Clinical exams Flashcards
Cardio Exam FULL
VITALS
- Pulse- regular
GENERAL INSPECTION
- Devices,
- SOB
- Body habitus
- Syndromic
HANDS&ARMS
- IE: Oslers nodes, janeway lesions, splinter hameorrhages
- Anaemia: palmar crease pallor
- Clubbing
- Xanthomata
- Cyanosis
- RR delay, pulse
FACE & NECK
- EYES: Xanthomata, icterus
- Malar flush
- Mouth: dentition, palate
- NECK
- JVP
- Carotids
PRAECORDIUM
“inspection, palpation, ausculation”
1) Inspection
- scars
- deformity
- pusations
2) palpation
- apex
- heaves & thrills
3) Ausculatation
- MTPA, radiation
- Dynamic maneovers
BACK
- Sacral odema
- Bases
Abdomen
- Pulsatile, enlarged liver
Peripheral oedema,tropic change and pulses
Respiratory FULL
VITALS
GENERAL INSPECTION
- SOB
- Habitus
- Cyanosis
HANDS&ARMS
- Nicoteine staining
- Cap refil
- Clubbing
- Cyanosis
- PEMBERTONS & Flapping tremor
FACE & NECK
- Horners
- central cyanosis
- Plethora
NECK
- Trachael deviation
- Cervical LN
PRAECORDIUM (ANTERIOR AND POSTERIOR)
“inspection, palpation, ausculation”
1) Inspection
- scars
- deformity
2) palpation
- Expansion
- Vocal fremitus
PERCUSSION
3) Ausculatation
BACK
- Sacral odema
- Bases
CARDIOVASCULAR EXAM- perticularly for CCF
GASTRO FULL
VITALS
GENERAL INSPECTION
- Jaundice
- Mental state
- Obvious ascites
HANDS
- Signs of CLD: Dupertryns, palmar erythema, clubbing
FACE & NECK
- Jaundice
- Parotids
- Fetor hepaticus
- Ulceration
- Stomatitis
NECK
- Cervical LN, virchovs node
ARMS & CHEST
- Hepatic flap
- Spider Naevi
- IVDU
- Excoritations
- Gynaecomastia
ABDOMEN
“INSPECTION, PALPATION, AUSCULATION”
- Distension
- Scars
- Pusatile liver
- Jaundice
Palpation:
- 9 regions
- Liver, spleen & kidneys
- Shifting dullness
Auscultate bowel sounds
EXTRAS
- Hernias
- Peripheral oedema
- bruising
- RHF
- DRE if bleedign or concern for CRC
LUMP exam
4 Students, 3 Teachers around CAMPFIRE
- size
- shape
- Site
- Surroudning
- Tender
- Transillumination
- Temperature
- Consistence
- Appearance
- Mobililty
- Flucutant
- Irreducible
- REGIONAL LN
- edge
THYROID EXAM
VITALS
GENERAL INSPECTION
- Anxious
- Tremulous
- Depressed
- Obvious goitre
HANDS
HYPER:
- Fine tremor
- Onycholysis
- Sweaty
- CLubbing
HYPO:
- peripheral cyanosis
- Dry skin
ARMS
- Pembertons
- Pulse
- Reflexus
FACE & NECK
- Opthalmoplegia
- lid lag
- Exomphalmos
- Thinning of hair 1/2 eye brows
NECK
- Scars
- Distended veins
- Tracheal deviation
- Percuss for retrosternal extension
- Poke out tongue (thyroglossal down)
- Swallow test (Thyroid down)
Thyroid (stand behind)
- Palpate: isthmus and two lobes assessing for consistnece, nodules, shape
- Ausculate for bruits
Lower limb:
- Myxodema
- Reflexxes
- Myopathy
RADIAL NERVE MOTOR AND SENSORY
M:
- Thumbs up
- Wrist extension
S: snuffbox
sign of injury: drop wrist
MEDIAN NERVE MOTOR AND SENSORY
M: OKAY sign
S: Middle finger palmar side
Sign of injury: hand of benediction, ape hand
ULNAR NERVE MOTOR AND SENSORY
M: abduct pinky
Sensory: pinky
Sign of injury: claw hand
CRANIAL NERVE EXAM
- OLFACTORY
- Smell - OPTIC
- VA
- VF
- Fundoscopy - OCCULOMOTOR
- PEARL
- RAPD
- EYEMOVEMENTS - TROCHLEAR
- ABDUCENS
- TRIGEMINAL
- Facial sensation
- Muscles of mastication
- jawjerk - FACIAL NERVE
- Facial expression (eyebrows, cheeks, frown)
- Sens: ant 2/3 tongue - VESTIBULOCOCLEAR
- Gross screen
- Weber and Rinnes - GLOSSOPHARYNGEAL
- Uvula
- Gag reflex - Hypoglossal
- Assess tongue - Accessory:
Trap
SCM
Quick CN
- Smell
- VA
- VF
- Fundoscopy
- PEARL
- RAPD
- EYEMOVEMENTS
- Facial sensation
- Muscles of mastication
- jawjerk
- Facial expression (eyebrows, cheeks, frown)
- Sens: ant 2/3 tongue
- Gross screen hearing
- Weber and Rinnes
- Uvula
- Gag reflex
- Assess tongue
- Trap
- SCM
Approach to Weakness
CONGENITAL:
eg CMT, Myesthenia gravis, Duchennes
ACQUIRED:
Metabolic: DM, B12, etOH
Infective: GBS, HIV
Neoplastic: SSLC
Drugs: Chemo
EXAM:
UMN vs LMN
Symmetrical vs Asymmetrical
Sensory vs motor
Location of lesion: Supraspinal, spinal , Horn cell, Peripheral nerve, NMJ, Musccular
History for weakness
- Timing: episodic, persistent
- Pattern: distal, proxmial
- Acute, chronic
- Progressive
- Fatiguability
- One side
- Trauma
- Family history
- Drugs
- Unwell
- Systemic: eg fever
Knee exam
- Wash hand, consent, position, expose
1) GENERAL EXAM
2) GAIT
LOOK FEEL MOVE
LOOK
- Front back and sides
- Quads
- Scars
- Deformity
FEEL
Extension
- Milk down then patella tap
- then sweep
90
- Joint line
MOVE
