Examinations

Question 1

How would you begin an examination?

Answer 1

1. Wash your hands and don PPE if appropriate
2. Introduce yourself to the patient including your name and role
3. Confirm the patient’s name and date of birth
   4 Briefly explain what the examination will involve using patient-friendly language. Tell patient that the examiner will act as a chaperone
   5 Gain consent to proceed with the examination
   6 Adjust head of the bed
   7 Adequately expose the patient
   8 Ask if the patient has any pain

Question 2

How would you summarise a cardiovascular examination?

Answer 2

1. “Today I examined Mrs Smith, a 64-year-old female. On general inspection, the patient appeared comfortable at rest and there were no objects or medical equipment around the bed of relevance.”
2. “The hands had no peripheral stigmata of cardiovascular disease and were symmetrically warm, with a normal capillary refill time.”
3. “The pulse was regular and there was no radio-radial delay. On auscultation of the carotid arteries, there was no evidence of carotid bruits and on palpation, the carotid pulse had normal volume and character.”
4. “On inspection of the face, there were no stigmata of cardiovascular disease noted in the eyes or mouth and dentition was normal.”
5. “Assessment of the JVP did not reveal any abnormalities and the hepatojugular reflux test was negative.”
6. “Closer inspection of the chest did not reveal any scars or chest wall abnormalities. The apex beat was palpable in the 5th intercostal space, in the mid-clavicular line. No heaves or thrills were noted.”
7. “Auscultation of the praecordium revealed normal heart sounds, with no added sounds.”
8. “There was no evidence of peripheral oedema and lung fields were clear on auscultation.”
9. “In summary, these findings are consistent with a normal cardiovascular examination.”

Question 3

What further assessments would be performed from a CV examination?

Answer 3

1. BP
2. Peripheral Vascular Examination
3. Record a 12 lead ECG
4. Dipstick urine
5. Bedside capillary glucose
6. Fundoscopy

Question 4

How would you summarise a respiratory exam?

Answer 4

1. “Today I examined Mrs Smith, a 64-year-old female. On general inspection, the patient appeared comfortable at rest, with no evidence of shortness of breath. There were no objects or medical equipment around the bed of relevance.”
2. “The hands had no peripheral stigmata of respiratory disease and were symmetrically warm. There was no evidence of a fine tremor or asterixis.”
3. “The pulse was regular at 70 beats per minute and the respiratory rate was 16 breaths per minute.”
4. “On inspection of the face, there were no stigmata of respiratory disease.”
5. “Assessment of the JVP did not reveal any abnormalities. The trachea was centrally located and the cricosternal distance was within the normal range.”
6. “Closer inspection of the chest did not reveal any scars or chest wall deformities. The apex beat was palpable in the 5th intercostal space, in the mid-clavicular line and chest expansion was equal.”
7. “Percussion of the chest revealed normal resonance throughout all lung fields.”
8. “Auscultation of the chest revealed normal vesicular breath sounds, with no added sounds. Vocal resonance was also normal.”
9. “There was no lymphadenopathy on assessment.”
10. “There was no evidence of peripheral oedema and the calves were soft and non-tender.”
11. “In summary, these findings are consistent with a normal respiratory examination.”

Question 5

What pieces of information are on the FRAX score?

Answer 5

1. Age
2. Sex
3. Weight
4. Height
5. Previous Fracture
6. Parent fractured hip
7. Current smoking
8. Glucocorticoids
9. RA
10. Secondary osteoporosis
11. Alcohol - 3 or more units/day
12. Femoral neck BMD

Question 6

What are the risk factors for the CHADSVASC score?

Answer 6

1. Age (0 = <65, 1 = 65-74, 2 = >75)
2. Sex
3. Congestive heart failure history
4. HTN history
5. Stroke/TIA/thromboembolism history
6. Vascular disease history
7. Diabetes history

Question 7

What are the risk factors for ABCD2 score?

Answer 7

1. Age >60 years
2. BP > 140/90
3. Clinical features of TIA (Unilateral weakness = 2, speech disturbance = 1, other symptoms = 0)
4. Duration of symptoms (<10 minutes = 0, 10-59 minutes = 1, >60 minutes = 2)
5. History of diabetes

Question 8

What are the Well’s criteria for DVT?

Answer 8

1. Active cancer treatment
2. Bedridden recently >3 days, major surgery within 12 wks
3. Calf swelling >3cm compared to other leg
4. Collateral superficial veins present
5. Entire leg swollen
6. Localised tenderness along deep venous system
7. Pitting oedema, confined to symptomatic leg
8. Paralysis, paresis, recent plaster immobilisation
9. Previous DVT
   10 Alternative diagnosis more likely (-2)

Question 9

What are the risk factors in QRISK2?

Answer 9

1. Smoking status
2. Diabetes
3. Angina/heart attack in 1st degree relative <60
4. CKD stage 4 or 5
5. AF
6. HTN treatment
7. Rheumatoid arthritis
8. Cholesterol/HDL ratio
9. Systolic BP
10. BMI