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GP FELLOWSHIP RNZGP > Clinical exams > Flashcards

Clinical exams Flashcards

1
Q

Cardio Exam FULL

A

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

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2
Q

Respiratory FULL

A

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

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3
Q

GASTRO FULL

A

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

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4
Q

LUMP exam

A

4 Students, 3 Teachers around CAMPFIRE
- size
- shape
- Site
- Surroudning

  • Tender
  • Transillumination
  • Temperature
  • Consistence
  • Appearance
  • Mobililty
  • Flucutant
  • Irreducible
  • REGIONAL LN
  • edge
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5
Q

THYROID EXAM

A

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

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6
Q

RADIAL NERVE MOTOR AND SENSORY

A

M:
- Thumbs up
- Wrist extension

S: snuffbox

sign of injury: drop wrist

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7
Q

MEDIAN NERVE MOTOR AND SENSORY

A

M: OKAY sign

S: Middle finger palmar side

Sign of injury: hand of benediction, ape hand

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8
Q

ULNAR NERVE MOTOR AND SENSORY

A

M: abduct pinky

Sensory: pinky

Sign of injury: claw hand

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9
Q

CRANIAL NERVE EXAM

A
  1. OLFACTORY
    - Smell
  2. OPTIC
    - VA
    - VF
    - Fundoscopy
  3. OCCULOMOTOR
    - PEARL
    - RAPD
    - EYEMOVEMENTS
  4. TROCHLEAR
  5. ABDUCENS
  6. TRIGEMINAL
    - Facial sensation
    - Muscles of mastication
    - jawjerk
  7. FACIAL NERVE
    - Facial expression (eyebrows, cheeks, frown)
    - Sens: ant 2/3 tongue
  8. VESTIBULOCOCLEAR
    - Gross screen
    - Weber and Rinnes
  9. GLOSSOPHARYNGEAL
    - Uvula
    - Gag reflex
  10. Hypoglossal
    - Assess tongue
  11. Accessory:
    Trap
    SCM
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10
Q

Quick CN

A
  • 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
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11
Q

Approach to Weakness

A

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

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12
Q

History for weakness

A
  • Timing: episodic, persistent
  • Pattern: distal, proxmial
  • Acute, chronic
  • Progressive
  • Fatiguability
  • One side
  • Trauma
  • Family history
  • Drugs
  • Unwell
  • Systemic: eg fever
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13
Q

Knee exam

A
  • 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

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14
Q

Breaking bad news framework

A

Setting up
Perception (what they understand)
Invitation (from patient)
Knowledge
Emotion (empathy)
Strategy and Summary

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15
Q

Mental Health Consult

A

Symptoms explore

Then screen for other DDx
- Psychosis
- Mania
- Emptiness
- Trauma - PTSD

Functional issue

Drugs & ETOH

Home life: HEADS

SNAP

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16
Q

Fatigue differentials

A

Endocrine:
- DM
- Hypothyroidism

Nutiritonal
- Iron, B12

Anaemia

Mood: depression

Sleep:
- Poor sleep/inadequate
- OSA

Medications
- Benzos, opioids

17
Q

Aboriginal consult - Don’t miss

A
  • Offer Aboriginal health worker
  • Interpreter
  • Safety at home
  • Modifiable risk factors
  • Close the gap
18
Q

Menstrual History

A
  • LMP
  • Menarche
  • Length and duration
  • Heaviness
  • Pain
  • OTHER: PCB, IMB
  • Last CST
19
Q

Sexual history

A
  • Currently sexually active
  • Last encounter
  • Consensual
  • Type of sex
  • Protection

BBV risk
- Gender of partners
- Sex workers
- Contraception
- Protected
- IVDU
- Drugs with intercourse

20
Q

Genital exam

A

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!!

21
Q

Respiratory History

A

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

22
Q

Metabolic Sydrome

A
  • 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
23
Q

Dementia/aged care non-pharmacological management considerations

A
  • 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
24
Q

Derranged LFTs DDx

A
  • MAFLD
  • Alcoholic LD
  • Hepatitis
  • HCC, Metastes
  • Haemachormatosis
  • Wilsons
  • A1 antitrypsin
25
Q

Confidence interval

A

If the confidence interval contains 1 it is not statistically significant

26
Q

Forrest plot interpretation

A
  • If the diamond edges crosses 1 overall not significant
  • If the individual lines cross 1 then not significant
  • Forrest plots used in meta analyses
27
Q

Case control vs cohort study

A

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

28
Q

Things to think about with critical appraisal:

A
  • Australian?
  • Type of study?
  • Size?
  • Exlusion? drop out number?
  • Statistically signficant ?
  • Who funded?
  • Clincially relevant or applicable?
29
Q

HEADS questions

A

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?

30
Q

Fatigue DDx

A

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

31
Q

Lifestyle Management

A

“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

32
Q

Smoking cessation

A

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
33
Q

5As for smoking and etOH

A

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

34
Q

Night Sweat Differentials

A

Haematological
- MM
- Lymphoma
- Leukaemia

Malignant
- RCC
- Thyroid tumour

Endocrine
- HyperTH
- Phaeochromocytoma

Infective
- HIV
- Abcess
- TB

GP FELLOWSHIP RNZGP (20 decks)

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