Clin Skills Pathologies Flashcards

1
Q

resp: end of the bed

A

environment:
- inhalers
- oxygen
- walking aids
- sputum pots
- medications

patient:
- alert and comfortable at rest
- tachypnoeic or dyspnoeic
- obvious cyanosis

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2
Q

resp: hands

A
  • clubbing
  • peripheral cyanosis
  • tar staining
  • CO2 retention tremor
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3
Q

resp: face

A

eyes:
- conjunctival pallor
- Horner’s syndrome (anhydrosis, ptosis and miosis)

mouth:
- central cyanosis

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4
Q

resp: neck

A
  • raised JVP
  • tracheal deviation
  • scars (tracheotomy etc)
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5
Q

resp: chest

A
  • scars e.g. lateral thoracotomy or sternotomy
  • chest wall movement (symmetrical?)
  • chest wall deformities
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6
Q

resp: back

A
  • exaggerated kyphosis
  • scars
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7
Q

cardio: end of bed

A

environment:
- GTN spray and other medications
- oxygen

patient:
- alert and comfortable at rest
- pale, sweaty, flushed
- breathlessness
- mechanical ticking of a pacemaker

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8
Q

cardio: hands

A
  • capillary refill
  • tar staining
  • bruising
  • splinter haemorrhages
  • other peripheral stigmata of endocarditis
  • such as: jane way lesions (palms not painful) and osler’s nodes (fingers painful)
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9
Q

cardio: arms

A
  • scars
  • bruising
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10
Q

cardio: face

A
  • malar flush

eyes:
- xanthelasma
- corneal arcus
- conjunctival pallor

mouth:
- central cyanosis
- good dentition

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11
Q

cardio: neck

A
  • raised JVP
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12
Q

cardio: chest

A
  • scars (e.g. lateral thoracotomy or sternotomy)
  • pacemaker
  • visible apex beat
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13
Q

abdo: end of bed

A

environment:
- nil by mouth signs
- feeding paraphenalia
- vomit bowls

patient:
- alert and comfortable at rest
- obvious abdominal distension
- obvious jaundice
- nasogastric tubes

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14
Q

abdo: hands

A
  • dupuytren’s contracture
  • palmar erythema
  • bruising
  • leukonychia
  • koilonychia
  • clubbing
  • asterixis (liver flap)
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15
Q

abdo: arms

A
  • AV fistula
  • excoriations
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16
Q

abdo: face

A

eyes:
- jaundiced sclera
- conjunctival pallor
- keiser fleischer rings
- xanthelasma

mouth:
- oral hydration
- ulcers
- dentition

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17
Q

abdo: neck

A
  • supraclavicular lymph nodes
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18
Q

abdo: chest

A
  • gynaecomastia
  • spider naevi
  • excoriations
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19
Q

abdo: abdomen 😃

A
  • abdominal distension
  • caput medusa
  • stoma
  • scars
  • grey turner’s/cullen’s signs
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20
Q

peripheral vascular: end of bed

A

environment:
- medications
- prosthesis
- waling aids/wheelchair

patient:
- alert and comfortable at rest
- amputations
- dressings

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21
Q

peripheral vascular: hands and arms

A
  • colour
  • hair loss
  • ulcers
  • gangrene
  • scars
  • shiny skin
  • tar staining

CHUGSS + T

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22
Q

peripheral vascular: abdomen

A
  • scars
  • visible pulsation
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23
Q

peripheral vascular: lower limb

A
  • colour
  • hair loss
  • ulcers
  • gangrene
  • shiny skin
  • scars
  • tar staining

CHUGSS + T

extras:
- varicose veins
- ‘no signs of venous insufficiencies’

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24
Q

DRE: inspection

A

anus and surrouding skin:
- skin tags
- external haemorrhoids
- fissures
- fistula
- abscess
- prolapse
- rash, excoriations

