Alimentary FoCM 2, 4, 5 & 6 Flashcards

1
Q

What are the initial 8 steps in every consultation?

A
  1. Wash your hands
  2. Introduce yourself
  3. Patient’s ID, CHECK BAND ON WRIST
  4. Explain why your there/what you will be doing
  5. GAIN CONSENT !!!
  6. Pain, especially in areas you are going to examine
  7. Position the bed to 45 degrees, and adjust bed height
  8. Exposure: ask the patient to remove any clothes which as necessary for examination.
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2
Q

In regards to initial & environmental assessment, what do we look for ?

A
  1. General obs: patient comfort, State of patient (consciousnesses(hepatic enecepha, pain relieving position)
  2. Look for any equiptment near bed, i.e. sick bowls, iv line etc.
  3. NEWS CHARTS: Temp, pulse, BP, RR
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3
Q

When moving onto the peripheral examination what do we start with?

A

Hands & Arms

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4
Q

When accessing hands what do we look for ?

A
  • Tar staining
  • Nail colour (anaemia , leukonychia (hypoalbuminaemia ))
  • Nail Shape (Clubbing, koilonychia (iro deficiency anaemia)
  • Palms (Palmar erythema, pale creases & dupuytren’s contracture (Sing finger towrd palm (alcohol)
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5
Q

When accessing the arms what do we look for ?

A
  • Bruising (liver dysfucntion)
  • Scratch marks / pruritus (chronic cholestasis)
  • Muscle wasting (inadequate nutrition, poss. sepsis)
  • Forearm loss of turgour (dehyrdation)
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6
Q

When accessing tremor what things do we look for ?

A

Flapping Tremor (indicative of CO2 retention => Liover failure - “liver flap”)

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7
Q

What is the most important and final aspect of initial peripheral examination ?

A

PULSE
RR
BP

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8
Q

When accessing the head what do we first observe ?

A

The face

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9
Q

In regards to GI what signs do we look for in the face?

A

Parotid swelling - Alcohol

In the eyes: yellow (jaundice) & anaemia (GI blood loss/pernicious/iron deficiency)

NOTE for anaemia and jaundice ask the patient to look down then up and pull eyelids down (look for pale eyelids i.e. loss of blood)

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10
Q

And in the mouth?

A

Angular stomatitis & sore red tongue (Fe deficiency anaemia)

Detect the odour of foetor hepaticus if present (“mouldy hay’ - liver failure)

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11
Q

If there is time which further examination can be done?

A

Using a torch and tongue depressor.

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12
Q

What things can be examined using a torch & tongue depressor ?

A
  • Swelling and/or bleeding
  • Dentition
  • Glands & ducts
  • Infection (e.g. candidaisis/tonsilitis)
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13
Q

What disease should indicate this examination as a necessity?

A

Inflammatory Bowel Disease

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14
Q

REVIEW LYMPH NODES DIAGRAM

A

Do it, learn names of them!!

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15
Q

What drains into the Virchow’s node?

A

Thoracic duct

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16
Q

What drains into the Tonsillar node?

A

Oropharynx

17
Q

What drains into the Submandicular nodes?

A

2/3 tongue & floor of mouth

18
Q

What drains into the Submental nodes?

A

drains the tip of tongue & anterior floor of mouth

19
Q

In the neck line what three things do we look for ?

A
  1. Spider naevi
  2. Gynaecomastia
  3. Loss of body hair in males
20
Q

What is spider naevi?

A

Swollen blood vessels, which has radiated vessels affected. Which look like a spider web

21
Q

What is gynaecomastia ?

A

enlargement of a man’s breasts, usually due to hormone imbalance or hormone therapy

22
Q

In the legs what things do we look for ?

A
  1. Peripheral Oedema
  2. Loss of body hair
  3. Erythema nodosum
23
Q

What is Erythema Nodosum ?

A

Erythema nodosum is swollen fat under the skin causing red bumps and patches

24
Q

When performing an abdominal examination, how should the patient lay?

A

Supine (lying down), one pillow, arms at side & legs uncrossed. Expose the patient from the breast -> Pubic region

25
Q

What things should we say to the examiner?

A

No signs of:

  1. Scars
  2. Skin lesions
  3. Stoma (ileostomy/colostomy)
  4. Visible pulsation
  5. Petechiae (pin-head sized spots)
  6. Weight loss
  7. Distention (5f’s: Fat, faeces, flatus, fluid or foetus)
26
Q

When palpating the abdomen, what is the proper positioning ?

A

Examining hand should lie flat on the surface of the abdomen, in line with the forearm. NOTE adjust the bed height or sit on a chair

27
Q

Which joints should you use when palpating the abdomen?

A

metapharyngeal (MCP) joints. Fingers only.

NOTE ask if the patient is in any pain before palpating the abdomen .