Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCS-Critical care > Examinations > Flashcards

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

To complete peripheral vascular exam

A

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

Ix:
- ABPI
- Dupplex/CT angio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Inspections of arterial exam

A

Hands:
- tar staining
- tendon xanthomata

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where do you find arterial ulcers

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where do you find venous ulcers

A

Gaiters area (above medial and lateral malleolus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

To complete thyroid exam

A

Exams:
- Check bicipital and knee reflex
- proximal myopathy

Ix:
- ECG
- TFTs
- USS + FNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lid lag test

A

Sign of Graves

Moving finger from up to down
Eyelid lags behind eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Proximal myopathy

A

Complication of multinodular goitre/GRAVES

Wasting of proximal muscles

Arms crossed stand from sitted position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pretibial myxoedema look

A

Oedema plaque shaped lesions

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Parotid exam

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How to investigate parotid lumps

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to investigate mandibular gland swelling

A

USS
Sialogram (?stones)
CT

FNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Indications of pacemaker

A
  • symptomatic sinus brady
  • complete heart block
  • HOCM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pre op investigations for COPD

A
  • Peak flow or spirometry
  • CXR
  • consider a baseline ABG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Signs of hyperpituitary

A

Most commonly signs of high growth hormone and prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Signs of high growth hormone

A

prominent brow
macroglossia
enlarged hands and feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Signs of high prolactin

A

Increased lactation
Loss of libido
ED in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Further investigations after otoscopy

A

CT head
Audiometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Further investigations after otoscopy

A

CT head
Audiometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Further investigations after otoscopy

A

CT head
Audiometry

28
Q

Knee exam

A

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
Q

To complete exam of knee

A

Assess join above and below
NVS of lower limbs

Ix:
- XR
- ?MRI
- Aspirate

30
Q

McMurray’s test

A

Medial meniscus:
- palpate posteromedial knee
- extend and externally rotate

Lateral meniscus
- palpate anteromedial knee
- extend and internally rotate

31
Q

Management of meniscus tear

A

RICE
Operative:
- repair vs meniscectomy

32
Q

Mx of OA of knee

A

Conservative: NSAIDS, steroid injection, PT for muscles

Surgical:
- Arthroscopy
- realignment osteotomy
- replacement

33
Q

Hip exam

A

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
Q

How to measure apparent vs true leg length

A

Apparant: umbilicus to medial mal
True: ASIS to medial mal

Difference between apparent but not true suggests shortening due to pelvic tilt

35
Q

To complete hip exam

A
  1. assess joints above and below
  2. full neurovascular exam
  3. Imaging XR/MRI
36
Q

How to do thomass test

A

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
Q

How to test for trendelenburg test for hip

A

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
Q

Spinal exam for lower back pain

A

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
Q

Schobers test

A
  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
Q

Straight leg raise

A

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
Q

Femoral nerve stretch test

A
  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
Q

Ankle exam

A

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
Q

Simmonds test

A

Kneel on a chair
Squeeze calf
Foot should plantar flex

Sign of achilis rupture

44
Q

Anterior drawer test of ankle

A

Assesses ATFL

  1. pt sat down
  2. cup the heel with one hand and apply anterior force to foot by other
45
Q

Talar tilt test

A
  1. pt sat down
  2. flex knee to 90
  3. valgus and varus test applied to ankle

Valgus = medial lig
Varus= calcaeneofibular lig

46
Q

Obturator sign

A

Internal rotation of hip (stretching obturatoror internus) causes pain

47
Q

Varicose vein exam

A
  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
  4. Special tests:
    - telendenberg’s test
    - Torinquet test
    - Perthe’s test
    - hand held doppler test
48
Q

How to differentiate sapheno varix from inguinal hernia

A

Dilatation of saphenous vein at junction joining femoral vein

Lump that vanishes on lying down

49
Q

How to do percussion test for varicose veins

A
  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
Q

Tourniquet test

A

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
Q

Trendelenburg test

A

To identify position of incompetent valve.

Like tourniquet test, but occlude the SFJ with finger instead of tourniquet

52
Q

Perthes test

A

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
  3. if varicose veins become more distended, means insufficiency in the deep venous system (eg DVT)
53
Q

Handheld doppler test

A

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
Q

Further investigations for varicose veins

A

Dupplex ultrasound

To check patency of deep venous system

55
Q

Management options for varicose veins

A

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
Q

What are the superficial and deep veins of lower limb

A

Superficial:
- long saphenous and short saphenous

Deep:
- ant/post tibial
- fibular
- popliteal
- common femoral
- profunda femoris

57
Q

Cerebellar exam

A
  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
Q

Romberg’s test

A

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
Q

Rebound phenomenon

A
  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
Q

How are reflexes different in cerebellar disease

A

Described as pendular

Less brisk and slower in rise and fall

61
Q

Differentials for causes of cerebellar signs

A

Stroke
Mets (eg lung)
Trauma
MS
Primary tumour: astrocytomas

62
Q

Hand exam

A

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
Q

Breast exam steps

A

Inspect
- arms by side, on hips, above head

Palpate
- breast
- axillary tail
- nipple areolar complex

Lymph nodes
- axillary
- cervical
- supraclavicular
- parasternal

64
Q

To complete breast exam

A

Triple assessment

65
Q

To complete gynocomastia examination

A
  1. visual fields (pituitary tumour)
  2. thyroid exam (hypothyroidism could cause)
  3. liver derangement
  4. testicular tumours
66
Q

Shoulder exam

A
  1. look
    - front, side, back
  2. Whilst standing, winging of scapula
  3. palpate
    Front:
    - temp
    - sternoclavicular, clavicle, ACJ, humerus

Back:
- acromion, spine, scapula angles

  1. 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
  2. Special tests:
  • Jobe test: empty can test
  • Gerber’s lift off

MRCS-Critical care (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions