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Examinations Flashcards

1
Q

Peripheral vascular exam part 1 checklist

A
  1. WIPER
  2. General inspection
  3. Hands:
    - Inpsect: tar staining/tendon xanthomata
    - Palpate: radial, radio-radial, temp
  4. Elbow: BP + Brachial
  5. Offer Carotids + Abdo: aorta
  6. Legs
    - Inspect
    - Palpate: Temp, CRT, 4 pulses, femoro-radial delay, Buergers test
    - Auscultate: femoral bruits
    - Gross sensation
    - ABPI
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2
Q

To complete peripheral vascular exam

A

Exams:
- CVS exam
- Upper limb vascular exam
- auscultate abdo/renal bruits

Ix:
- ABPI
- Dupplex/CT angio

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3
Q

Inspections of arterial exam

A

Hands:
- tar staining
- tendon xanthomata

Legs:
- colour (red vs blue)
- venous insufficiency (lipodermatosclerosis, haemosidirin)
- Ulcers

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4
Q

Where do you find arterial ulcers

A

Punched out
1st and 5th metatarsal head
Tips of toes
Heel

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5
Q

Where do you find venous ulcers

A

Gaiters area (above medial and lateral malleolus)

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6
Q

Thyroid exam

A
  1. WIPER
  2. Gen inspection
  3. Hands:
    - inspect (palmar erythema)
    - radial pulse
    - tremor
  4. Eyes:
    - Inspect: (exophthalmos, lid retraction (Graves)
    - movements (pain -> Graves)
    - Lid lag (Graves)
  5. Thyroid
    - inspect (+ swallow/protrusion)
    - palpate (masses/thrills +swallow/protrusion)
  6. Lymph nodes
  7. Trachea deviation (enlarged thyroid)
  8. Percussion of sternum (retrosternal dullness? large thyoid gland)
  9. auscultate: each lobe with bell (increased vascularity in Graves)
  10. Legs:
    - pretibial myxoedema
    - proximal myopathy
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7
Q

To complete thyroid exam

A

Exams:
- Check bicipital and knee reflex
- proximal myopathy

Ix:
- ECG
- TFTs
- USS + FNA

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8
Q

Lid lag test

A

Sign of Graves

Moving finger from up to down
Eyelid lags behind eye

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9
Q

Proximal myopathy

A

Complication of multinodular goitre/GRAVES

Wasting of proximal muscles

Arms crossed stand from sitted position

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10
Q

Why cant FNA differentiate between follicular adenoma and carcinoma

A

Cytology looks at cellular structure

Needs to look at histology to know if it is invading the capsule or surrounding structures

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11
Q

Pretibial myxoedema look

A

Oedema plaque shaped lesions

Usually sign of hyperthyroidism (eg graves) but can be also hypothyroid

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12
Q

What is Myxoedema coma

A

Hypothyroid patients could enter a Myxoedema coma in response to insult (infection, surgery, etc)

Low HR, Temp, BP, glucose
Altered mental state

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13
Q

Parotid exam

A
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14
Q

Submandibular gland exam

A
  1. look
  2. Feel:
    - gland
    - duct (bimanual)
    - Sensation of tongue (lingual)
    - lymph nodes
  3. Move:
    - stick tongue out (hypoglossal)
    - smile (marginal mandibular)
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15
Q

How to investigate parotid lumps

A

Imaging:
- USS
- CT or MRI to assess perineural invasion
- FNAC

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16
Q

How to investigate mandibular gland swelling

A

USS
Sialogram (?stones)
CT

FNA

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17
Q

Treatment options for sialothesis

A
  1. conservative
    analgesia, abx, hydration, gland massage
  2. sialogram (sometimes pushes the stone out)
  3. Intraductal stones: duct lay opened (not closed as stricture)
  4. Siolendoscopy: stone retrieval via endoscopy
  5. submandibular excision
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18
Q

Indications of pacemaker

A
  • symptomatic sinus brady
  • complete heart block
  • HOCM
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19
Q

Precautions in patients undergoing ops with pacemaker

A

Pre and post op pacemaker checks
Inform anaesthetist
Avoid monopolar if possible or only short bursts
If must: place the return electrode far from pacemaker and leads

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20
Q

Pre op investigations for COPD

A
  • Peak flow or spirometry
  • CXR
  • consider a baseline ABG
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21
Q

