Communication and Professionalism

Question 1

Describe how to examine the abdomen?

Answer 1

Wash hands, ensure adequate exposure, consent and ensure patient comfort
Inspect hands for stigmata of GI disease, feel pulse
Examine eyes for jaundice and mouth
Chcek Virchows node
Inspect abdomen - scars, distension etc
Palpate - superficial and deep
Palpate for organs - liver spleen kidneys bladder and aorta
Percuss for shifting dullness and for peritonism
Auscultate - bowel sounds, aortic bruits
To complete - hernial orifces, external genitalia, PR, urine and HCG (if f) and check observations

Question 2

Describe how to examine the breast?

Answer 2

Wash hands, consent and chaperone, ensure exposure from waist up, sat on edge of bed initially for insepction then at 45 degrees for palpation
Inspect for lumps, skin changes, nipple changes, scars/markers of treatement - including around back (lat dorsi) and abdomen (TRAM/DIEP etc)
Lift arms above head, hands on hips and tense and hands behind head for skin/muscle tethering
Palpate - each quadrant starting with normal breast, palpate under nipple, tail of breast and axillary node groups. Also supraclavicular fossa
To complete - redress, offer to examine met areas e.g. spine, abdomen, chest, neuro, wash hands and present

Question 3

RFs for breast cancer?

Answer 3

Early menarche, late menopause
FHx
Genetics
Obesity
Late first pregnancy
Not breasfteeding
Age
Being female
Lesions like ductal hyperplasia
HRT
Smoking, alcohol

Question 4

Describe how to do a cardiovascular exam?

Answer 4

Wash hands, consent, expose thorax
Inspect hands and body for scars, clues etc
Feel hands for warmth, peripheral and central pulse
Assess mouth
Look at JVP
Palpate thorax for apex beat, heaves and thrills
Auscultate over RSE 2ICS (Aortic), LSE 2ICS (puml), LSE 4ICS (tricusp), 5ICS MCL (mitral) for murmurs
Assess for radiation into the axilla for mitral and carotid for aortic
Listen to lungs for signs of HF
Assess for peripheral oedema - whilst doing this look at legs for signs of venous harvest
Offer to assess rest of pulses
To complete - ECG and obs

Question 5

What is the ejection fraction and its normal values?

Answer 5

Percentage of preload (EDV) that is ejected in a single ventricular contraction
Usually 55-70%

Question 6

Give 4 grafts that may be used in CABG?

Answer 6

Great saphenous vein
Radial artery
Internal thoracic artery
Prosthetic grafts

Question 7

What innervates platysma?

Answer 7

Cervical branch of facial nerve

Question 8

How to examine each branch of facial nerve?

Answer 8

Temporal - raise eyebrows
Zygomatic - scrunch eyes
Buccal - blow out cheeks
Marginal mandibular - show teeth
Cervical - platysma

Question 9

What sensory supply does the CN7 do?

Answer 9

Sensory nerve to EAM

Also taste to ant 2/3 of tongue

Question 10

Describe how to examine the ear and hearing?

Answer 10

Wash hands, consent, gather equipment
Inspect both pinnae and surrounding areas
Palpate for tenderness over mastoid, palpate for LNs
Tests- whisper test for gross hearing
Rinnes (nb positive = normal) AC louder than BC
Webers unicorn test
Assess facial nerve
Assess vestibular function - Rombergs, nystagmus etc
Otoscopy
Offer to examine oropharynx, nasendoscopy etc

Question 11

What are the bits you can see on otoscopy? How can you tell which ear?

Answer 11

Cone of light - points anteriorly
TM
Umbo in middle
Manubrium of mallleus is long bit to top
Pars flaccida at top with anterior and posterior folds coming off

Question 12

Differentials for conductive hearing loss?

Answer 12

EAM/external canal - wax, tumour, foreign body, OE
Perf TM
Middle ear - OME, haemotympanum, cholesteatoma, otosclerosis

Question 13

What are the symptoms of Ramsey Hunt syndrome and what causes it?

Answer 13

VZV reactivation within geniculate ganglion of CN7
Tinnitus, pain, dizziness, facial droop, SN hearing loss and vertigo
with vesicles on pinna/EAM region

Question 14

Describe how you would examine a lump generally?

Answer 14

Site, size, shape, surface changes
Palpate for temperature, tenderness, tethering/mobility,, consistence, fluctuance
Special characteristics depending on site - cough impulse, transillumination, reducibility, compressability, pulsatility
Examine for other lumps e.g. regional LNs or relevant nearby system

Question 15

Differentials for scrotal lump depending on whether you can feel it separately to testicle or not?

Answer 15

Separate - epididymoma/epididymitis, spermatocoele, or non-testicular e.g. hernia varicocele , LN, lipoma, cyst
Non-separate - testicular tumour, hydrocoele, orchitis, torsion, syph granuloma

Question 16

Testicular lump plus raised pALP = ?

Answer 16

Seminoma

Question 17

Testicular lump plus raised AFP = ?

Answer 17

NSGCT

Question 18

What test is used to assess collateral blood flow in wrist?

Answer 18

Allen’s test

Question 19

Pathology of rheumatoid arthritis?

Answer 19

Rheumatoid synovitis - increase in inflammatory macrophages/T lymphocytes in synovium with resultant effusion and granulation pannus that destroys joint and then eventually bone

Question 20

Extra-articular features of RhA?

Answer 20

Rh nodules
Eyes - scleritis/episcleritis
Lymphadenopathy
Vasculitis
Feltys syndrome
Pericarditis/pericardial effusions
Fibrosing alveolitis
Tendonitis
C Spine disease

Question 21

What is a rheumatoid nodule?

Answer 21

Accumulation of collagen within a central area of necrosis and surrounding fibroblasts/macrophages

Question 22

XR changes in RhA?

Answer 22

Loss of joint space
Periarticular osteopenia
Boney erosion
Soft tissue swelling

Question 23

What does an apparent-true leg legnth discrepancy indicate?

Answer 23

Pelvic tilt due to adductor/abductor weakness

Question 24

What 2 eponymous tests may be used in hip exam?

Answer 24

Trendelenburg

Thomas - fixed flexion deformity with hand under back

Question 25

What is Lachmans test?

Answer 25

Push thigh posteriorly and leg anteriorly, anterior displacement of thigh on femur = positive for ACL injury

Question 26

Repair techniques for ACL tear?

Answer 26

Arthroscopic repair w hamstring or bone/patella/bone autograft, or synthetic graft
Primary repair
Extra articular reconstruction