Abdominal & Neurological Clinical Examination

Abdominal & Neurological Clinical Examination

Abdominal Examination

Inspection: distension (6 Fs: Fat, Fluid, Foetus, Flatus, Faeces, Filthy big mass), caput medusae (portal HTN), scars

Palpation: start away from pain; guarding (voluntary or involuntary); rigidity; rebound tenderness = peritonism

• Liver: percuss upper border (normally 5th ICS); palpate from RIF; hepatomegaly causes, texture (smooth vs nodular)
• Spleen: palpate from RIF diagonally; cannot get above it; splenomegaly causes (lymphoma, portal HTN, haematological)
• Murphy's sign: arrest of inspiration on palpation in RUQ (acute cholecystitis)

Percussion: shifting dullness + fluid thrill = ascites

Auscultation: bowel sounds (absent = ileus; tinkling = obstruction)

Peritonism Signs

• Guarding: involuntary muscle rigidity
• Rebound tenderness: pain worse on releasing pressure (peritoneal irritation)
• Rovsing's sign: RLQ pain on palpating LLQ (appendicitis)

Neurological Examination

UMN vs LMN Signs:

| Feature | UMN | LMN |

|---------|-----|-----|

| Tone | Spastic Ôåæ | Flaccid Ôåô |

| Power | Reduced (pyramidal pattern) | Reduced |

| Reflexes | Brisk/hyperreflexic | Absent/diminished |

| Plantar | Extensor (Babinski +ve) | Flexor |

| Wasting | Absent (late) | Present |

| Fasciculations | Absent | Present |

Cerebellar Signs — DANISH

• Dysdiadochokinesis, Ataxia (gait), Nystagmus, Intention tremor, Slurred speech (dysarthria), Hypotonia

Cranial Nerve Summary

• CN III palsy: eye down and out, ptosis, dilated pupil (posterior communicating artery aneurysm)
• CN VII (LMN): entire ipsilateral face weakness (Bell's palsy); UMN: forehead spared
• CN XII: tongue deviates toward side of lesion