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BRS YEAR2 > CPA > Flashcards

CPA Flashcards

1
Q

Introduce a cardiovascular exam

A

hand santiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct a cardiovascular examination which will involve…. ( a look, feel, listen to chest) is that okay?
Can i confirm your name and DOB
The examination will require you to be exposed from the waist upwards and sitting on the couch at a 45 degree angle, do you need any assistance ?
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know

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2
Q

palpate the radial artery, calculate rate and rhythm

A

between tendon flexor carpi radialis and brachioradialis

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3
Q

palpate the ulnar artery

A

between tendon flexor carpi ulnaris and fexor digitorum superficialis

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4
Q

palpate the brachial artery

A

medial to biceps tendon

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5
Q

palpate the common carotid artery

A

medial border of SCM and lateral border of thyroid cartilage

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6
Q

palpate the apex beat

A

feel the beat first by moving axillary to mid clavicular then count the intercostal spaces middle finger should be in 5th ICS mid calvicular

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7
Q

what can cause a displaced apex beat

A

cardiomegaly

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8
Q

what can cause an absent apex beat

A

obesity, pleural effusion, pericardial effusion, emphysema

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9
Q

palpate for heaves

A

left of patients sternum (parasternal)

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10
Q

what is a heave

A

a precordial impulse

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11
Q

why do we palpate for heaves

A

if feel the heel of hand raise its right ventricular hypertrophy

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12
Q

palpate for thrills

A

hand horizontally at all four valves

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13
Q

what is a thrill

A

a palpable murmur/vibration caused by turbulent blood flow through a valve

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14
Q

palpate the head and neck arteries

A

carotid artery
superficial temporal : infront of ear tragus
subclavian

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15
Q

palpate and name the four lower limb arteries

A

1) femoral artery- mid inguinal point
2) popliteal artery- knee at 30 degrees relax, thumbs on tibial tuberosity feel behind knee
3) posterior tibial pulse- posterior of medial mallelus, slightly under
4) dorsal pedis- slightly lateral to high point of big toe tendon (lateral to extensor hallicus longus)

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16
Q

Describe the location of the four heart valves

A

Aortic: from right sternal border, 2nd ICS
Pulmonary: left sternal border, 2 ICS
Tricuspid: left Costosternal border, 5ICS
Mitral: left 5th ICS at Mid clavicular line

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17
Q

What are the surface markings of the heart

A

Upper right : 1cm from right sternal border in 3rd CC
Lower right: 1cm from right sternal border 6th CC
Upper right: 2.5cm from left sternal border at the 2nd ICS by the 2nd CC
Lower right: in the left 5th ICS, until where the apex beat (usually mid clavicular line)

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18
Q

Auscultate the heart

A

aortic, pulmonary, tricuspid and mitral

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19
Q

aortic stenosis causes what murmur

A

ejection systolic

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20
Q

What other pathologies can cause an ejection systolic murmur

A

aortic stenosis
Pulmonary stenosis
Aortic sclerosis
Atrial septal defect
Hypertrophic obstruction cardiomyopathy

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21
Q

aortic regurgitation causes what murmur

A

early diastolic

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22
Q

mitral regurgitation causes what murmur

A

pansystolic

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23
Q

mitral stenosis causes what murmur

A

mid diastolic

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24
Q

describe the borders of the heart

A

RU- 3CC 1cm right from sternal edge
RL- 6CC 1cm from sternal edge
LU- 2ICS/2CC 2.5cm from sternal edge
LL- 5ICS mid clavicular line at apex beat

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25
Q

Accentuation manoeuvre of aortic stenosis

A

Auscultate carotid artey using bell and ask patient to hold breath, will get radiation of ejection systolic murmur. slow rising pulse with a narrow pulse

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26
Q

What is the accentuation manoeuvre of aortic regurgitation

A

Auscultate over aortic area, ask patient to sit forward and breathe out

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27
Q

accentuation manoeuvre of mitral regurg and mitral stenosis

A

mitral regurgitation: over mitral area use diaphragm, LEFT LATERAL DECUBITUS POSITION (roll onto left hand side) breath in out and hold, should get louder with expiration, then tell to breathe normally and auscultate round axila to check for radiation
mitral radiation: using bell auscultate, LEFT LATERAL DECUBITUS ask to breathe in an out and hold

