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MRCS B Examinations and practical skills > Examination summaries > Flashcards

Examination summaries Flashcards

1
Q

Breast examination

A

Inspection:
-Hands on hips
-Hands behind head

Feel
-Breast: all 4 quadrants, nipple/areolar
-If mass: ask to tense chest muscle to assess tethering to underlying structures
-Axilla: medial, posterior, lateral, apex
-Examine for palpable nodes in supraclavicular fossa

To complete:
-Full history
-Examine abdomen and chest
-Triple assessment: US +/- mammography (>35)

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2
Q

Ear examination

A

Inspection: pinna

Palpation
-Feel + move pinna (otitis externa: pain on moving pinna)
-Feel mastoid bone (mastoiditis)

Otoscopy: if light reflex shines to right side: right ear

Test hearing: whisper in pt’s ear and ask them to repeat while occluding other ear

If abnomality –> Weber + rinne test

Examine oropharynx (tonsils)

Examine CN VII + VIII

To complete:
-Full examination including remaining CNs
-Flexible nasendoscopy
-Cervical lymph nodes

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3
Q

Weber + rinne interpretation

A

Weber
–> Conductive: louder in affected ear
–> sensorineural: louder in normal ear
–> Midline: both ears normal or abnormal

Rinne:
-Conductive: bone conduction louder than air conduction
-Sensorineural: Both diminished

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4
Q

Thyroid local

A

Local evidence of disease:

Inspect: front and side

Ask to swallow water
Ask to protrude tongue

Palpation
-Repeat swallowing/protruding while palpating
-Feel over isthmus and both lobes
-Feel for enlarged neck nodes
-Palpate for tracheal deviation

Percuss over sternum

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5
Q

Thyroid systemic

A

Systemic:
-Hands (clubbing/palmar erythema/temperature)
-Pulse
-Face (loss of eyebrows/dry skin)
-Eyes:
–>ask pt to follow finger down with eyes (lid lag/retraction)
–> Look from side
–> ophthalmoplegia, proptosis, chemosis pathognomonic of graves
-proximal myopathy
–> shoulder abduction
–> standing from sitting
-Reflexes
-Pretibial myxoedema

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6
Q

Peripheral vascular exam special test:

A

Buerger’s test

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7
Q

Peripheral vascular exam: to complete examination

A

Complete examination
-ABPI
-Full neuro exam lower limbs
-Full CVS exam
-Vascular exam upper limbs
-Feel abdomen for AAA/renal/aortic bruits

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8
Q

How to do ABPI measurement

A

Brachial pressure
1. With the patient lying on the examination couch, place the sphygmomanometer cuff over the left arm proximal to the brachial artery and position the Doppler probe on the brachial artery at a 45° angle (medial to the biceps tendon in the antecubital fossa).

  1. Inflate the cuff 20-30 mmHg above the pressure at which the Doppler pulse is no longer audible and then deflate the cuff slowly, noting the pressure at which you first detect a pulse from the Doppler. This represents the systolic pressure in the vessel being assessed.
  2. Now repeat steps 1 and 2 on the right brachial artery to assess systolic pressure.
  3. Record the higher of the two systolic readings for use when calculating ABPI.

Measure ankle pressure

  1. Place the sphygmomanometer on the left ankle and position the Doppler probe over the posterior tibial artery, which is located posterior to the medial malleolus.
  2. Inflate the cuff 20-30 mmHg above the pressure at which the Doppler pulse is no longer audible and then deflate the cuff slowly, noting the pressure at which you first detect a pulse from the Doppler. This represents the systolic pressure in the vessel being assessed.
  3. Keep the sphygmomanometer in the same location but re-position the Doppler probe over the dorsalis pedis artery of the left foot, which is located lateral to the extensor hallucis longus tendon.
  4. Assess the systolic pressure in the dorsalis pedis artery of the left foot by repeating step 2.
  5. Record the highest of the two pressures obtained from dorsalis pedis (DP) and the posterior tibial artery (PTA) for use when calculating the left ABPI.
  6. Repeat the same process on the right leg to calculate the right ABPI.
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9
Q

Calculating ABPI

A

Left ABPI = (highest pressure of either left PTA or DP) ÷ (highest brachial pressure)

Right ABPI = (highest pressure of either right PTA or DP) ÷ (highest brachial pressure)

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10
Q

Peripheral vascular exam lower limb

A

General inspection
–> General (GTN spray/bypass scars)
–> hands (nicotine/splinter haemorrhage)
–> Skin and hair

Specific inspection
–> Legs (ulcers, scars, colour)

