Monday, April 23, 2018

Physical exam

Q: 78 year old male in ICU is recovering from pneumonia and is waiting for transfer to floor. All "lines and tubes" have been removed. Patient starts complaining of lower abdominal pain. Nurse informed you that there is no urine output since last 8 hours. Distended bladder is suspected. Physical exam with percussion over urinary bladder area, if distended bladder is present should be (select one)

A) dull
B) tympanic

Answer: Dull

Objective of above question is to highlight the importance of basic physical exam in ICU. Percussion easily distinguishes between air (tympanic sound) and mass or fluid (dull sound). It would not be appropriate to directly jump to a radiological workup. Proper collection of information (history) and physical exam should continue to be the initial steps of patient management.

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