Clinic1: General examination Flashcards by Elizabeth McCabe

How does the type of sound detected by the bell and the diaphragm vary?

bell - low frequency sounds
Diaphragm - high frequency sounds

How well did you know this?

Not at all

Perfectly

What is the general routine for completing a clinical exam?

CHOICE
Consent - from patient
Hygeine and PPE
Offer assistance and privacy e.g chaperone
Instruct and inform - what is going to happen
Competence: position the patient correctly and in the right clothing
Elicit and present the relevant findings

How well did you know this?

Not at all

Perfectly

What does IPPA stand for during a clinical examination?

The different tests you may want to run regardless of the system being investigated
Inspection
Palpation
Percussion
Ausultation

How well did you know this?

Not at all

Perfectly

What areas of the body should be observed in the initial inspection?

Hands
Wrist and arms
Face
Necks

How well did you know this?

Not at all

Perfectly

What are the difference components of the ‘end of the ned assessment’?

Appearance: BMI, extremities, hygiene, clothing,
Demeanour: anxious, depressed, confused
Speech: language level, confusion, shortness of breath
Faces: down syndrome
Posture and gait:
Colour: Pale (anaemic), blue (cyanosed) yellow (juandice), red (pyrexia/polycythaemia)
Monitoring: ECG, central line
Treatment: inhaler, PEG tube
Aids: walking sticks, hearing aids
Products: chest drain, cathether, sputum pot

How well did you know this?

Not at all

Perfectly

What are the facial features of cushionoid?

Round moon face
Redness in colour
Often acne

How well did you know this?

Not at all

Perfectly

What are the facial features of down syndrome?

Flattened facial features
Upwards slanting eyes

How well did you know this?

Not at all

Perfectly

For an inspection of the hand what features should be looked at?

Abnormal movements
Dorsum of hand
Nails
Pamlar featurs
Musculoskeletal features

How well did you know this?

Not at all

Perfectly

What abnormal features should be considered in the hands?

Tremor - parkinsons
Flap - when held like stop sign, indicates carbon dioxide retention or liver failure
Pain on supination

How well did you know this?

Not at all

Perfectly

What features should be considered on the dorsum of the hand?

Digits
Nails
Webs

Pay attension to colour, wasting, brusing, lesions, freckiling and scars

How well did you know this?

Not at all

Perfectly

What can be indicated from the nails of the hands?

Clubbing - congenital and many diseases
Koilonychia (spooning) - iron deficiency
Biting/trauma
Pitting - psoriasis
Splinter haemorrhages
Cyanosis
Leuconychia (white): protein deficiency, renal failure

How well did you know this?

Not at all

Perfectly

What features can be seen on the palmar surface of a hand?

Compare both palms
Palmar erthyema (Liver or rheumatoid arthiritis)
Anemia on stretching palmar creases
Nodules on tendons
Aponeurosis thickening
Finger pulp
Scar
Temperature
Nail bed capillary refill time

How well did you know this?

Not at all

Perfectly

What are the symptoms of osteoarthiritis in the hands?

Herdens nodes
Bouchard nodes

How well did you know this?

Not at all

Perfectly

What are the features of rheumatoids arthiritis in the hands?

Swelling of the knuckles

How well did you know this?

Not at all

Perfectly

What are the signs of gout in the hands?

Red, swollen and sore joints

How well did you know this?

Not at all

Perfectly

What are the signs of psoriasis in the hands?

Scales or flakes of skin
Skin discolouration
Dry skin
Nail pitting

What are the signs of sclerodema on the hands?

Thickening and swelling of fingers
Numb and tingling fingers when exposed to stress or cold

What features should be examined in the wrist and arms?

Wrist: radial pulse, compare in both wrist

Liver disease: skin excoration, spider naevi, bruising

Antecubital fossa - track marks for IV drug use

Extensor aspect of arm: psoriatic plaques or rheumatoid nodules

Blood pressure

What features should be looked at in the face?

Mask like - parkinsons

What can features of the cheeks indicate?

Butterfly rash - Systemic lupus erthmatosis
Malar flush - mitral valve disease
High red colour in cheeks - polycythaemia
Slapped cheeks - fifth disease

What diseases can be indentifed from the eyes?

Raised cholesterol - corneal arcus, xanthelasma in skin around eye
Anemia - conjuctive pallor
Jaundice - yellow sclera
Drooping under eyelid - ptosis
Lid lag and bulding - graves disease

What diseases can be indicated by the nose?

Rhinophyma - rosacea
Septal perforation - cocaine

What diseases can be indicated by the ears?

Temperature measurement Gouty tophi
Sun damage to outer helix - cancerous
Diagonal earlobe crease - coronary artery disease

What should be looked for in the mouth to identify diseases?

Central cyanosis
Dehydration
Angular stomatisis
Dental caries
Breath smell
Telangiectasia

What abnormalities may be spotted in the neck?

Thyroid goitre - midline swelling rises with swallowing Thyroglossal cyst - midline swelling rising when protrude tongue Lymph node enlargement - lymphoma, cancer, TB Carotid artery - exaggerated pulse, expansile and pulsatile swelling Raised - jugulovenous pressure Tracheal deviation Torticollis - abnormal head/neck tilt

What are where are the different lymph nodes in the neck that should be palpated?

What should be done in the cardiovascular system examination?

Listen for heart valves (APMT 2245) Inspect for pacemaker scats Palpate apex beat Check back of chest for sacral oedma or pedal odema

Where should the stethoscope be placed to listen to different heart valve sounds?

APTM2245

What tests should be completed as part of the respiratory exam?

Lung sounds - compare left and right Inspect chest shape and scars Feel chest expansion Percussion - comparing both sides Should be done on the anterior and posterior

Where should you listen for lung sounds to ensure coverage of all lobes of the lungs?

How should you inspect the abdomen?

Inspect for distention, scars, hernias, caput medusae, straie etc Palpate 9 areas superficially then deep Percuss any masses and the bladder region Auscultate for bowel sounds, aorta and renal arteries

What features should be looked for in the lower leg?

Bowed legs of rickets unilateral calf swelling (deep vein thrombosis) Lymphoedema Erythema nodosum (red and inflamed lesion along shin) Ankle oedma Gout Flat feet Ulcers

What counts as skin lesions?

Rashes, scars, lumps and bumps.

What needs to be recorded about skin lesions?

Site and symmetry Shape Size Surface Tender

What does haemodynamically stable mean in a patient?

If the blood pressure and heart rate are stable

What vital signs should be included in a general examination?

Blood pressure Temperature Radial pulse Respiratory rate Oxygen saturation Manual and automated BP