How to reduce risk pts undergoing ops for COPD

A
  1. Ask GP/Resp to optimise meds
  2. Treat any infections
  3. Encourage to stop smoking
  4. Chest physio before and after
  5. HDU afterwards
  6. avoid laparoscopic as pneumoperitoneum reduces lung volume and compliance
  7. use regional instead of general
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22
Q

Signs of hyperpituitary

A

Most commonly signs of high growth hormone and prolactin

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23
Q

Signs of high growth hormone

A

prominent brow
macroglossia
enlarged hands and feet

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24
Q

Signs of high prolactin

A

Increased lactation
Loss of libido
ED in men

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25
Further investigations after otoscopy
CT head Audiometry
26
Further investigations after otoscopy
CT head Audiometry
27
Further investigations after otoscopy
CT head Audiometry
28
Knee exam
Gait Look: - anterior, lateral, posterior - swelling, scar, muscle wasting Feel: 1. extended - assess joint line - sweep test (sweeping up medial, holding, pushing down on lateral) - patellar tap - measure muscle bulk (?wasting) 2. 90 degrees joint line Move: - active: ?ROM 0-140 - passive: weakness/pain - ACL/PCL: anterior/posterior draw + Lachmans (30 degree) - MCL/LCL: McMurray
29
To complete exam of knee
Assess join above and below NVS of lower limbs Ix: - XR - ?MRI - Aspirate
30
McMurray's test
Medial meniscus: - palpate posteromedial knee - extend and externally rotate Lateral meniscus - palpate anteromedial knee - extend and internally rotate
31
Management of meniscus tear
RICE Operative: - repair vs meniscectomy
32
Mx of OA of knee
Conservative: NSAIDS, steroid injection, PT for muscles Surgical: - Arthroscopy - realignment osteotomy - replacement
33
Hip exam
Gait Look - anterior/lateral/posterior Feel: - temp - greater trochanter Move: - passive and active - flexion, extension, abduction, adduction, internal/external rotation Special tests: - measure leg length (apparent and true) - thomas test - trendelenburg test
34
How to measure apparent vs true leg length
Apparant: umbilicus to medial mal True: ASIS to medial mal Difference between apparent but not true suggests shortening due to pelvic tilt
35
To complete hip exam
1. assess joints above and below 2. full neurovascular exam 3. Imaging XR/MRI
36
How to do thomass test
If flexion of the hip leads to a rise in the contralateral hip, then thomas positive Contralateral hip is 'tight' has a fixed flexion deformity as cannot extend to stay on the bed
37
How to test for trendelenburg test for hip
Palpate the ASIS bilaterally Get patient to lift one leg off If hip goes down on the foot off the ground, that's a positive sign of weakness of abductors on the contralateral side
38
Spinal exam for lower back pain
Gait Look: 4 sides Feel: - spinous processes - paraspinal muscles Move: - Cervical: lateral flexion, rotation, flexion, extension - Thoracic: rotation - Lumbar: lateral flexion, flexion and extension Special tests: - Straight leg raise - Femoral stretch - schobbers test
39
Schobers test
1. Mark the spine at level of posterior superior iliac spine in midline 2. 5 cm above and 10 cm below make marks 3. ask for maximal lumbar flexion 4. if the distance between 2 marks is greater than 20cm then normal lumbar flexion
40
Straight leg raise
Checks sciatic nerve 1. supine 2. lift ankle keeping knee straight to maximal hip flexion 3. dorsiflex foot Positive if pain in posterior buttock
41
Femoral nerve stretch test
1. Prone 2. flex knee to 90, extend hip joint 3. plantar flex hip Pain in thigh/inguinal region shows femoral nerve root compression
42
Ankle exam
Gait Look Feel - MTP squeeze - proximal fibula palpation Move: - plantar/dorsal flexion - Inversion/eversion Special tests: - Simmonds - anterior drawer of ankle (ATFL) - talar tilt tests
43
Simmonds test
Kneel on a chair Squeeze calf Foot should plantar flex Sign of achilis rupture
44
Anterior drawer test of ankle
Assesses ATFL 1. pt sat down 2. cup the heel with one hand and apply anterior force to foot by other
45
Talar tilt test
1. pt sat down 2. flex knee to 90 3. valgus and varus test applied to ankle Valgus = medial lig Varus= calcaeneofibular lig
46
Obturator sign
Internal rotation of hip (stretching obturatoror internus) causes pain
47
Varicose vein exam
