Examinations Flashcards
(58 cards)
What should you do at the beginning of every examination
Wash hands, introduce yourself, identify patient, explain what you are going to do, gain consent
General inspection of patient and their surroundings from end of bed. Note:
-patient demeanour/ whether they appear well at rest
-any walking aids/medications etc
Describe the steps in the hand and face part of a cardiovascular examination
Hands:
-general observation eg colour, tar staining
-assess temperature
-assess clubbing
-cap refill time
-measure radial pulse
-assess radio-radial delay
-locate brachial pulse
-assess collapsing pulse (aortic regurg) ASK ABOUT PAIN IN SHOULDER!
-ask the examiner if they would like you to measure BP/say you would measure BP
Face:
-general inspection of face
-check for anaemia
-ask patient to open mouth so you can inspect gums and tongue
-check for JVP by positioning patient at 45 degrees and getting them to turn their head to the left
-hepatojugular reflex may not be required but mention that you would do it
-auscultate the carotids
-feel the carotids
Describe the steps in the chest part of the cardiovascular examination
(ask patient to expose their chest)
General Inspection:
-look at patient’s chest for scars, visible cardiac pulsation etc
Palpation:
-heaves
-thrills
-palpate the apex beat
Auscultation (feel carotid pulse while you auscultate)
-listen to all 4 areas with diaphragm
-listen to all 4 areas with bell
-listen to axilla
-ask patient to roll to their left and listen to mitral area with bell. Ask them to exhale and hold while you do this (mitral stenosis)
-ask patient to sit forwards, exhale and hold, and listen to aortic area (aortic regurg)
-listen to carotids while patient holds their breath
Describe the rest of the cardiovascular examination
-inspect back
-auscultate lung bases
-check for sacral oedema
-check for pitting oedema in the ankles
Describe the hand and face steps of a respiratory exam
Hands:
-general inspect of hands
-assess temperature
-cap refill
-clubbing
-assess fine tremor and flapping tremor
-assess radial pulse
Face:
-assess eyes for anaemia ect
-ask patient to open mouth and inspect gums, tongue and general mouth health
-check JVP
-assess tracheal deviation
-check lymph nodes
Describe the chest steps in a respiratory exam
Palpation:
-assess chest expansion
-palpate apex beat
-place hands on chest and ask patient to say 99 (tactile vocal fremitus) may be reduced in effusion or pneumothorax
Percussion:
-percuss both sides and start from the shoulders/clavicles
-make sure to percuss axilla
Auscultation:
-listen to all areas while patient breathes in and out through their mouth
-listen to all areas again while patient says 99
-if you suspect consolidation, get the patient to whisper two two as this will appear louder in areas of consolidation
Describe the back and last steps in the respiratory exam
Repeat all the chest steps but on the back with the patient sitting forwards
-palpate ankles for oedema
Describe the inspection steps of the thyroid exam
-inspect general appearance of patient
-inspect the hands for temperature, clubbing, sweating, palmar erythema etc
-check for a tremor by asking the patient to put their hands in front of them and placing a piece of paper on their hands
-check the pulse
-check for signs of muscle wastage
-inspect eyes
-ask patient to follow your finger in a H shape
ask patient to follow your finger up and down to look for lid lag
-inspect the neck for masses
-ask the patient to stick their tongue out (mass move up means
thyroglossal cyst)
-inspect tongue
-ask patient to swallow some water (if mass moves then thyroid mass)
Describe the palpation steps of a thyroid exam
-palpate trachea
-palpate neck from behind to look for masses
-ask patient to stick tongue out
-ask patient to swallow some water
- if there is a mass, determine size, if it moves or is fixed, if it moves on swallowing and tongue sticking out
-palpate lymph nodes
Describe percussion, auscultation and last steps of a thyroid exam
Percuss:
-percuss upper sternum
Auscultation:
-ask patient to hold breath and auscultate over thyroid
Other:
-ask patient to stand from a chair while holding their arms over their chest
-assess ankle reflexed
Describe the main categories assessed in an upper and lower limb neurological examination
Tone, Power, Reflexes, Coordination, Sensation
Describe the tone and power steps in an upper limb examination
Tone: assess passive movement of shoulder, elbow and wrist on both sides and compare as you go.
Power: assess shoulder, elbow and wrist again. Assess only one side at a time.