bear down:
- incontinence/leakage
- internal haemorrhoids

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25
DRE: palpation (what to feel for)
anus: - contraction and relaxation at the margin - tone - masses/ulceration/tenderness rectum: - masses (location, size, surface, consistency, mobility) - stool - tenderness prostate: - size (enlarged?) - median sulcus (presence?) - symmetry - surface (smooth, irregular, masses?) - consistency (hard, firm, soft?) - tenderness
26
neck and thyroid: inspection
- scars - swellings (e.g. goitre) - pulsation (in goitre)
27
thyroid status: inspection of patient
- anxious/agitated or lethargic/slow - clothing - appropriate for environment? - voice - fast, slow, gravelly
28
thyroid status: questions + answers for hyper/hypo
1 = hypER 2 = hypO skin + hair + nails 1. hair loss, sweaty 2. hair loss, brittle hair and nails weight 1. loss 2. gain energy levels + mood 1. high, anxious/agitation 2. low, depressed mood appetite 1. increased 2. decreased tremor 1. yes 2. no intolerance to temperature 1. too hot 2. too cold nervous system - palpitations 1. yes 2. no GI + GU + Gynae 1. diarrhoea, amenorrhoea 2. constipation, menorrhagia
29
thyroid status: hands
- sweaty palms/cool dry - palmar erythema - acropachy (grave's hypO) - onycholysis - tremor
30
thyroid status: face
- myxoedematous facies - peaches and cream complexion - eyebrow thinning eyes: - lid retraction - lid lag - exophthalmos/proptosis (grave's hypO) - opthalmoplegia (grave's) - chemosis (grave's)
31
thyroid status: lower limb
- pre-tibial myxoedema - generaised myxoedema
32
describing masses
- site - size - shape - surface - consistency - contour - thethering - tenderness - transillumination
33
phleb: things to think about/say
bottles: - **purple** - FBC, reticulocytes, ESR - blue - coagulation studies - red - no additives (?) - yellow - U+Es, lipids sharps bin: - position first in a convenient place intro stuff: - ask patient to confirm name + dob - check wrist band - check blood request form details match - ask about pain! - have you ever fainted after having your blood taken? - are you on any blood thinning medications? - have you got any allergies? latex? - risks of procedure: small risk of infection but I will be wearing gloves and using an alcohol wipe to negate this, risk of bleeding but I will be applying pressure with some cotto wool afterwards - consent for taking blood a second time in case the first is unsuccessful other: - 'sharp scratch' - release tourniquet!! - in the event of a sharps injury: wash area with soap and running water without scrubbing, cover with plaster and allow natural bleeding, report immediately to OH or A&E out of hours for risk assessment and post exposure prophylaxis if needed
34
ear: outer ear
- scars - swellings or lumps - deformity - inflammation - skin condition e.g. eczema, lesions - hearing aids - discharge
35
ear: external auditory meatus using otoscope
- inflammation - eczema - furuncles - vesicles - wax or debris - foreign bodies - discharge
36
ear: tympanic membrane using otoscope
- handle of the malleus - pars flaccida and attic (above malleus) - pars tensa (below and around malleus)
37
sensory + motor: upper + lower limb
- skin changes - scars - dry skin from lack of sweating - pale/cyanosed/red - smooth shiny - unreported injury or ulceration - swelling or deformity (e.g. charcot's joints)
38
motor: inspection of gait + stability
trunk when sitting: - truncal ataxia stance: - ask pt if they are able to stand - eyes closed - big difference between standing eyes closed and open = positive Romberg's gait: - non-antalgic gait - normal gait cycle
39
motor: upper + lower limb inspection
SWIFT - scars - wasting - involuntary muscle movements - fasiculations - tremor
40
eye: general inspection and pupils
general: - obvious abnormality or asymmetry of face or eyes - glasses or contact lenses pupils: - irregularities in shape - pupil size and symmetry
41
CN: general inspection
- obvious abnormality in head, face, eyes e.g: - facial asymmetry - eye related signs - fasiculations (LMN) - scard - tracheostomy - nasogastric tubes
42
CN: what to look for when testing CN IX+X
vagus and glossopharyngeal tell pt to open mouth and say ahhh, use pen torch - tongue retracts - pharynx contracts - palate rises symmetrically - uvula remain in midline
43
CN: what to tell pt to do and look for when testing CN XII
hypoglossal - open mouth but keep tongue inside - fasciculation and wasting - stick out tongue - deviation (tongue points towards abnormality) - wiggle tongue side to side - speed, difficulty, asymmetry
44
cognitive function: AMTS questions
1. how old are you? 2. what time is it? remember the following address: 20 West Street, repeat it for me 3. who is that person (dr/nurse), what do they do? 4. what year is it? 5. what is the name of this place? 6. what is your date of birth? 7. what year did world war 1 start? 8. who is the present monarch? 9. count backwards from 20-1 10. tell me the address I gave you earlier 7 or less = dementia/delerium
45
shoulder: look
environment: - aids e.g. sling - analgesia + other med patient: - alert and comfortable at rest look: - colour: bruising, erythema - deformities - wasting of deltoids (side), supraspinatus (behind), infraspinatus (behind) - asymmetry of arms + acromioclavicular joints - rashes - fasiculations - swelling + scars DWARFS
46
shoulder: what to feel
- sternoclavicular joint - clavicle - acromioclavicular joint - subacromial bursa - glenohumeral joint anteriorly and posteriorly - bicipital groove - coracoid process
47
elbow: look