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28
Q

What are the two types of aortic dissection and how would they present

A

Type A- a tear in ascending aorta, presents with severe chest pain, both anterior and posterior
Type B- a tear in descending aorta, presents with back pain mostly, chest and abdominal pain after

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29
Q

Describe S1, S2, S3, S4

A

S1 is the mitral and tricuspid valves closing
S2 is the aortic and pulmonary valves closing
S3 rapid filling of ventricles- congestive heart failure
S4 forceful atrial contraction

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30
Q

introduce an abdominal examination

A

hand sanitiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct abdominal examination which will involve…. ( a look, feel, listen to tummy) is that okay?
Can i confirm your name and DOB
The examination will require you to be exposed from the waist upwards and lying flat on the couch , do you need any assistance ?
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know

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31
Q

On general inspection of the abdomen what are you looking for

A

skin abormalities, surgical scars, masses, hernias, asymmetry
respiration being diaphragmatic
obesity- sunken umbilicus
umbilical hernia would be distended and everted

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32
Q

palpate the abdomen and name the regions whilst

A

light palpation first then mention it may feel slightly uncomfortable so let me know if you want me to stop then deeper palpation, monitor face for pain
Regions: Right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, right lumbar, right iliac fossa, suprapubic/hypogastric, left iliac fossa

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33
Q

name the organs that are in each section of the abdomen

A

Right Hypochondriac- Liver, gallbladder, biliary system
Epigastric- Liver, stomach, pancreas, duodenum
Left Hypochondriac- pancreas spleen
Right lumbar- right kidney, ascending colon
Umbilicus- small intestine, transverse colon, abdominal aorta
Left lumbar- descending colon, left kidney
Right Iliac Fossa- appendix, caecum, right ovary
Suprapubic/Hypogastric- bladder, uterus
Left Iliac Fossa- sigmoid colon, left ovary

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34
Q

name some pathologies that can occur in each section of the abdomen

A

Right Hypochondriac- hepatitis, cholesystitis, cholangitis, gallstone, hepatomegaly
Epigastric- gastritis, GERD, pancreatitis
Left Hypochondriac - pancreatitis, splenic infarct, splenomegaly, splenic abscess
Right Flank- kidney stones, renal cancer, colitis
Umbilicus- small bowel obstruction, abdominal aortic anneurysm
Left flank- kidney stones, colitis, kidney infection (pylonephritis)
Right Iliac Fossa- appendicitis, ovarian torsion, colitis, ovarian cyst
Suprapubic/Hypogastric- UTI, STI, Pregnancy, ectopic pregnancy
Left Iliac Fossa- colitis, ovarian torsion or cyst, diverticulitis

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35
Q

palpate the liver

A

start from right iliac fossa, ask for deep breath in then push in, then out

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36
Q

three causes of hepatomegaly

A

viral hepatitis (hep A or hep B)
toxic hepatitis (med overdose)
alcohol associated hepatitis,
congestive heart failure
leukaemia, haemolytic anaemia
liver tumour/ liver cancer

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37
Q

palpate the spleen

A

right iliac fossa towards left costal margin

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38
Q

three causes of splenomegaly

A

haemolytic anaemia
splenic metasteses
congestive heart failure
endocarditis (bacterial infection)
portal hypertension due to cirrhosis

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39
Q

palpate the kidney

A

kidney balloting, left hand behind right flank then feel ontop with right hand

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40
Q

causes of kidney enlargement

A

bilateral- polycystic kidney disease, hydronephrosis, amyloidosis
unilateral- renal tumor

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41
Q

Describe the different signs seen on palpation and what they indicate

A

tenderness- minimal pressure over a wide area = peritonitis
Guarding- contracts voluntary when palpation causes pain
Rigidity- inflammation on parietal peritoneum, reflex contraction, involuntary guarding, dont see any abdominal movements during respiration
Rebound tenderness- localised or general peritonitis if abdonimal wall compressed slowly then released they get sharp stabbing pain

