks alcohol daily. On physical examination, the patient is found on the stretcher lying in the fetal position.He is febrile and appears ill. The skin of his abdomen has an area of bluish periumbilical discoloration.There is no flank discoloration. Abdominal examination reveals decreased bowel sounds. The patient has severe mid epigastric tenderness on palpation and complains of exquisite pain when your hands are abruptly withdrawn from his abdomen. Rectal examination is normal. Which of the following is the most likely diagnosis?
a. Acute cholecystitis
b. Pyelonephritis
c. Necrotizing pancreatitis
d. Chronic pancreatitis
e. Diverticulitis
f. Appendicitis
ANSWER:(c)- The patient most likely has necrotizing pancreatitis, which is a complication of acute pancreatitis. Other complications of pancreatitis include pseudocyst, abscess, and phlegmon. The periumbilical discoloration (Cullen sign) suggests a hemoperitoneum. Discoloration of the flanks would be a positive Turner sign. When the patient experiences pain as the hands of the examiner are abruptly withdrawn from the abdomen, he or she is said to have rebound tenderness (a sign of peritonitis). Decreased bowel sounds are another sign of peritonitis. Risk factors for acute pancreatitis include alcohol use, trauma, hyperlipidemia, gallstones, and medications. An abdominal radiograph in acute pancreatitis might show a sentinel loop (air-filled small intestine in the LUQ) and colon cu toff sign (air in the transverse colon). Patients with chronic pancreatitis present with bouts of abdominal pain and signs of pancreatic insufficiency (weight loss, steatorrhea, and diabetes). The abdominal radiograph in patients with chronic pancreatitis demonstrates calcifications in the pancreas (pathognomonic).
3. Which of the following best describes the location of McBurney’s point?
a. In the midclavicular line just under the right costal margin
b. At the midpoint of a line connecting the symphysis pubis and the anterior superior iliac spine
c. Midway along the right inguinal ligament
d. One-third of the way along a line drawn from the right anterior superior iliac spine to the umbilicus
e. One centimeter to the right of the umbilicus
ANSWER:(d)-McBurney’s point is the point on the abdomen that overlies the anatomic position of the appendix and is the site of maximum tenderness in a patient with appendicitis. McBurney
described the point as being “between an inch and a half to two inches from the anterior spinous process of the ileum on a straight line drawn from the process to the umbilicus.”
4. A patient with a long history of cirrhosis presents with asterixis. He is alert and oriented to person, place, and time. His breath is positive for fetor hepaticus. His abdomen is significant for caput medusae and a positive fluid wave. He has no focal neurologic deficit. His wife states that the patient is very functional at home but is moderately confused and drowsy. Which is the most likely stage of hepatic encephalopathy in this patient?
a. Stage 1 hepatic encephalopathy
b. Stage 2 hepatic encephalopathy
c. Stage 3 hepatic encephalopathy
d. Stage 4 hepatic encephalopathy
ANSWER:(b)-Asterixis is also referred to as “liver flap” or “flapping tremor.” It is a nonrhythmic, asymmetric lapse in a sustained position of an extremity. It is nonspecific for cirrhosis and may be seen in other metabolic derangements (i.e., renal disease and metabolic
acidosis). Fetor hepaticus (due to mercaptans) is a musty odor of the breath and urine and is part of the encephalopathy. Caput medusae is the dilated abdominal veins seen in patients with portal hypertension. It is often helpful to stage the hepatic encephalopathy to follow the course of
the illness:
Stage 1: Euphoria/depression, mild confusion, slurred speech, disordered sleep, +/-asterixis
Stage 2: Lethargy, moderate confusion, +asterixis
Stage 3: Marked confusion, incoherent speech, sleeping but arousable, +asterixis
Stage 4: Comatose, −asterixis
5. Which of the following factors may cause a false-negative fecal occult blood test (FOBT) result?
a. Vitamin C
b. Turnips
c. NSAIDs
d. Red meat
e. Aspirin
f. Horseradish
g. Poultry
h. Fish
ANSWER:(a)-Vitamin C may cause a false-negative test. The false-positive rate for FOBT is
1–5%, and patients must be told to abstain from ASA, NSAIDs, poultry, fish, red meat, and vegetables with peroxide activity (horseradish and turnips) for 72 h before testing.