- Passive and active motion
Special
- Ligamentous laxity
- Anterior and posterior drawer
- Mcmurrays
TEST HIP and lower back
Breaking bad news framework
Setting up
Perception (what they understand)
Invitation (from patient)
Knowledge
Emotion (empathy)
Strategy and Summary
Mental Health Consult
Symptoms explore
Then screen for other DDx
- Psychosis
- Mania
- Emptiness
- Trauma - PTSD
Functional issue
Drugs & ETOH
Home life: HEADS
SNAP
Fatigue differentials
Endocrine:
- DM
- Hypothyroidism
Nutiritonal
- Iron, B12
Anaemia
Mood: depression
Sleep:
- Poor sleep/inadequate
- OSA
Medications
- Benzos, opioids
Aboriginal consult - Don’t miss
- Offer Aboriginal health worker
- Interpreter
- Safety at home
- Modifiable risk factors
- Close the gap
Menstrual History
- LMP
- Menarche
- Length and duration
- Heaviness
- Pain
- OTHER: PCB, IMB
- Last CST
Sexual history
- Currently sexually active
- Last encounter
- Consensual
- Type of sex
- Protection
BBV risk
- Gender of partners
- Sex workers
- Contraception
- Protected
- IVDU
- Drugs with intercourse
Genital exam
CONSENT
CHAPERONE
Vitals
Inspection: Size, swelling, skin, colour, discharge)
Herniae and groin (LN)
Scrotum (varico/hydrocoele)
Testes& epi (size, lie, tenderness, lumps) prehns sign
DRE
CREMASTERIC REFLEX!!
Respiratory History
Smoking
Travel
Occupational exposure to possible irritants
Vaccination history
Sputum production
Systemic symptoms eg fever
Asthma history eg wheeze
Medication history eg ACEi
Exposure to birds
Post tussive vomiting
Metabolic Sydrome
- Waist circumference >88
(>80 for asian, african, mediterranean) - Triglycerides >1.7
- HDL-C <1
(1.3 in women) - HTN: >130 or >85
- Fasting glucose >5.5
Dementia/aged care non-pharmacological management considerations
- My aged care assessment
- Enduring guardian
- Advanced care directive
- Legally needs to inform RMS of diagnosis
- Home medication review
- Dementia australia website
- Maintain social activities
- Exercise for 30 mins most days
Derranged LFTs DDx
- MAFLD
- Alcoholic LD
- Hepatitis
- HCC, Metastes
- Haemachormatosis
- Wilsons
- A1 antitrypsin
Confidence interval
If the confidence interval contains 1 it is not statistically significant
Forrest plot interpretation
- If the diamond edges crosses 1 overall not significant
- If the individual lines cross 1 then not significant
- Forrest plots used in meta analyses
Case control vs cohort study
Case control:
- Looks at people (groups) with or without outcome x and looks to compare whether there was a certain exposure
Cohort (retrospective or prospective)
- Looks at exposure (whether had or not) then compares outcome
Things to think about with critical appraisal:
- Australian?
- Type of study?
- Size?
- Exlusion? drop out number?
- Statistically signficant ?
- Who funded?
- Clincially relevant or applicable?
HEADS questions
H)
Tell me about home?
E)
Tell me about school?
E)
Do you find thoughts of food, dieting or the way you look dominate your life?
A)
What do you enjoy in your free time?
D)
Have you experiemented with drugs? or take them regularly?
S)
Are you sexually active ?
Donsensual ?
Age of parter?
S) Tell me about your mood
S) Have you had thoughts of hurting yourself?
Fatigue DDx
Endocrine:
- HypoTH
- DM
- Cushings/addisons
Nutritional
- Iron
- b12
Systemic
- Anaemia
- Malignancy
- Coeliac
- CCF
Sleep
- OSA
- Inadequate sleep
Mood:
- Depression
Substances & medication
Infective
- Post viral
- HIV
Lifestyle Management
“5-10% WL
Smoking cessation
EtOH reduction
Improved physical activity “
1) Education:
- on safe levels of etOH
- on recommended exercise targets (300mins/week)
- on diet (5&2)
And provide fact sheets
2) Arrange referrals under GPMP to allied health
- Exercise physiology
- Physiotherapist
- Drug and etOH
- Psychologist possibly
Smoking cessation
Assess and assist
- Offer return consult to discuss options and to make a plan
- Arrange referral to quitline
- Address barriers
- Setting Quit date
- Discuss NRT
- Medications: Varenicline, Bupropion
- Regular review
5As for smoking and etOH
Ask:
- Quantify use
- How soon after waking
- Previous attempts
Advise
- Advise on harm and urge to quit
Assess:
- Willingness to quit
Assist
- Quit line
- Medications
- Setting quit date
Arrange
- FU
Night Sweat Differentials
Haematological
- MM
- Lymphoma
- Leukaemia
Malignant
- RCC
- Thyroid tumour
Endocrine
- HyperTH
- Phaeochromocytoma
Infective
- HIV
- Abcess
- TB