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42
Q

palpate the abdominal aorta

A

above the bellybutton, slight triangle shape push down, will be on patients left

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43
Q

when palpating the abdominal aorta what are you feeling for

A

non expansile and pulsatile, if expansile and pulsatile then abdominal aortic anneurysm

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44
Q

when does the abdominal aorta bifurcate and into what

A

L4
left and right common iliac artery

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45
Q

Name the planes of the abdomen and what they signify

A

Transpyloric plane- L1, pylorus of stomach, neck of pancreas, fundus of gallbladder, renal hilum, duodenojejunal flexure, end of spinal cord. Is midway between jugualr nothch and pubic symphysis/ lower end of sternal body and umbilicus

Subcostal plane- L3, inferior mesenteric artery begins, under 10th CC

Supracristal- L4, birfurcation of aorta (bellybutton)

Intertubercular- L5, tubercle crest of ilium

Interspinous- S2, horizontal through anterior superior iliac spines (boundry between umbilical and hypogastric region)

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46
Q

percuss the liver

A

Percuss from right iliac fossa upwards, should change to dull note at costal border, keep percussing upwards until becomes resonant or go from upper 4th rib downwards after

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47
Q

what are the surface markings of the liver

A

Right 5th ribs at the midclavicular line
Left 5th rib ICS at the midclavicular line
Lower end of the sternum
Costal margin of the 10th rib at right mid axillary line

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48
Q

percuss the spleen

A

percuss from right iliac fossa diagonally to the left anterior axillary line
at 10th intercostal space ask to breathe in fully, percuss, breathe out fully percuss

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49
Q

What are the surface markings of the spleen

A

upper border: superior border of left ninth rib
lower border: superior border of left 11th rib
medially- at the left lateral border of erector spinae muscles, (5 cm from the midline)
laterally- left midaxillary line

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50
Q

percuss for ascites

A

percuss from midline to flank noting where becomes dull, ask to turn onto opposite side, wait 30 seconds and percuss again, if becomes resonant then fluid moved

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51
Q

What causes ascites

A

accumulation of fluid in the peritoneal cavity due to liver cirrhosis
decreased metabolism of aldosterone and ADH by liver leads to salt and water retention
liver produces less albumin which reduces oncotic pressure so fluid leaks out of vessels

52
Q

auscultate bowel sounds

A

listen to two places slightly under bellybutton, should listen for 3-4 mins before coming to conclusion

53
Q

what are you listening for when listening to the bowel

A

listening for gurgling from peristalsis
absent bowel sounds- paralytic ileus or peritonitis
intestinal obstruction- high pitched and frequent

54
Q

What are the most common regions where stones reside

A

he ureteropelvic junction (UPJ)
the ureteral crossing of the iliac vessels
the ureterovesical junction (UVJ).

55
Q

How would you diagnose urinary tract stones

A

Non contrast CT scan

56
Q

If urinary tract stones were found how would you treat it

A

if smaller than 5mm let it pass, if larger then lithotripsy or stenting

57
Q

auscultate the abdomen for bruits

A

right and left iliac arteries (under bellybutton)
abdominal aorta (above and left of bellybutton)
renal arteries (left and right of abdominal aorta
superior mesenteric arteries: epigastrum midline
liver tumour: over liver

58
Q

what are the borders of the liver

A

upper border- right dome of diaphragm which is marked by right 5th rib and costal cartilage extends across lower end of sternum

oblique border- right costal margin mid axillary, through tip of the 9th and 8th CC (which is the junction between the costal margin and lateral border of rectus abdominus) to the 5th ICS in mid clavicular line

Right border - down anterior right axillary line

59
Q

What are the surface markings of the gallbladder

A

where the transpyrloric plane intersects with the right midclavicular line

transpyloric plane which runs through the tips of 9th CC
mid clavicular line runs along the lateral border of rectus abdominis

60
Q

what is the surface marking of the kidney

A

medial border is 4-5cm from posterior median line
superior border is 12th rib
inf 3-4cm above iliac crest

transpyloric plane runs through L1 (midpoint between inf angle of scapula and highst point of iliac crest is T12 then count one down)

61
Q

what are the dimensions of the kidney

A

width: 5-7 cm
Height: 9-12 cm

62
Q

what is the surface marking of the ureter

A

5cm lateral to posterior median line at L1 (transpyrloric plane)
through posterior superior iliac spine

63
Q

Introduce a neurological exam

A

hand sanitiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct an examination of the upper and lower limb which will involve…. ( moving your arms and legs and testing sensation in those areas) is that okay?
Can i confirm your name and DOB
The examination will require exposure of your arm and legs, and you sitting upright at 45 degrees is that okeh
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know

64
Q

assess the tone of the upper limb

A

ask patient to relax arm
circumduct the shoulder joint, support hand and elbow
flex and extend elbow
circumduct wrist

65
Q

if there is an upper motor neurone lesion what would you find upon examination

A

pyramidal tract lesion/ UMN

spasticity, hypertonia

66
Q

if there is hypotonia/rigidity in the arm what is this a sign of

A

extrapyramidal tract/ LMN

67
Q

assess the power of the upper limb, whilst saying what myotome and muscles are being worked

A

shoulder - abduction C5- stop from pushing down- deltoid
shoulder- adduction C6/7- stop from pushing up- teres major, latissumus dorsi, pec major
elbow- flextion C5/6- stop me from pushing forearm away- biceps brachii
elbow- extension C7- stop from pushing towards- triceps brachii
wrist- flexion C6/7- flex wrist down, stop from pulling up- flexors of the wrist (flexor carpi ulnaris, flexor carpi radialis
wrist extension: C7- wrists back, stop from pushing down

68
Q

how is power scored

A

MRC Muscle Power Scale : scale of 0-5
0- no movement
1- flicker of movement
2- voluntary movement cant overcome gravity
3- voluntary can overcome gravity
4- voluntary can overcome resistance
5- normal strength

69
Q

test the reflexes of the upper limb and name what nerve is being tested

A

relax fully
biceps- C5, C6- place finger over bicep tendon and tap
triceps- C7, C8- rest arm at 90 flexion, find tendon tap
supinator- C6- brachioradialis tendon, 4 inch from tumb base

70
Q

lesions to the UMN and LMN would have what effect on relexes

A

UMN- hyperreflexia
LMN- areflexia

71
Q

test the sensation of the upper limb and state which dermatome is being tested

A

demonstrate normal sensation on the sternum with eyes closed, then say you will do this on both arms, say yes if you can feel. alternate between two arms
c3- clavicle bit
c4- deltoid
c5- bicep
c6- thumb
c7- middle finger
c8- pinkie
t1- medial epicondyle
t2- axilla

72
Q

assess the tone of the lower limb

A

ask patient to relax leg
leg roll
leg lift (life at knee joint)
ankle clonus- dorsiflex the foot quickly

73
Q

asses power of leg

A

as patient to perform these movements
hip flexion- stop from moving down ( psoas major and iliacus, femoral nerve)
hip extension- patient pushes against the couch, exmainer pulls up (gluteus maximus, inferior gluteal nerve)
hip abduction- stop from pushing in (gluteus medius and minimus, superior gluteal nerve)
hip adduction- stop from pushing out (adductor longus, adductor brevis, adductor magnus, obturator nerve)

lift leg slightly up and hold
knee flexion- patient pushes leg towards ankle
knee extension- patient kicks out

74
Q

what test is used to check the hip abductors

A

Trendelenburg test
when right foot is raised the left abductor is tested- glut med and min

75
Q

assess knee joint and say which muscles and nerves are being tested

A

extension- patient kicks out whilst applying downward pressure (test quadriceps and femoral nerve)
knee flexion- patient pushes leg towards ankle whilst pulling outwards (hamstrings and sciatic nerve)