Palpation
–> temperature
–> CRT
–> Pulses (femoral, popliteal, posterior tibial, DP)
–> Radial pulse and radio-femoral delay
–> Doppler if unable to detect clinically

Special test
–> Buerger’s test

Complete examination
-ABPI
-Full neuro exam lower limbs
-Full CVS exam
-Vascular exam upper limbs
-Feel abdomen for AAA/renal/aortic bruits

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11
Q

Stoma complete examination

A

To complete
-Full abdo exam
-Inspect perineum for scars
-Assess stoma position sitting + standing

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12
Q

Stoma palpation

A

Palpate
-Digitate (for stenosis)
-Transilluminate to assess for ulceration
-Reattach bag

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13
Q

Stoma specific inspection

A

Stoma inspection:
-site, spout and what comes out
-Lumens
-Colour
-Prolapse/retraction/parastomal hernia
-Surrounding skin

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14
Q

Stoma general inspection

A

Scars

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15
Q

Stoma examination

A

General inspection
–> scars

Stoma inspection:
-site, spout and what comes out
-Lumens
-Colour
-Prolapse/retraction/parastomal hernia
-Surrounding skin

Palpate
-Digitate (for stenosis)
-Transilluminate to assess for ulceration
-Reattach bag

To complete
-Full abdo exam
-Inspect perineum for scars
-Assess stoma position sitting + standing

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16
Q

Neck lump examination

A

Look from front + side
Look for cup of water ?? thyroid: ask pt to protrude tongue and swallow to see what examiner does

Move behind pt, systematically palpate neck: anterior and posterior triangles, midline for thyroid

Palpate for enlarged lymph nodes (submental, submandibular, anterior cervical chain, posterior cervical chain, pre and post auricular, occipital, supraclavicular

Palpate tracheal position

Look for cutaneous lesions on scalp

To complete examination:
-Examine oral cavity
-Assess voice and vocal cord function

17
Q

Groin examination

A

Inspection from end of bed
Note relation to pubic tubercle
Is it testicular or groin swelling?

Palpate: cough impulse, try to reduce, try to get above lump
Direct vs indirect: reduce hernia + apply pressure over deep inguinal ring. Ask pt to cough. If hernia reappears: direct, if not indicect

Testicular examination

18
Q

Hand examination summary

A

Look
-Cascade, dorsal (nails, digits), volar (wasting)
-Elbows and ears

Feel:
-pulse/CRT/Allens
-Temperature
-MCP joint squeeze, bimanual Wrist/MCPs/DIPs/PIPs
-Snuffbox/Muscle bulk/dupuytren’s

Move
-Wrist flexion/extension
-Extension of fingers/Abduction of fingers
-FDS/FDP flexion
-Thumb extension/abduction/flexion
-Check DRUJ
-Functional: Squeeze fingers, pick up object, pincer grip

Neuro assessment:
-Ulnar, median (OK sign), radial sensation and motor

Special tests:
-Phalen’s/tinel’s

19
Q

Spinal examination

A

Look
General inspection
Closer inspection of spine (anterior/posterior/lateral)
Adam’s forward bend (accentuates scoliosis)

Feel

Temperature
Spinal processes and sacroiliac joints
Paraspinal muscles
Sacroiliac joints
Chest expansion if kyphoscoliosis

Move

Cervical spine: Flexion, extension, lateral flexion, rotation
Lumbar spine: Flexion, extension, lateral flexion
Thoracic spine: rotation

Special tests

Schober’s
Sciatic stretch
Femoral stretch

To complete exam

Neurovascular examination of the upper and lower limbs.
Examination of the hip and shoulder joints.
Bloods if indicated
PR and bladder scan if concerned
Further imaging if indicated (e.g. X-ray/MRI).

20
Q

Shoulder examination

A

Shoulder examination

General inspection (clinical signs, objects or equipment)
Closer inspection of shoulder (anterior, lateral, posterior)

Feel

Temperature
Shoulder joint

Move

Compound movements

Active:
-Flexion
-Extension
-Abduction
-Adduction
-External rotation
-Internal rotation
-Scapular movement

Passive
-Repeat above movements passively

Special tests

-Supraspinatus assessment
-Painful arc (impingement syndrome)
-External rotation against resistance
-Internal rotation against resistance (Gerber’s lift off test)
-Scarf test

21
Q

Cerebellar examination

A

Inspection
Gait: normal, heel toe
Romberg’s test
Speech: British constitution, baby hippopotamus
Eyes: H test: assess for dysmmetric saccades
Upper limbs: finger nose, rebound, tone, dysdidochokinesis
Lower limbs: tone, reflexes, heel shin test

MRCS B Examinations and practical skills (13 decks)

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