6. A 16-year-old boy has had lifelong constipation. He requires suppositories and often enemas to initiate bowel movements. His abdomen is distended. Palpation reveals a tubular mass in the left lower quadrant. Rectal exam reveals no stool in the vault. Barium enema reveals a dilated colon above a normal-appearing rectum. Which of the following is the most likely diagnosis?
a. Colon carcinoma
b. Gardner syndrome
c. Peutz-Jeghers syndrome
d. Hirschsprung’s disease
e. Volvulus
ANSWER:(d)- Hirschsprung’s disease (aganglionic megacolon) is a disorder characterized by the absence of enteric neurons in the submucosal and myenteric plexuses. The contracted segment of bowel is unable to relax and a mass may become palpable. Hirschsprung’s disease may lead to megacolon, but resection of the affected bowel is curative. Peutz-Jeghers syndrome is autosomal dominant (AD) and is characterized by hamartomatous polyps in the small intestine and perioral melanin deposits. Gardner syndrome (also AD) is familial adenomatous polyposis syndrome. Gardner syndrome and Peutz-Jeghers syndrome are risk factors for colon cancer. Volvulus (malrotation that leads to gangrene) is usually seen in the first year of life; infants present with bilious vomiting, bloody stools, rigid and discolored abdomen, and shock.
ok.tamat sudah ujian kita hari ini.
PERHATIAN!
b. Auscultation, inspection, palpation, percussion
c. Inspection, percussion, auscultation, palpation
d. Inspection, auscultation, percussion, palpation
e. Inspection, percussion, palpation, auscultation
ANSWER:(d)- It is necessary to auscultate the abdomen prior to percussion and palpation because percussion may alter the frequency and the intensity of bowel sounds.
2. A 40-year-old man presents to the emergency room complaining of severe abdominal pain that radiates to his back accompanied by several episodes of vomiting.He drinks alcohol daily. On physical examination, the patient is found on the stretcher lying in the fetal position.He is febrile and appears ill. The skin of his abdomen has an area of bluish periumbilical discoloration.There is no flank discoloration. Abdominal examination reveals decreased bowel sounds. The patient has severe mid epigastric tenderness on palpation and complains of exquisite pain when your hands are abruptly withdrawn from his abdomen. Rectal examination is normal. Which of the following is the most likely diagnosis?
a. Acute cholecystitis
b. Pyelonephritis
c. Necrotizing pancreatitis
d. Chronic pancreatitis
e. Diverticulitis
f. Appendicitis
ANSWER:(c)- The patient most likely has necrotizing pancreatitis, which is a complication of acute pancreatitis. Other complications of pancreatitis include pseudocyst, abscess, and phlegmon. The periumbilical discoloration (Cullen sign) suggests a hemoperitoneum. Discoloration of the flanks would be a positive Turner sign. When the patient experiences pain as the hands of the examiner are abruptly withdrawn from the abdomen, he or she is said to have rebound tenderness (a sign of peritonitis). Decreased bowel sounds are another sign of peritonitis. Risk factors for acute pancreatitis include alcohol use, trauma, hyperlipidemia, gallstones, and medications. An abdominal radiograph in acute pancreatitis might show a sentinel loop (air-filled small intestine in the LUQ) and colon cu toff sign (air in the transverse colon). Patients with chronic pancreatitis present with bouts of abdominal pain and signs of pancreatic insufficiency (weight loss, steatorrhea, and diabetes). The abdominal radiograph in patients with chronic pancreatitis demonstrates calcifications in the pancreas (pathognomonic).
3. Which of the following best describes the location of McBurney’s point?
a. In the midclavicular line just under the right costal margin
b. At the midpoint of a line connecting the symphysis pubis and the anterior superior iliac spine
c. Midway along the right inguinal ligament
d. One-third of the way along a line drawn from the right anterior superior iliac spine to the umbilicus
e. One centimeter to the right of the umbilicus
ANSWER:(d)-McBurney’s point is the point on the abdomen that overlies the anatomic position of the appendix and is the site of maximum tenderness in a patient with appendicitis. McBurney
described the point as being “between an inch and a half to two inches from the anterior spinous process of the ileum on a straight line drawn from the process to the umbilicus.”