-Shoulder abduction= elbows out to side and push down
-Shoulder adduction= elbows out to side and push up
-elbow flexion= hands like a boxer and pull away
-elbow extension= hands like a boxer and push towards patient
-wrist extension= make a fist and cock wrists up, try and push them down
-wrist flexion= make a fist and flex wrists down, try and push them up
-finger extension= hold fingers out and press down
-finger abduction= splay fingers out and try and press them in
-thumb abduction= palm up, point thumb up to the ceiling and push down
Describe the reflex and sensation steps of an upper limb neurological examination
Reflex:
-biceps, triceps and supinator reflexes
Sensation: (patient must have eyes closed and you must first demonstrate the feeling on their sternum)
-use cotton wool for light tough sensation (dorsal columns and spinothalamic tracts)
-use the sharp end of a neuro tip for pin prick sensation (spinothalamic tracts)
-use a tuning fork for vibration sensation (dorsal columns) and start at the thumb. Only move proximally if they have reduced sensation in the thumb
Proprioception: dorsal columns
-demonstrate up and down to the patient
-ask them to close their eyes
-ask them which direction you are moving their thumb in
Describe the coordination steps of an upper limb neurological examination
Finger to nose test:
-ask patient to touch their nose and then your outstretched finger as fast as they can
-if patients struggle to do this, may indicate underlying cerebellar pathology
Dysdiadochokinesia:
-flipping hand up and down on other hand
Describe the face, hand and neck steps of a GI examination
Hands:
-inspect hands and nails for pallor, erythema, spoon shaped nails, dupuytren’s contracture
-check for finger clubbing
-check for flapping tremor
-check temperature
Face:
-ask to pull down eyelids and look up for signs of anaemia, jaundice etc
-look for xanthelasma
-ask patient to open mouth to check for ulcers, general dental hygiene, glossitis etc
Neck:
-palpate for lymphadenopathy
-check JVP (?)
Describe the abdominal palpation steps in the GI examination
Ask if they are in any pain first!!!
General Inspection:
-general look at stomach and abdomen for scars, swelling, distention, stretch marks
Light palpation:
-lightly palpate 9 areas while patient breathes normally and watch their face as you do this
Deep Palpation:
-deeply palpate the 9 areas while patient breathes normally and watch their face as you do. If one area is painful, palpate last
Liver Palpation:
-ask patient to take deep breaths in
-start in right iliac fossa and move superiorly towards the ribs
Gallbladder Palpation:
-palpate at right costal margin
-ask patient to take a deep breath in
Spleen palpation:
-start in right iliac fossa
-ask patients to take deep breaths in
-move towards left costal margin
Aorta palpation:
-use both hands and perform deep palpation just below the umbilicus
Bladder palpation:
-gentle palpation of bladder
Describe the percussion and auscultation step of a GI examination
Percuss liver:
-using same direction as palpation
Percuss spleen:
-using same direction as palpation
Percuss bladder:
-percuss down from umbilicus
assess shifting dullness if indicated
Listen to bowel sounds in at least two areas
Auscultate the aorta
Describe the upper limb section of a peripheral vascular examination
General inspection:
-inspect and compare both limps outstretched for pallor, cyanosis, tar staining, gangrene etc
-check temperature of both
-check cap refill time of both
-check the radial pulses
-measure radio-radial delay
-perform Allen’s test
-check the brachial pulses
-offer to check BP
Describe the abdominal section of a peripheral vascular examination
-auscultate the carotid artery while asking the patient to hold their breath
-palpate the carotid artery
-inspect the abdomen
-palpate the aorta
-auscultate the aorta
-auscultate the renal arteries
Describe the lower limb section of a peripheral vascular examination
General inspection:
-inspect and compare both lower limbs for cyanosis, pallor, ulcers, hair loss, scars, paralysis etc
-check temperature
-check cap refill time
-palpate femoral pulse
-palpate popliteal pulses
- palpate posterior tibial pulse
-palpate dorsalis pedis pulse
-assess sensation by using a bit of cotton wool and moving from distal to proximal, comparing each side as you go
-Buerger’s test: raise patient’s feet 90degrees for 1-2 mins and then have them hang their legs over the side of the bed. In normal people, the legs should stay pink even when elevated
Describe the first and tone parts of a lower limb examination
-Assess the patient’s gait by first asking them to walk to the end of the room and back, and then ask them to do heel to toe walking
-Romberg’s test- ask patient to stand with feet together and arms by their side and ask them to close their eyes
Tone:
-roll legs from side to side
-lift and drop knee onto bed
-test ankle clonus
What should you do at the beginning of every examination
Wash hands, introduce yourself, identify patient, explain what you are going to do, gain consent
General inspection of patient and their surroundings from end of bed. Note:
-patient demeanour/ whether they appear well at rest
-any walking aids/medications etc
Describe the power steps in a lower limb examination
Power:
-hip flexion: ask patient to lift leg up and then push down
-hip extension: ask them to push your hand into the bed while you push down
-ask them to push their thighs together
-ask them to push their thighs apart
-knee flexion: ask them to bend their knee and stop you straightening their leg
-knee extension: ask them to bend their knee and try and straighten their leg
-ankle plantarflexion: ask them to push down against your hand as if they are trying to straighten their feet
-ankle dorsiflexion: ask them to pull their feet away from you towards their body
-big toe extension: ask them to pull their big toe towards their body while you try and straighten it
Describe the reflex, sensation and coordination steps in a lower limb examination
Reflexes: assess knee jerk, ankle jerk and plantar reflexes
Sensation:
-test light touch and pink prick sensation
-test vibration sensation starting at interphalangeal joint of the patient’s big toe
-test proprioception using the big toe
Coordination:
-heel to shin assessment