76
Q

assess ankle joint and say which muscles and nerves are being tested

A

dorsiflexion- push foot down- tibialis anterior, externsor hallicus longus, extensor digitorum longus. deep fibular nerve
plantarflexion- push foot up- tibial nerve S1-2
inversion- place hand laterally
eversion- place hand medially

77
Q

what joint does inversion and eversion take place at

A

subtalar joint

78
Q

asses the reflexes in the lower limb and say what nerves are being tested

A

Knee jerk reflex- patellar reflex tendon, L3, L4, patients legs hanging off bed, do Jendrassik manoeuvre (clench teeth and pull hands)

ankle jerk reflex- S1,S2, at achilles tendon, hip slightly abducted knee flexed and ankle dorsiflexed, tap tendon

79
Q

Describe the different nerve lesions of the lower body and what motor and sensory loss this would result in

A

Femoral nerve: quadraceps paralysis/knee weakness and anterior thigh and medial thigh, leg and foot have sensory loss

Obturator nerve: adductor paralysis (cant sit cross legged), pain on medial thigh as usually from a tumour in pelvis

Common fibular nerve: foot extensors and evertors paralysed- foot drop. loos of sensation on anterior and lateral side of leg, dorsum of foot

Tibial nerve: hamstrings and all posterior muscles of leg, sole of foot too. foot in dorsiflexed and everted position. sole of foot loses sensation

sciatic nerve: hamstrings and all ,uscle below the knee paralysed, knee flexion affected. foot drop (in plantarflexion). Can only feel the medial side of leg and foot the saphenous nerve area

80
Q

What is sciatica caused by

A

pain radiating from posterior back into buttock, into posterior thigh and leg
L5-S1 sciatic nerve compressed by herniated lumbar intervertebral disk

81
Q

What are the borders of the femoral triangle

A

Inguinal ligament
Adductur longus
Sartorius

82
Q

assess the dermatomes of the lower limb and state which dermatome is being tested

A

ALTERNATE BETWEEN LEFT AND RIGHT
l1- top of thigh
l2- just below
l3- medial knee
l4- medial side of leg and big toe
l5 lateral side of calf and three middle toes
s1- little toe and lateral half of posterior leg
s2- medial half of posterior leg

83
Q

what is it called when venous drainage becomes blocked due to pressure in the leg, how would this present, what are the causes and what is the treatment

A

compartment syndrome where pressure in muscle compartment so high it blocks venous drainage which can cause muscle ischaemia and death

presentation- pain, muscel tenderness and swelling, movement painful (6P- pallor, pulselessness, paralysis, perishingly cold, pain, paraesthesia)

cause- fractures, burns, infections, prolonged limb compression

treatment - relieve ressure, open fasciotomy where skin and deep fascia opened along the length of the muscle compartment to relieve pressure

84
Q

introduce a respiratory exam

A

hand sanitiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct a respiratory examination which will involve…. ( having a look, feel and listen to your chest) is that okay?
Can i confirm your name and DOB
The examination will require you to be exposed from the waist upwards and sitting at a 45 degree angle on the couch, do you need any assistance ?
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know

85
Q

assess the repiratory rate

A

looking at the chest wall movement check the respiratory rate, pretend to check radial
express in breaths per minute

86
Q

palpate the trachea

A

warn may be uncomfortable, lean back and relax
push upwards and backwards

87
Q

displacement of the trachea signifies what

A

displacement towards the lung lesion- upper lobe collapse, upper lobe fibrosis, pneumectomy, (goes to wherever is less pressure/air/collapse)

displacement away from side of lesion pleural effusion, tension pneumothorax, chest expansion

88
Q

what level does the trachea bifurcate at

A

sternal angle, T4/5

89
Q

assess chest expansion

A

place hands below 5th and 6th ribs, thumbs meet at anterior midline ask to take DEEP breathe in, fingers should move more than 5cm

repeat posterior at T10

90
Q

what lobes does anterior chest expansion test for, and what lobes for posterior

A

Anterior: left lungs upper and middle lobes, right lungs upper lobe
Posterior- left and right lungs lower/inferior lobes

