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Final Osce > Examinations > Flashcards

Examinations Flashcards

1
Q

End of bed respiratory

A

Sputum pots
Oxygen/nebulisers/inhalers

Patient alert or drowsy, using accessory muscles, hypoxic

audible wheeze, stridor, cough

oedema

patient able to speak in sentences

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2
Q

Hands in respiratory

A

Clubbing - COPD
Palmar erythema - co2 retention
Tar staining - smoking
Fine tremor - salbutamol overuse
Flapping tremor - co2 retention

pulse

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3
Q

Inspection in respiratory

A

Inspect JVP

Inspect chest
- scars - sternotomy, lobectomy
- skeletal deformities - kyphosis, scoliosis, pectus excavatum, barrel chest
- air entry
- chest drains
- use of accessory muscles

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4
Q

Palpation in respiratory

A

Tracheal position

Chest expansion

Lymph nodes

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5
Q

Percussion in respiratory

A

Percuss over regions

Resonant - normal
Dull - consolidation, mass, ,lobar collapse
Stony Dull - pleural effusion
Hyper-resonant - air in lung space - pneumothorax

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6
Q

Auscultation in resp

A

Is breathing vesicular or bronchial, is air entry equal across lung fields, are there any added sounds

Fine crackles - fibrosis
Coarse crackles - consolidation or fluid
Wheeze
Stridor
Rubs

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7
Q

Vocal resonance findings

A

Normal

Increased = consolodation or lobar collapse
Decreased - pneumothorax, pleural effusion

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8
Q

Abdo end of bed

A

Patient alert, in pain, confused, restless, lying still

Sick bowl
Stoma
NG tube

jaundice
ascites
hernia
pallor
cachexia

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9
Q

Abdo exam hands and arms

A

pallor
dupytrens
koilonychia (anaemia or nutritional deficiencies)
leukonychia (hypoalbuminaemia)
palmar erythema (liver disease)
clubbing (IBD)
Asterixis

Pulse

Track marks
spider naevi (liver disease)
excoriations (jaundice)

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10
Q

Abdo exam face and neck

A

pallor or jaundice
xanthalasmata
glossitis or angular stomatitis
keyser-fleisher rings
oral candiasis
ulceration

supraclavicular lymph node
spider naevia

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11
Q

Abdo inspection

A

PATIENT MUST BE LYING FLAT

Abdo shape - scaphoid, distended?

5 Fs of abdo distension
- fat, faeces, flatus, fluid, fetus

Scars

Visible pulsatile massess

Stomas (ileostomy on left (patients right), colostomy on right (patients left)

Hernias

Caput medusea

Bruising

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12
Q

Abdo palpation

A

Palpate all regions superficially and deep

If mass is found
- shape, size, consistency, motility, location

Tenderness
Rigidity
Guarding

Hernias - are they reducable

Hepatomegaly - liver (hepatitis, leukaemia, haemolytic anaemia), spleen (haemolytic anaemia), kidneys (PKD, renal cell carcinoma)

Aorta - if fingers are pulled in then normal, if pushed away then enlarged

Bladder - warn patient prior

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13
Q

Abdo percussion

A

Liver and splenic edge

If ascites suspected then shifting dullness

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14
Q

Abdo auscultation

A

Bowel sounds
Aorta
Renal artery bruits
Rubs

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15
Q

How to end abdo exam

A

Thank patient
redress patient

examine any hernias, do PR and external genitalia exam if appropriate

summarise findings and plan management

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16
Q

Breast exam intro

A

Introduce self, check patient ID, explain procedure and gain consent, chaperone

Position patient sitting upright

Ask patient to remove all clothes from waist up, provide blanket for modesty

Ask patient about pain

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17
Q

Breast inspection

A

ask patient to rest hands on thighs to relax pec muscles

Look for
Asymmetry
Scars
Nipple changes - inversion or discharge, ask what is normal for patient
Skin changes - flaky skin, erythema, skin puckering or tethering, peau d’orange

Hands pushing into hips
- examine skin tethering
- masses
- nipples

Hands above and leans forward
- accentuates skin puckering and breast asymmetry

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18
Q

Breast palpation

A

Moving in concentric circles
- inspect for masses
- comment on location, size, shape, consistency, motility,
overlying skin changes
Inspect NAC for discharge
- colour, consistency and volume

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19
Q

Axillary exam

A

Inspect axilla for scars, masses, skin changes and lymph nodes

End examination

refer for rest of triple assessment

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20
Q

Cardio end of bed

A

Alert/drowsy/confused
Pain?
Hypoxic/cyanotic
SOB
Oedematous
Increased JVP
Pallor

Telemetry
ECG
GTN
Fluids

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21
Q

Cardio exam - hands and arms

A

Splinter haemorrhages, janeway lesions, oslers nodes (infective endocarditis)

Clubbing (congenital heart disease)

Xanthomata

Capillary refill time

Pulse - rate, rhythm, character both radial and brachial, radial radial delay

track marks

blood pressure

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22
Q

Cardio exam - neck

A

JVP

Carotid pulse

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23
Q

Cardio exam - precordium inspection

A

Scars - sternotomy, thoracotomy
Skeletal deformities
Pacemaker

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24
Q

Cardio exam - precordium palpation

A

Pacemaker
Apex beat
Thrills - across each valve for palpable murmur
Heaves - parallel to left sternal edge for palpable murmur

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25
Q

Cardio exam - precordium auscultation

A

Palpate carotid pulse whilst listening across each valve
Listen with diaphragm and bell

MURMURS
- Carotid arteries for bruits - ask patient to hold breath(Aortic stenosis)
- Lean forward (aortic regurg)

  • Lie on left - listen at mitral valve and then out towards axilla for bruits (mitral regurg). Listen at mitral valve with bell for mitral stenosis
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26
Q

Neuro upper limb general inspection

A

Scarring
Wasting
Involuntary movements
Fasiculations
Tremors

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27
Q

Neuro upper limb pronator drift interpretation

A

Patient should hold hands infront of them with palms facing upwards

If hands drift, then pronator drift is positive, indicating a UMN lesion

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28
Q

Neuro upper limb tone findings

A

Move patients arm for them, whilst they relax their upper limbs. Move all joints.

