Clinical medicine Flashcards
MSK examination: GALS
- Pre-examination questions (3)
- Pain/stiffness in muscles, joint and back?
- Can u dress yourself without difficulty?
- Walk up/ down stairs without difficulty?
MSK examination: Gait
Gait
- Ask patient to undress, walk in a straight line forwards and back
- Watch for smoothness and symmetry in Gait
MSK examination: Arms - Ask 1- Abduction/external rotation of glenohumeral joint 2- Pronation/supination 3- Elbow extension 4- Wrist extension/flexion 5- Elbow extension 6- Hand and wrist strength, grip strength 7- thumb and index finger opposition 8- coordination, metacarpal inflammation
Ask patient to copy the movements
1- Hands behind head, elbows back
2- Elbows at the side, 90degrees, palms up/down
3- Elbows at side and touch shoulders
4- Prayer sign up/down
5- Arms straight out in front
6- Make a fist and relax, squeeze my fingers
7- Pincer grip (pull apart)
8- touch fingers to thumbs, squeeze hand bones
MSK examination: Legs 1- Hip flexion/extension 2- knee flexion extension 3- Hip internal external rotation 4- Knee inflammation 5- Feet inspection
- Ask patient to lie supine on the bed
1- Thomas’s test: flex both legs as far as possible, feel lumbar spine flattening
2- While hip is flexed, flex and extend knee
3- Flex knee to 90 degrees, passively rotate internally and externally
4- palpate knee for any swelling/heat
5- Observe feet for abnormalities, observe toe alignment, squeeze toes together
MSK examination: Spine
- Safety
1- Visual spinal examination (leg shortening)
2- Spinal flexion, limited hip movement, scoliosis
-3 Rotation in thoracic spine
4- Lateral flexion in lumbar spine
5- Lateral Cervical flexion, cervical extension/flexion
6- Function of temperomandibular joint
- Lower bed to safe height for patient to climb off, stand behind patient
- Asses spine straightness, and muscle bulk, (difference in iliac crest levels)
- Check posterior muscle groups for swelling/abnormalities
- Touch toes
- Hold hips, turn side to side
- Slide hand down corresponding thigh
- Ear to shoulder, look at ceiling/floor
- Open jaw, move side to side
MSK examination: LOOK
-SWEDS
S - Swelling W - Wastage E - Erythema (redness) D - Deformity S - Scars
MSK examination: FEEL
- TTJ
- Temperature
- Tenderness
- Joint swelling
MSK examination: tredelenburg gait
- Uneven pelvis while walking
- Weakness of gluteus medius and minimus
- Normal side sags
CVS examination: auscultations
- Pulmonary area: 2nd intercostal space, left sterna border
- Aortic area: 2nd intercostal space, right sternal border
- Tricuspid area: 5th intercostal space, left sternal area
- Mitral area: 5th intercostal space, midclavicular line
GI examination: Palpation
- Light and deep Across each of the nine regions
- Liver: deep palpations up right side
- Spleen: deep along lower line
- Aorta: midline
- kidneys: palpate laterally
GI examination: Endofbedogram
- Inspect for
- Bod habitus
- Scars
- Jaundice
- Abdominal distention
- Masses
GI examination: hands, arms, eyes and neck
- Check hands for deformation/limited movement
- Check range of movement of arms
- Check eyes and mouth for any abnormalities
- Palpate neck for any prominent lymph nodes
GI examination:
GI hormones that regulate secretions of endocrine cells (1)
- GIP: stimulates insulin release
Right hypochondriac organs:
- Liver
- Gall bladder
- Biliary