91
Q

what do unilateral and bilateral decreases in chest expansion signify

A

bilateral- asthma or COPD
unilateral- pneumothorax, pleural effusion, collapsed lung, consolidation

92
Q

percuss the anterior and posterior chest

A

switch between L and R as go down
apex of lung
2 ICS (superior lobe0
4 ICS (middle lobe) can do at acilla
6 ICS- (inferior lobe) below breast
mid axillary line

BACK: ask to roll sholders forward or cross arms (scapulae has to be rotated anteriorally)
apex- trapezius level
spine of scapulae (superior lobe)
level of 10th rib (inf lobe)
mid axillary line

93
Q

what conditions would cause hyperresonance

A

pneumothorax, hollow bowels, COPD
more air space

94
Q

what conditions would cause hyporesonance

A

pleural effusion (stoney/dull) , lung tumour, consolidation, collapsed lung (other three flat/dull)

95
Q

what are the two types of sounds heard on auscultation, describe their character and where can you hear them

A

Bronchial- high pitch as air turbulence heard without filtering as no alveolar tissue. can hear over manubrium, trachea, suprasternal notch and between c7-t3 on back
character- hollow and high pitches, expiratory phase more, pause between inspiration ann expiration, these sounds heard over pathological areas (like consolidation or collapsed lung as no alveolar tissue)

Vesicular- low pitch where normal lung tissue is
character- inspiratory sound in lobar and segmental airway, expiratory in central airway, more in inspiratory phase, no pause
lower intensity vesicular sounds can be because of asthma and chronic bronchitis

96
Q

auscultate the chest

A

same areas just with diaphragm ALTERNATE
Apex (above clavicle use bell)
2nd ICS
4th ICS or below right axilla
6th ICS
mid axillary

apex
2nd ICS
10th/11th rib
mid axillary

97
Q

assess tactile vocal fremitus

A

ask patient to say 99 and put hand over each area

98
Q

what is a decrease in tactile vocal fremitus caused by

A

decrease in density (more air) pneumothorax, COPD or pleural effusion

99
Q

what is a increase in tactile vocal fremitus caused by

A

consolidation, tumour tissue

100
Q

palpate the lymph nodes

A

patient must be sitting up, examine from behind

submental(chin), submandibular (angle of mandible)
preauricular, postauricular, occipital
superior deep cervical, inferior deep cervical, supraclavicular nodes

101
Q

what are the causes of cervical lymphadenopathy

A

lung cancer metastisising
tuberculosis
sarcoidosis
resp tract infection

102
Q

how would a patient with CA pneumonia present and what would you look for on a scan

A

sharp pain on deep inspiration
dullness where affected on percussion
which has crackles instead of vesicular sound in affected area

look for:
consolidat: denser than air : pus, haemorrhage
air bronchograms: small airways still filled with air looking very dark over the very white surrounding
silhoette sign: loss of normal border/blunting

103
Q

what is the triangle of safety for chest drains

A

lateral edge of pec major
base of axilla
5th ICS
lateral edge of latissimus dorsi

104
Q

what is the surface marking of the lungs

A

ANTERIORALLY
1 inch above medial 1/3rd of clavicle
medial edge of sternum and body
rib 6 mid clvicular line
approximately under xiphosternal joint

left lung cardiac notch between rib 4-6

POSTERIALLY
spine of C7
mid point between: posterior medial line and scapular line
10th rib mid axillary

105
Q

what is the surface marking of the lung pleura

A

1 inch above medial 1/3rd of clavicle
medial edge of sternum and body
rib 8 mid clavicular line
tip of 9th rib where lateral border of rectus abdominus meets the 9th CC

POSTERIALLY
spine of C7
mid point between: posterior medial line and scapular line
10th rib costal margin

106
Q

Describe what levels are the lung fissures

A

Left horizontal fissure : rib 4 mid clavicular
Left oblique fissure : rib 6 mid clavicular

Right oblique fissure: rib 6 mid clavicular

POSTERIALLY
oblique fissures at T3

107
Q

introduce a musculoskeletal examination

A

hand sanitiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct an examination of your leg which will involve…. moving your leg and feeling around your knee is that okay?
Can i confirm your name and DOB
The examination will require you to be exposed mid thigh downwards and sitting on the couch at 45 degree angle, do you need any assistance ?
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know

