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Year 2 Med > Clin Skills Pathologies > Flashcards

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
Q

DRE: palpation (what to feel for)

A

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

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26
Q

neck and thyroid: inspection

A
  • scars
  • swellings (e.g. goitre)
  • pulsation (in goitre)
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27
Q

thyroid status: inspection of patient

A
  • anxious/agitated or lethargic/slow
  • clothing - appropriate for environment?
  • voice - fast, slow, gravelly
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28
Q

thyroid status: questions + answers for hyper/hypo

A

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
Q

thyroid status: hands

A
  • sweaty palms/cool dry
  • palmar erythema
  • acropachy (grave’s hypO)
  • onycholysis
  • tremor
30
Q

thyroid status: face

A
  • 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
Q

thyroid status: lower limb

A
  • pre-tibial myxoedema
  • generaised myxoedema
32
Q

describing masses

A
  • site
  • size
  • shape
  • surface
  • consistency
  • contour
  • thethering
  • tenderness
  • transillumination
33
Q

phleb: things to think about/say

A

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
Q

ear: outer ear

A
  • scars
  • swellings or lumps
  • deformity
  • inflammation
  • skin condition e.g. eczema, lesions
  • hearing aids
  • discharge
35
Q

ear: external auditory meatus using otoscope

A
  • inflammation
  • eczema
  • furuncles
  • vesicles
  • wax or debris
  • foreign bodies
  • discharge
36
Q

ear: tympanic membrane using otoscope

A
  • handle of the malleus
  • pars flaccida and attic (above malleus)
  • pars tensa (below and around malleus)
37
Q

sensory + motor: upper + lower limb

A
  • 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
Q

motor: inspection of gait + stability

A

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
Q

motor: upper + lower limb inspection

A

SWIFT
- scars
- wasting
- involuntary muscle movements
- fasiculations
- tremor

40
Q

eye: general inspection and pupils

A

general:
- obvious abnormality or asymmetry of face or eyes
- glasses or contact lenses

pupils:
- irregularities in shape
- pupil size and symmetry

41
Q

CN: general inspection

A
  • obvious abnormality in head, face, eyes e.g:
  • facial asymmetry
  • eye related signs
  • fasiculations (LMN)
  • scard
  • tracheostomy
  • nasogastric tubes
42
Q

CN: what to look for when testing CN IX+X

A

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
Q

CN: what to tell pt to do and look for when testing CN XII

A

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
Q

cognitive function: AMTS questions

A
  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
Q

shoulder: look

A

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
Q

shoulder: what to feel

A
  • sternoclavicular joint
  • clavicle
  • acromioclavicular joint
  • subacromial bursa
  • glenohumeral joint anteriorly and posteriorly
  • bicipital groove
  • coracoid process
47
Q

elbow: look

A

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
Q

elbow: what to feel

A
  • olecranon
  • medial epicondyle
  • lateral epicondyle
  • posterior border of the ulna for rheumatoid nodules
  • temperature
49
Q

hand and wrist: look - bedside

A

environment:
- walking aids
- eating/writing aids
- analgesia, steriods + other meds

patient:
- alert and comfortable at rest
- obvious tremor

50
Q

hand and wrist: look - joints

A

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
Q

hand and wrist: look - muscle

A
  • in pronation - interossei muscle wasting
  • in supination - thenar and hypothenar eminences for wasting
52
Q

hand and wrist: look - nails

A
  • clubbing
  • pitting
  • onycholysis
  • ragged nail folds,
  • dermatomyositis
  • splinter haemorrhages
53
Q

hand and wrist: look - elbows

A
  • psoriatic rashes
  • rheumatoid nodules
  • gouty tophi
54
Q

hand and wrist: what to feel

A
  • 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
Q

hip: look

A

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
Q

hip: what to feel

A
  • greater trochanter
  • ASIS
  • mid inguinal point
  • temperature
57
Q

knee: look

A

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
Q

knee: what to feel

A
  • patellar margins
  • patellar tendon
  • tibial tuberosity
  • fibular head
  • medial & lateral joint lines
  • swelling in popliteal fossa
  • patella apprehension
  • effusion
59
Q

ankle: look

A

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
Q

ankle: what to feel

A
  • Temp
  • Medial tibia
  • Head & shaft of fibula
  • Both malleoli
  • Base of 5th metatarsal
  • Ligament - ATF, PTF, CF, deltoid (medial)
  • Tendons: achilles, peroneus brevis
61
Q

spine: look

A

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
Q

spine: what to feel

A

in prone position
- spinour processes
- facet joints
- sacroiliac joints

63
Q

gynae: inspection of vulva, perineum, pubic area

A
  • warts, ulcers
  • lumps
  • vulvitis, vulval atrophy
  • eczema, psoriases, excoriations, infestations
  • swelling, erythema
  • discharge
  • obvious prolapse
64
Q

gynae: inspection using speculum

A

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
Q

male genital: inspection

A

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
Q

antenatal: end of the bed + peripheral

A

patient:
- gait (when they walked into room) and sitting - pain, discomfort
- pallor
- breathlessness

peripheral:
- finger oedema
- ankle oedema

67
Q

antenatal: abdo

A
  • degree of abdominal distension
  • striae gravidarum
  • linea nigra
  • everted umbilicus
  • scars e.g. previous caesarean section
  • visible foetal movements
68
Q

breast: inspection with patient sitting on edge of bed, arms by sides

A
  • 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

Year 2 Med (4 decks)

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