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Final Med > examination > Flashcards

examination Flashcards

1
Q

superficial lumps are most likely?

A

lipomas abcesses epidermal cysts and dermoid cysts

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2
Q

ddx for a lump in the anterior triangle of the neck

A

brachial cyst sinus fistula
carotid body tumour (chemodectoma)
carotid artery aneurysm
salivatory gland and lymphadenopathy

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3
Q

ddx for lump in the posterior triangle

A

lymphatic malformation, cervical rib, pharngeal pouch, subclavian aneurysm and lymphadenopathy

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4
Q

how do you tell if the lump in the neck is attached to the muscle?

A

ask the patient to nod their head against resistance

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5
Q

hard lump ddx

A

malignancy

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6
Q

rubbery lump

A

lymphoma or a chronic inflammatory (TB)

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7
Q

soft lump lymph node

A

acute inflammatory lymph nodes

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8
Q

fluctuant lumps

A

brachial cysts cystic hygrometer, paryngeal pouches, laryngoceles, cold abcess epidermal cysts, dermoid cyst

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9
Q

what should you also check for in a parotid swelling?

A

facial nerve

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10
Q

A lump that is tethered to the underlying muscle in the anterior triangle of the neck is a what? until proven otherwise?

A

squamous cell carcinoma metastasised to the lymph nodes until proven otherwise.

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11
Q

Pembertons sign

A

elevation of arms above the head results in venous congestion and plethora due to thoracic inlet obstruction by a retrosternal mass.

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12
Q

virchow node

A

supraclavicular node positive in oesophageal carcinoma

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13
Q

patient with dysphagia one exam 5 things

A
  1. CN bulbar palsy
  2. GI exam for malignancy
  3. neck mass goitre
  4. features of cREST syndrome
  5. koilonychia (iron deficiency anaemia) plummer vinson syndrome with esophageal webbing
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14
Q

tender cervical lymphadenopathy in a patient with cough

A

upper respiratory tract infection

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15
Q

sign of raised co2

A

asterisks

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16
Q

wasting of dorsal interossei

A

due to apical lung cancer due to T1 nerve root invasion.

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17
Q

causes of clubbing cardio

A 
cardio 
infective endocarditis 
congenital cyanosis heart disease
atrial myxoma 
axillary artery aneurysm 
brachial arterovenous fistula
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18
Q

resp cause of clubbing

A

pulmonary fibrosis
suppurative lung disease- abcess, empyema, CF, bronchiectasis
bronchial carcinoma, mesothelioma, TB

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19
Q

gastro causes of clubbing

A 
IBD
cirrhosis
malabsorption= coeliac disease
gastric lymphoma
liver abcess
liver or bowel ca
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20
Q

other causes of clubbing (not cardio, resp, or GI)

A

congenital clubbing

thyroid acropachy

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21
Q

cholesterol deposits on the back of the hand or bony prominences

A

xanthomata

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22
Q

cholesterol deposits around the eyelids

A

xanthelasmata

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23
Q

you are listening to a patient’s chest with COPD what are you expecting to hear?

A

reduced air entry, and prolonged expiratory phase

may have wheeze if exacerbated COPD

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24
Q

you are listening to a patient with asthma’s chest what are you expecting to hear?

A

polyphonic wheeze

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25
Q

you are listening to a patient with interstitial lung disease’s chest what are you expecting to hear?

A

late inspiratory fine crackles (heard best at the apex or the bases depending on the aetiology)

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26
Q

what are some signs of heart failure on exam

A

displaced apex beat (LVH)
third and fourth heart sound
crackles in both lung bases
raised JVP hepatolmegaly, peripheral oedema (ankles and sacrum)

27
Q

what would you be looking for on examination if you wanted to rule out ankylosing spondylitis?

A

hands - mono-arthritis mostly tenderness or stiffness in the large joints
dactylitis inflammation of the entire digit (sausage digit) due to soft tissue oedema and tenosynovial and joint inflammation
progressive loss of spinal movement GALS examination
look for signs of sacroiliitis
question mark posture.

Schooners test asking the patient to touch the toes to test spine flexion.
look at the achilles’ tendon- achilles tendinitis and plantar fasciitis

28
Q

bruising around the umbilicus or flank what sign is it? nad what does it indicate?

A

grey turners sign and it indicated in severe pancreatitis

29
Q

How do you illicit murphy’s sign

A

palpate the abdomen underneath the right 9th costal cartilage apply pressure and ask the patient to take in a deep breath. Gallbladder will brush against the fingers and patient will arrest inspiration this is suggestive of inflamed gallbladder.

30
Q

if in your differential is even a thought of pancreatitis what investigation would you look for?

A

serum amylase or lipase levels.

31
Q

Prehn’s sign

A

relief from epididymitis when elevating the testes

32
Q

Roving sign positive

A

when you palpate the left illiac fossa this results in greater degree in RIF pain than the left… acute appendicitis

33
Q

Mcburney’s point

A

two thirds of the distance from the umbilicus laterally towards the anterior illiac spine.