108
Q

what are you looking at the knee for

A

scars
wasting of muscle - maybe a LMN lesion or pain from arthritis causes disuse
knee deformities- valgus- knock knees or varus- bow legged

109
Q

assess the temperature

A

use back of hands, above, on and below patellar. both hands on both knees

110
Q

If the knee is very warm what could it be

A

septic arthritis, osteoarthritis

111
Q

palpate the knee

A

feel patella, medial and lateral joint lines, tibial tuberosity, head of fibula, feel around the popliteal fossa

112
Q

swelling in the popliteal fossa causes what

A

bakers cyst

113
Q

what is an effusion

A

excess synovial fluid

114
Q

perform the tap method, what does it test for

A

ensure patients knee is extended
slide non dominant hand down thigh to empty suprapatellar pouch then press firmly on patella with dominant hand
test for moderate effusion - would feel a tap

115
Q

perform the sweep method

A

ensure patients knee is extended
sweep upwards on medial side with non dominant, keep in place then used dominant hand to sweep down
test for small effusion, would see a bulge of fluid appearing on medial side of knee

116
Q

assess patients range of motion

A

ask patient to bed right knee in and straighten, bend left knee and straighten (0-140 degrees) look at pain

117
Q

What muscles are responsible for flexion and extension of the knee

A

Flexion: hamstrings: biceps femoris, semitendinosus, semimembranosus

Extension: quadriceps: vastus medius, vastus lateralis, vastus intermedius, rectus femoris

118
Q

assess patients range of motion when relaxed

A

flex and ectend patients legs to maximum
lift patientswhole leg by ankle when relaxed
10 degrees of hyperextension is normal

119
Q

perform the anterior draw test and posterior sag test

A

flex patients leg to 90 degrees, check and look for posterior sag (posterior subluxation of the tibia on the femur)
this creates a flase positive anterior drawer sign

hands behind upper tibia and thumbs on tibial tuberosity, pull tibia anteriorly
more than 1.5 cm suggest an ACL pathology

120
Q

test the medial collateral ligament

A

flex leg at 30 degree, hand on lateral aspect of lower thigh, other on medial aspect of upper calf, apply valgus stress

121
Q

test lateral collateral ligament

A
122
Q

What imaging is always used for knee

A

MRI

123
Q

Describe the clinical response to different NEWS2 Score categories

A

0- monitor every 12 hours, cont NEWS monitoring
1-4 pts: every 4-6 hours , inform registered nurse who will assess and decide whether escalation necessary
3pts on a single parameter: every hour, registered nurse to inform medical team caring for patient, who will review and escalate if needed
5 or more: every hour, reigstered nurse immediately informed medical team caring for patient, reg nurse requests urgent assessment by clinician or team trained in car of acute illness, clinical care in environment with monitoring facilities
7 or more: continuous monitoring, registered nurse immediately informed medical team caring for patient-specialist registrar level, emergency assessment by team with critical care competencies including practicioners with airway management skills, consider tranfer to level 2 or 3 clinical care facility, higher dependence or ICU, clinical care in environment with monitoring facilities

124
Q

What is the basic structure of SBAR

A

SItuation: I am LB a (role), i am calling abount (patient x, DOB, Hospital number) from (department x) because I am conserned that (NEWS 2 worsening, specific concerning vitals)

Background: Patient X was admitted on – with (presenting complaint). They have had (meds/surgery whatever management or investigation). Since then (obs change, NEWS change specific parameters).

Assessment: suspected clinical diagnosis, report what has been administered. OR i am not sure what the problem is but I am concerned that patient x is deteriorating

Recommendation: i recommend (according to NEWS the frequency of monitoring, clnical team, escalation of care) and i would like you to come have a look.
Is there anything I need to do in the meantime

125
Q

How to complete an exam

A

The examination is over, thank you for your time.
Do you need any help with getting dressed

BRS YEAR2 (11 decks)

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