environment: - aids e.g. sling - analgesia + other meds patient: - alert and comfortable at rest look: - deformities - wasting - biceps (ask to bend elbow), triceps (flex elbow) - asymmetry - psoriatic rash, eczema - rashes - fasiculations - scars (trauma, surgery) and swelling (rheumatoid nodules, gouty tophi) - colour - bruising, erythema DWARFS
48
elbow: what to feel
- olecranon - medial epicondyle - lateral epicondyle - posterior border of the ulna for rheumatoid nodules - temperature
49
hand and wrist: look - bedside
environment: - walking aids - eating/writing aids - analgesia, steriods + other meds patient: - alert and comfortable at rest - obvious tremor
50
hand and wrist: look - joints
swelling: - soft tissue (inflammatory) - bony hard nodes - heberden's at DIPs, bouchard's at PIPs - firm nodules - rheumatoid arthritis subcutaneously mobile - gouty tophi deformities: - ulnar deviation - subluxation - swan-neck deformity - z-shaped deformity - claw hand - anomalous deformities from traumatic injuries
51
hand and wrist: look - muscle
- in pronation - interossei muscle wasting - in supination - thenar and hypothenar eminences for wasting
52
hand and wrist: look - nails
- clubbing - pitting - onycholysis - ragged nail folds, - dermatomyositis - splinter haemorrhages
53
hand and wrist: look - elbows
- psoriatic rashes - rheumatoid nodules - gouty tophi
54
hand and wrist: what to feel
- temperature wrist and hand pronation: - distal radius and radial styloid - distal ulna and ulnar styloid - joint line of wrist - MCP PIP DIP half supinated: - CMC MCP IP thumb fully supinated: - palmar fascia + dupuytren's contracture - along flexor tendons
55
hip: look
environment: - walking aids - analgesia + other meds patient: - alert and comfortable at rest look: - deformity - tilted pelvis, exaggerated lordosis, abnormal leg positioning, leg length discrepancy - wasting - difficult to assess - asymmetry - rashes - fasiculations - swellings/scars - make sure to look at back - colour - bruising DWARFS AND: - gait - trendelenburg
56
hip: what to feel
- greater trochanter - ASIS - mid inguinal point - temperature
57
knee: look
environment: - walking aids - analgesia + other meds patient: - alert and comfortable at rest gait: - non-antalgic gait - normal gait cycle look: - deformity - valgus/varus, hyperextension, fixed flexion - wasting - quads particularly - asymmetry - rashes - psoriatic - fasiculations - swelling - scars - colour - bruising, erythema
58
knee: what to feel
- patellar margins - patellar tendon - tibial tuberosity - fibular head - medial & lateral joint lines - swelling in popliteal fossa - patella apprehension - effusion
59
ankle: look
environment: - walking aids - analgesia + other meds patient: - alert and comfortable at rest gait: - non-antalgic gait - normal gait cycle look: - Deformities - Wasting - Asymmetry - Rashes - Fasciculations - Scars - Swelling - Colour - bruising, erythema
60
ankle: what to feel
- Temp - Medial tibia - Head & shaft of fibula - Both malleoli - Base of 5th metatarsal - Ligament - ATF, PTF, CF, deltoid (medial) - Tendons: achilles, peroneus brevis
61
spine: look
environment: - walking aids - analgesia + other meds patient: - alert and comfortable at rest look: - deformities - wasting - asymmetry - normal/pathological lordosis/kyphosis, scoliosis - rashes - fasiculations - swelling + scars e.g. laminectomies posture specifically; - head - balanced centrally - shoulders - balanced centrally, relaxed - cervical spine - gentle lordosis - thoracic spine - gentle kyphosis - lumbar spine - gentle lordosis - pelvis - normal slight downwards anterior tilt - hip - 0 degree angle - knee - straight not hyperextended - abdomen - flat, not portruding - feet - vertical turned out at 10 degrees
62
spine: what to feel
in prone position - spinour processes - facet joints - sacroiliac joints
63
gynae: inspection of vulva, perineum, pubic area
- warts, ulcers - lumps - vulvitis, vulval atrophy - eczema, psoriases, excoriations, infestations - swelling, erythema - discharge - obvious prolapse
64
gynae: inspection using speculum
vagina: - discharge - colour, odour, amount - warts - masses - irregular areas cervix: - polyps - ectropian - warts - nabothian cysts - discharge - ulcers - bleeding - irregular areas - masses - products of conception if appropriate ? - nulli/multi parous
65
male genital: inspection
standing: - general - comfortable alert, pain, skin (excoriations of scabies etc), joints (inflammation), eyes (conjunctivitis, uveitis) - lower abdo + pubic area - swellings, lumps, ulcers, scars, erythema, rashes, excoriations, infestations - inguinal + femoral region - bear down to see swellings, lymphadenopathy, scars - scrotum - lumps, swellings, skin abnromalities, bear down to see varicocoele lying down (inspection parts only): - penis - inspect all aspects for hypospadias, ulcers, nodules, rash, masses (only palpate if indicated) - drawback foreskin to inspect for phimosis - urethral meatus - position, discharge - frenulum - corona - warts, inflammation, rashes, ulcers
66
antenatal: end of the bed + peripheral
patient: - gait (when they walked into room) and sitting - pain, discomfort - pallor - breathlessness peripheral: - finger oedema - ankle oedema
67
antenatal: abdo
- degree of abdominal distension - striae gravidarum - linea nigra - everted umbilicus - scars e.g. previous caesarean section - visible foetal movements
68
breast: inspection with patient sitting on edge of bed, arms by sides
- symmetry - smooth/distorted contour, obvious masses - erythema - tethering/dimpling - peau d'orange - ulceration - scars - nipples and areola - symmetry, inversion or distortion, discharge, blood, signs of Paget's disease