ALS Lecture 3 - Introduction to General Examination and Clinical Reasoning DONE

Question 1

health literacy skills give people the motivation and ability to

Answer 1

access, understand and use info to promote and maintain good health

Question 2

43% of adults are below

Answer 2

expected literacy level at 16

Question 3

system review general questions

Answer 3

weight loss, night sweats, any lumps, fatigue, generally unwell, appetite

Question 4

system review cardiorespiratory questions

Answer 4

chest pain, breathlessness, PND, oedema, palpitations, cough, wheeze, haemoptysis

Question 5

system review GI questions

Answer 5

abdo pain, swallowing, indigestion, n/v, bowels, tenesmus, melaena, blood

Question 6

system review genitourinary questions

Answer 6

incontinence, dysuria, nocturia, polyuria, hesitancy, terminal dribble, discharge, menses

Question 7

system review neurological questions

Answer 7

seizures, faints, headache, paraesthesia/numbness, limb weakness, speech issues, psychiatric symptoms

Question 8

system review MSK questions

Answer 8

pain, stiffness, swelling, change through day, loss of function

Question 9

clinical reasoning (5 steps)

Answer 9

1. symptom
2. dds
3. distinguishing features
4. explanations for features
5. question to gather info

Question 10

how do experts make a diagnosis when the presentation is familiar (easy)? (3)

Answer 10

intuition, pattern recognition, pathognomonic presentations

Question 11

how do experts make a diagnosis when the presentation is more complex (hard)? (3)

Answer 11

deliberate analytical approach, extensive info gathering, consider many factors

Question 12

things needed to implement clinical reasoning (4)

Answer 12

1. purposeful info gathering
2. ask qs about DDs
3. summarise
4. red flags

Question 13

factors contributing to clinical reasoning (6)

Answer 13

epidemiology, meta-cognitive awareness, surgical sieve, communication skills, hypothetico-deductive reasoning, pathophysiology

Question 14

epidemiology

Answer 14

older ppl more likely to get degenerative conditions, cancer, whereas younger people more likely to get infections

Question 15

pathophysiology

Answer 15

pathology of body systems

Question 16

hypothetico-deductive reasoning

Answer 16

ask Qs to rule things in and out, narrow DDs

Question 17

surgical sieve

Answer 17

V - vascular
I - infective/inflammatory
T - trauma
A - autoimmune
M - metabolic
I - iatrogenic
N - neoplastic

C - congenital
D - degenerative
E - endocrine/environmental
F - functional

Question 18

metacognitive awareness

Answer 18

have insight into where errors and biases may happen in your thinking

Question 19

general physical examination order

Answer 19

hands, eyes, mouth, neck, axillae, groin, ankle

Question 20

for general physical examination, the bed should be at ________ degrees

Answer 20

45

Question 21

when looking for abnormalities, we should always look from…

Answer 21

end of the bed

Question 22

when examining the hands, we should look for

Answer 22

tremor, muscle wasting, peripheral cyanosis, splinter haemorrhage, clubbing, palmar erythema, capillary refill time, hydration status

Question 23

splinter haemorrhage

Answer 23

tiny blood clot under nail, caused by trauma or infective endocarditis

Question 24

clubbing

Answer 24

pt put hands in heart shape, diamond gap, caused by lung cancer, infective endocarditis, cirrhosis, IBD, pulmonary sepsis, etc.

Question 25

palmar erythema

Answer 25

red palms, caused by liver disease, rheumatoid arthritis, thyrotoxicosis

Question 26

capillary refill time

Answer 26

pinch nail see how long it takes to go back to normal colour, should be < 2 seconds

Question 27

hydration status

Answer 27

pinch skin see if springs back, if not dehydration

Question 28

when examining the face, we should look for

Answer 28

conjunctive and sclera, pull bottom eyelid down and ask pt to look up, pull top eyelid up and ask patient to look down, skin colour, lips and tongue colour, hydration status

Question 29

pull bottom eyelid down and ask pt to look up

Answer 29

pale could be anaemia

Question 30

pull top eyelid up and ask patient to look down

Answer 30

jaundice, redness, should be shiny, if not dehydration

Question 31

lips and tongue colour

Answer 31

if blue, central cyanosis

Question 32

hydration status

Answer 32

does mouth look moist?

Question 33

when examining the neck, we should look for

Answer 33

cervical lymph nodes, supraclavicular lymph nodes, thyrid

Question 34

supraclavicular lymph nodes

Answer 34

palpate from in front, Virchow’s node is L, lymphadenopathy of Virchow’s can mean gastric cancer

Question 35

thyroid

Answer 35

look and palpate to see if enlarged from behind, ask pt to swallow see if it moves

Question 36

when examining the axillae, we should look for

Answer 36

lymph nodes

Question 37

lymph nodes of axillae

Answer 37

ask pt to put hand on your shoulder and use the arm they are resting on to palpate axilla in diamond shape

Question 38

when examining the groin, we should look for

Answer 38

lymph nodes

Question 39

lymph nodes of groin

Answer 39

ask examiner if want you to palpate them

Question 40

when examining the ankle, we should look for

Answer 40

oedema, pitting oedema

Question 41

oedema

Answer 41

palpate behind medial malleolus

Question 42

pitting oedema

Answer 42

press firmly on skin above ankle, see if it rebounds, run finger over to check for dent