4. A patient with a long history of cirrhosis presents with asterixis. He is alert and oriented to person, place, and time. His breath is positive for fetor hepaticus. His abdomen is significant for caput medusae and a positive fluid wave. He has no focal neurologic deficit. His wife states that the patient is very functional at home but is moderately confused and drowsy. Which is the most likely stage of hepatic encephalopathy in this patient?
a. Stage 1 hepatic encephalopathy
b. Stage 2 hepatic encephalopathy
c. Stage 3 hepatic encephalopathy
d. Stage 4 hepatic encephalopathy
ANSWER:(b)-Asterixis is also referred to as “liver flap” or “flapping tremor.” It is a nonrhythmic, asymmetric lapse in a sustained position of an extremity. It is nonspecific for cirrhosis and may be seen in other metabolic derangements (i.e., renal disease and metabolic
acidosis). Fetor hepaticus (due to mercaptans) is a musty odor of the breath and urine and is part of the encephalopathy. Caput medusae is the dilated abdominal veins seen in patients with portal hypertension. It is often helpful to stage the hepatic encephalopathy to follow the course of
the illness:
Stage 1: Euphoria/depression, mild confusion, slurred speech, disordered sleep, +/-asterixis
Stage 2: Lethargy, moderate confusion, +asterixis
Stage 3: Marked confusion, incoherent speech, sleeping but arousable, +asterixis
Stage 4: Comatose, −asterixis
5. Which of the following factors may cause a false-negative fecal occult blood test (FOBT) result?
a. Vitamin C
b. Turnips
c. NSAIDs
d. Red meat
e. Aspirin
f. Horseradish
g. Poultry
h. Fish
ANSWER:(a)-Vitamin C may cause a false-negative test. The false-positive rate for FOBT is
1–5%, and patients must be told to abstain from ASA, NSAIDs, poultry, fish, red meat, and vegetables with peroxide activity (horseradish and turnips) for 72 h before testing.
6. A 16-year-old boy has had lifelong constipation. He requires suppositories and often enemas to initiate bowel movements. His abdomen is distended. Palpation reveals a tubular mass in the left lower quadrant. Rectal exam reveals no stool in the vault. Barium enema reveals a dilated colon above a normal-appearing rectum. Which of the following is the most likely diagnosis?
a. Colon carcinoma
b. Gardner syndrome
c. Peutz-Jeghers syndrome
d. Hirschsprung’s disease
e. Volvulus
ANSWER:(d)- Hirschsprung’s disease (aganglionic megacolon) is a disorder characterized by the absence of enteric neurons in the submucosal and myenteric plexuses. The contracted segment of bowel is unable to relax and a mass may become palpable. Hirschsprung’s disease may lead to megacolon, but resection of the affected bowel is curative. Peutz-Jeghers syndrome is autosomal dominant (AD) and is characterized by hamartomatous polyps in the small intestine and perioral melanin deposits. Gardner syndrome (also AD) is familial adenomatous polyposis syndrome. Gardner syndrome and Peutz-Jeghers syndrome are risk factors for colon cancer. Volvulus (malrotation that leads to gangrene) is usually seen in the first year of life; infants present with bilious vomiting, bloody stools, rigid and discolored abdomen, and shock.
ok.tamat sudah ujian kita hari ini.
PERHATIAN!
- soalan2 diatas bukan lah soalan yg direka oleh saya sendiri atau diambil dari kertas peperiksaan universiti perubatan tapi diambil dari buku Pretest PHYSICAL DIAGNOSIS 4th Edition by JO-ANN RETEGUIZ, M.D. & BEVERLY CORNEL-AVENDAÑO, M.D.
- saja2 kongsi untuk pelajar2 perubatan dan orang awam especially for my twp08 friends.(exam nk dekat da weii.....)
- good luck for TWPO8 untuk exam yg mendatang nih.-awal sgt ker wish???xkn...??hihihiihi..