1. Inspect 2. Palpate: - saphenofemoral junction for saphenofemoral varix - feel down the length of short and long saphenous for tenderness - feel the 4 pulses 3. Percussion 3. Special tests: - telendenberg's test - Torinquet test - Perthe's test - hand held doppler test
48
How to differentiate sapheno varix from inguinal hernia
Dilatation of saphenous vein at junction joining femoral vein Lump that vanishes on lying down
49
How to do percussion test for varicose veins
1. one finger on the saphenofemoral junction 2. tap the varicose vein identified 3. if detect a thrill at SFJ, continuity of the vein due to incompetent valves
50
Tourniquet test
To identify position of incompetent valve. 1. raise the leg and milk blood out into trunk 2. place tourniquet above SPJ whilst pt lying down 3. get them to stand and observe varicose vein filling - If veins did not fill, suggests incompetent valve was at the level of SFJ. - If vein filled, suggests incompetent valve lower down, so try 3 cm below and repeat until the vein stops filling
51
Trendelenburg test
To identify position of incompetent valve. Like tourniquet test, but occlude the SFJ with finger instead of tourniquet
52
Perthes test
To decide problem with superficial venous system vs deep venous system 1. apply tourniquet at thigh 2. get patient walk/dorsi/plantar flex multiple times 2. if varicose veins become more distended, means insufficiency in the deep venous system (eg DVT)
53
Handheld doppler test
Handheld doppler over SFJ at 45 degrees Squeeze patient calf If competent SFJ, a short 'swoosh' sound If incompetent SFJ, a long 'swoosh' sound as regurgitates down through the incompetent valve
54
Further investigations for varicose veins
Dupplex ultrasound To check patency of deep venous system
55
Management options for varicose veins
Depends on impact on QoL Conservative: graduated compression stockings, leg elevation, avoid prolonged standing 1st line: radiofrequency ablation, laser ablation 2nd line: scelotherapy 3rd line: Surgery: - ligation of vein and excision by stripping
56
What are the superficial and deep veins of lower limb
Superficial: - long saphenous and short saphenous Deep: - ant/post tibial - fibular - popliteal - common femoral - profunda femoris
57
Cerebellar exam
1. Gait: - normal and heel-to-toe 2. Romberg's test 3. Speech british constitution 4. Eyes: nystagmus 5. Upper limb - finger to nose test - dysdiadochokinesia - tone - rebound phenomenon 6. Lower limb - knee-jerk reflex - heel to shin test
58
Romberg's test
Checks for loss of proprioception or vestibular function 1. pt with their feet together, arms on their side 2. Ask to close eyes If they fall, positive rombergs
59
Rebound phenomenon
1. ask pt close eyes with arms in front of them 2. apply downward resistance and ask pt to maintain position 3. push downwards and immediately remove pressure If pt returns to a postion higher -> cerebral stroke If pt does not adjust at all, cerebellar disease
60
How are reflexes different in cerebellar disease
Described as pendular Less brisk and slower in rise and fall
61
Differentials for causes of cerebellar signs
Stroke Mets (eg lung) Trauma MS Primary tumour: astrocytomas
62
Hand exam
Look Feel - temp - MCP tenderness - anatomical snuffbox - pulse Move - active vs passive - extension, flexion of fingers - extension, flexion of wrist Nervs: - median, ulnar, radial Functional: - power grip - pincer grep - pick up small object Special tests: - Tinnels - Phalens
63
Breast exam steps
Inspect - arms by side, on hips, above head Palpate - breast - axillary tail - nipple areolar complex Lymph nodes - axillary - cervical - supraclavicular - parasternal
64
To complete breast exam
Triple assessment
65
To complete gynocomastia examination
1. visual fields (pituitary tumour) 2. thyroid exam (hypothyroidism could cause) 3. liver derangement 4. testicular tumours
66
Shoulder exam
1. look - front, side, back 2. Whilst standing, winging of scapula 3. palpate Front: - temp - sternoclavicular, clavicle, ACJ, humerus Back: - acromion, spine, scapula angles 3. move (passive +active) - compound moves: hand behind shoulder and use thumb to reach high on the back -simple moves: flex/extend/abduct/adduct/ ext rotate, int rotate 4. Special tests: - Jobe test: empty can test - Gerber's lift off

MRCS-Critical care (10 decks)

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