34
Q

patient with LIF pain that is writhing in pain

A

ureteric colic

35
Q

phalen’s test

A

test to induce the symptoms of carpal tunnel syndrome in the patients that have it.

36
Q

Tinel test

A

percussion over the median nerve to illicit nerve irritation in those with carpal tunnel syndrome

37
Q

oligouria definition

A

reduced urine output
less than 400 ml/day
less than .5 ml/kg/hour
less than 30 ml/hr

38
Q

what can cause bilateral crackles in the lung bases?

A

atelectasis or heart failure

39
Q

when you are examining a groin lump what are you looking for?

A

where is the neck of the swelling? Is it superior and medial to the public tubercle? inguinal
Or is it inferior and lateral to the pubic tubercle? femoral

40
Q

if the groin lump extends to the scrotum what do you think it is?

A

indirect hernia as opposed to direct.

41
Q

Palpation of a groin lump what are the steps?

A
  1. determine the site
  2. size
  3. tenderness
  4. pulsation?
  5. solid or fluctuant
  6. is there a cough impulse
  7. is the lump reducible
42
Q

How do you differentiate between a direct and indirect hernia clinically?

A

You reduce the hernia and place your finger at the level of the deep inguinal ring in order to preclude the space. The deep inguinal ring is at the midpoint of the inguinal ligament. Then you ask the patient the cough. If the hernia reappears then you know that the hernia was direct.

43
Q

What is the scale used to grade limb weakness?

A 
5 normal power
4 can move the limb against gravity and some resistance 
3. can move limb against gravity 
2. movement in a horizontal plane 
1. flicker
0 no movement
44
Q

hemiparesis definition

A

implies half the body paresis weakness

45
Q

hemiplegia

A

half the body not able to move (plegia)

46
Q

paraparesis

A

para (lower limb) paraseis (muscle weakness)

47
Q

paraplegia

A

lower limb not able to move

48
Q

quadriplegia

A

not able to move the upper or lower limbs.

49
Q

What are trophi?

A

They are deposits of urate crystals that have a characteristic chalk like appearance when they break through the skin. they are found anywhere on the body, but mostly on joints and bones.

50
Q

What are rheumatoid nodules?

A

subcutaneous nodules classically found on the elbows and ears. They are pathognomonic of rheum arthritis.

51
Q

What are the nail signs of psoriasis

A

pitting, subungual hyperkeratosis and onycholysis

52
Q

What are you looking for in suspected DVT

A

you measure 10 cm below the tibial tuberosity looking for a difference in circumference greater than 3 cm (measure three times)

53
Q

What is also important to assess if you suspect DVT beside just measuring?

A

neurovascular status of the limb.

tenderness on active and passive movement.

54
Q

What is the wells score?

A 
scoring system to assess risk of the patient having a deep vein thrombosis 
entire leg swollen 
calf swollen greater than 3 cm
pitting oedema on the effected side
paralysed leg
bed rest greater than 3 days 
tenderness in the deep veins
collateral superficial veins (not varicose) 
active ca 
previous DVT 
(alternative diagnosis for DVT -2) 
If greater than 2 it is likely a DVT
55
Q

What is the diagnostic approach for a DVT

A

if the wells score is less than 2
just D dimer if neg discharge
if less than 2 plus pos d-dimer than US required
if high risk and d dimer neg than Us req
if high risk and d dimer pos than 2 US req

56
Q

what do you give as treatment for DVT

A

low molecular weight heparin

compression stocking if ABI greater than 0.9-1.3 worn 1 week after diagnosis worn for 2 years.

57
Q

what are the features of compartment syndrome?

A

a tense, shiny swollen limb that is painful to passive movement and that has progressed to neurovascular compromise.

58
Q

What is the pathology of compartment syndrome?

A

limbs has inflexible fascia separating the muscle groups. The inflammation therefore can cause increased pressure occluding the deep veins. This leads to a vicious cycle of increased swelling and therefore further occlusion leading to necrosis of the tissues of it is not surgically decompressed.

59
Q

What is complication of compartment syndrome?

A

Volkmann’s contracture =- irreversible atrophy of the limb.

60
Q

What is the treatment for compartment syndrome?

A

surgical decompression via fasciotomy.

61
Q

Describe a fasciotomy procedure?

A

skin, subcutaneous tissue, and tight fascia surrounding the effected limb are divided and left open.
two longitudinal incisions
(anterior and lateral compartments
superficial and deep posterior compartments via medial incision)

62
Q

management of cellulitis

A

FBC bacterail infection (neutrophillia)
antibiotics- cover strep and staph such as flucloxacillin
demarcation- pen for progression or getting better
elevation- reducing swelling
if suspect an allergic reaction topical steroids and oral antihistamines

63
Q

What is a ruptured baker’s cyst

A

rupture of the synovial sac protruding from the knee in the popliteal fossa. the fluid can tract int he calf producing signs of a DVT. US can differentiate between the two.

64
Q

Treatment of a bakers cyst

A

elevation
aspiration of the fluid
injection of corticosteriods

Final Med (35 decks)

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