[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]”This patient is complaining of non-specific abdominal discomfort and nausea. Please examine their abdomen to find out why, and discuss your findings with the examiners.”[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191651″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][/vc_column][/vc_row]
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Examination of the normal abdomen begins with inspection of the patient. In the MRCP PACES it is appropriate to expose a female patient from the xiphisternum to the pubic symphysis as an appropriate balance of maintaining patient dignity without prejudicing your ability to detect clinical signs.
Beware, in particular, the transplanted kidney that may lurk below the line of many patients’ underwear.
A liver flap is usually detected first by palpation before it becomes sufficiently florid to cause a visible flap. Always support your patient’s hands to confirm the presence (or absence) of a liver flap.
Kidneys and spleens are usually easy to discriminate in PACES. If asked by an examiner, kidneys have a palpable upper border, move downwards (towards the patient’s back) on inspiration, do not have a notch, are ballotable and are resonant to percussion.
Riedel’s lobe is a normal variant of liver anatomy that occasionally extends inferiorly into the abdomen at the right-most margin of the liver. In a small number of patients this has been described in the right iliac fossa. However, if you palpate liver enlargement in the exam it is far more likely to be hepatomegaly than a palpable Riedel’s lobe.
A Mercedes Benz scar is most commonly seen in patients following liver transplantation.
Candidates should complete their examination by thanking their patient, assisting them to get comfortable, then turning to the examiners and stating that they would like to complete the clinical assessment by palpating for lymph nodes, examining the external genitalia and conducting a digital rectal examination. Testing patients’ mobility is an important part of any comprehensive clinical assessment but is not required in examination of the abdominal system. Ultrasound examination of the abdomen is not routinely indicated unless in response to certain clinical findings.
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Question 1 of 7
What is the diagnosis?CorrectIncorrect
Question 2 of 7
Which of the following indicate a mass is a spleen rather than a kidney?CorrectIncorrect
Question 3 of 7
While examining a patient’s abdomen you observe a Mercedes benz scar. What procedure have they had done?CorrectIncorrect
Question 4 of 7
To complete an abdominal examination in the MRCP PACES you should explain to the examiners that you would ordinarily:
Tick all that applyCorrectIncorrect
Question 5 of 7
In the MRCP PACES examination, appropriate exposure of your patient for the abdominal examination is:CorrectIncorrect
Question 6 of 7
A liver flap is better:CorrectIncorrect
Question 7 of 7
Riedel’s lobe is:CorrectIncorrect