Clinical Skills Exam Flashcards
Order of Consultation
WINDEC Presenting complaint History of presenting complaint including SOCRATES Relevant systemic enquiry ICE + effect on lifestyle PMH + JAMTHREADS Drug and Allergy history Family history Social history General systemic enquiry Summarise + review patient perspective \+ Plan of management \+ Explanation and planning Qs + End
SOCRATES
Site Onset Character Radiation Accompanying symptoms Timing (duration, course, pattern) Exacerbating/ relieving factors Severity \+ functional consequences
JAMTHREADS
Jaundice Anaemia MI TB Hypertension Rheumatic fever Epilepsy Asthma Diabetes Stroke
What should you find out about a patient’s drug history?
Name, dose, frequency, route, indication and concordance
What should you ask in social history?
Social/living circumstances Household members if relevant Work circumstances Driving status Physical activity - time spent active every week Diet - typical food eaten in a day Smoking - duration and amount Alcohol - amount and type Recreational drugs Hobbies Pets Overseas travel COVID
What is a good way to ask about recreational drug use?
This is a question we ask everyone, have you used recreational drugs?
General systemic enquiry
Fatigue/malaise Fever/rigors Weight/appetite Skin (rashes, bruising, bleeding) Sleep disturbance Thirst Pruritis Night sweats Neck swelling/lumps
Respiratory system systemic enquiry
Cough Sputum Haemoptysis Dyspnoea (SOB) Wheeze Chest pain (pleuritic) Symptoms of sinusitis (blocked nose, nasal discharge, facial pain, reduced smell Earache Sore throat Change of taste (COVID)
CV system systemic enquiry
Chest pain Dyspnoea - at rest/on exercise/orthopnoea/paroxysmal nocturnal Palpitations Ankle oedema varicose veins Claudication (pain in calves)
Alimentary/GI system systemic enquiry
Appetite/ weight loss or change Mouth/teeth/tongue Dysphagia Dyspepsia/heartburn Nausea/vomiting Haematemesis Fat intolerance Jaundice Abdominal pain Abdominal distension + bloating Bowel habit: change/constipation/diarrhoea/blood/mucus/melaena/faecal incontinence Perianal symptoms, haemorrhoids, pain, itching
Genito-urinary system systemic enquiry
frequency/dysuria/nocturia/polyuria/oliguria
Haematuria
Incontinence/urgency (near accidents)
Males: prostatic symptoms (difficulty initiating stream, dribbling), erectile dysfunction, sexually active?
Females: last menstrual period, gestation/EDD (expected date of delivery) if pregnant), PMB (postmenopausal bleeding), cycle (regularity/duration/degree of bleeding etc), intermenstrual or postcoital bleeding, contraception/HRT, sexually active? date of last cervical smear, obstetric history parity/gravidity, vaginal discharge
Nervous system systemic enquiry
Speech disturbance Cognitive impairment (use MSQ) Headache Fits/faints/loss of consciousness Dizziness, vertigo Balance Vision - acuity, diplopia Hearing Weakness Numbness/tingling/paraesthesia
MSK systemic enquiry
Do you have any pain or stiffness in your muscles, joints or back?
Can you dress yourself completely without any difficulty?
Can you go up and down stairs without any difficulty?
History of trauma?
Initial Assessment
WINDEC
Immediate intervention required? (use ABCDE system) Comfortable/distressed? Ask if in any pain?
Environment – medication/specimens/attachments Charts – NEWS
Order for Neuro examination
Observation: MISFTS - muscles atrophy, involuntary movement, skeletal deformity, fasciculations, tremors, scars
Tone: normal, hypo, hyper
- Clonus for lower limb, perform sudden dorsiflexion of ankle-
Power: shoulder, elbow, wrist, fingers, intrinsic muscles of hand, pronator drift then hip, knee, ankle, EHL (grade power on MRC scale 0-5)
Coordination: outstretched arms, finger-nose test, dysdiadochokinesis, heel to shin test
Reflexes: biceps, supinator, triceps then knee and ankle, plantar response, reinforcement if necessary
Sensation: light touch, pinprick, vibration, proprioception, Romberg’s test
Gait: walking and turning, heel to toe, rising from sitting, tiptoes & heels
