Alimentary FoCM 2, 4, 5 & 6

Question 1

What are the initial 8 steps in every consultation?

Answer 1

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.

Question 2

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

Answer 2

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

Question 3

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

Answer 3

Hands & Arms

Question 4

When accessing hands what do we look for ?

Answer 4

• 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)

Question 5

When accessing the arms what do we look for ?

Answer 5

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

Question 6

When accessing tremor what things do we look for ?

Answer 6

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

Question 7

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

Answer 7

PULSE
RR
BP

Question 8

When accessing the head what do we first observe ?

Answer 8

The face

Question 9

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

Answer 9

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)

Question 10

And in the mouth?

Answer 10

Angular stomatitis & sore red tongue (Fe deficiency anaemia)

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

Question 11

If there is time which further examination can be done?

Answer 11

Using a torch and tongue depressor.

Question 12

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

Answer 12

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

Question 13

What disease should indicate this examination as a necessity?

Answer 13

Inflammatory Bowel Disease

Question 14

REVIEW LYMPH NODES DIAGRAM

Answer 14

Do it, learn names of them!!

Question 15

What drains into the Virchow’s node?

Answer 15

Thoracic duct

Question 16

What drains into the Tonsillar node?

Answer 16

Oropharynx

Question 17

What drains into the Submandicular nodes?

Answer 17

2/3 tongue & floor of mouth

Question 18

What drains into the Submental nodes?

Answer 18

drains the tip of tongue & anterior floor of mouth

Question 19

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

Answer 19

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

Question 20

What is spider naevi?

Answer 20

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

Question 21

What is gynaecomastia ?

Answer 21

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

Question 22

In the legs what things do we look for ?

Answer 22

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

Question 23

What is Erythema Nodosum ?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

What things should we say to the examiner?

Answer 25

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)

Question 26

When palpating the abdomen, what is the proper positioning ?

Answer 26

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

Question 27

Which joints should you use when palpating the abdomen?

Answer 27

metapharyngeal (MCP) joints. Fingers only.

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