Spacistity is velocity dependant - increased tone with speed

Rigidity - tone is the same regardless of speed

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29
Q

Testing shoulder abduction

A

Dont let me push your arm down

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30
Q

Testing shoulder adduction

A

Dont let me pull your arms away from your sides

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31
Q

Testing elbow flexion

A

Dont let me pull your arms away

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32
Q

Testing elbow extension

A

Dont let me push you away

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33
Q

Testing wrist flexion

A

Try and push my hand down

34
Q

Testing wrist extension

A

Try and push my hand up

35
Q

Testing finger extension

A

Dont let me push them down

36
Q

Testing finger abduction

A

Do not let me push your fingers together

37
Q

What would a UMN and LMN lesion look like in the upper limbs >

A

Upper - extensors weaker than flexors
Lower - focal weakness

38
Q

MRC Scale

A

0 - no contraction
1 - flicker or trace of contraction
2 - active movement with gravity eliminated
3 - active movement agains gravity only
4 - active movement against gravity and resistance
5 - normal

39
Q

Nerves of reflexes in upper limbs

A

Biceps and brachioradialis - C5/C6
Triceps - C7

40
Q

What do reflexes look like in upper and motor neurone lesions?

A

UMN - hyperreflexia
LMN - hyporeflexia

41
Q

What tracts are tested in sensation?

A

Spinothalamic and dorsal column

Soft touch - both
Pin prick - spinothalamic
Vibration sense - dorsal column

Proprioception - dorsal columns

42
Q

Dermatomes of upper limbs

A

c5 - regimental badge
c6 -Thumb
c7 - middle finger
c8 - little finger
T1 - medial aspect of arm

43
Q

Testing upper limb coordination

A

Finger to nose
Dysdiadokinesia

44
Q

Lower limb neuro examination

A

Scars
Wasting
Involuntary Movement
Fasiculations
Tremor

45
Q

Assessing Gait

A

Assess walking normally, heel to toe walking, rombergs test

46
Q

How to test tone in lower limbs ?

A

Clonus and leg rolling

47
Q

Testing power in hip flexion and extending

A

Flexion - dont let me push leg fown
Extension - push my hand down

48
Q

Testing power in knee extension and flexion

A

Flexion - pull me towards
Extension - push me away

49
Q

Testing power in dorsi and plantarflexion

A

Dorsiflexion - dont let me push down
Plantarflexion - push my hand down

50
Q

Testing power in toes

A

Dont let me push big toe down

51
Q

UMN vs LMN in lower limbs when testing power

A

UMN - flexors weaker than extensors
LMN - focal

52
Q

Nerves for reflexes in lower limb

A

Knee jerk (l3,l4)
Ankle jerk (s1)

Plantar reflex - babinskis sign (l5, s1)

53
Q

Dermatomes for lower limb

A

l1 - inguinal
l2 - anterior thigh
l3 - medial aspect of thigh
l4 - lower leg and ankle
l5 - big toe
s1 - little toe

54
Q

How to test co-ordination in lower limbs

A

Heel shin test

55
Q

End of bed hip exam

A

Patient in pain
Leg obviously deformed
Walking aids
Wheelchair

Gait (if walking into room/from bed to chair)

56
Q

Hip Exam - Look

A

Expose hip adequately

Bruising
Swelling
Erythema
Quadriceps muscle wasting
External or interal rotation
Skin changes
Body habitus

57
Q

Hip exam - feel

A

Temperature of joint

Feel hip joint

Leg length discrepancy

58
Q

Assessing leg length discrepancy

A

Apparent - medial malleolus to the umbilicus
True - medial malleolus to ASIS

59
Q

MSK Hip - Move

A

Active hip flexion - knee to chest
Active hip extension - straighten leg out

Passively flex, extend, adduct, abduct, externally and internally rotate

Thomas’s test - if positive, fixed flexion deformities

Trendelenberg’s test- hip abductor weakness

60
Q

What does trendeleberg gait indicate?

A

Unilateral hip abductor weakness = l5 radiculopathy or gluteal nerve lesion

61
Q

What does a waddling gait indicate?

A

Myopathies such as Duchenne’s

62
Q

MSK Knee - look

A

Assess body habitus, walking aids and gait

Bruising
Redness
Swelling
Psoriatic plaques
Popliteal cysts
valgus and varus deformities

63
Q

MSK knee Feel

A

With knee extended
- temp of joint
- patella, joint spaces
- quadriceps bulk
- tibia

With knee flexed
- joint lines
- patella
- popliteal fossa

?Effusion
- sweep test
- patellar tap

Look for posterior sag

64
Q

MSK Knee - move

A

Active knee flexion and extension
Passive knee flexion and extension

Anterior draw test
Posterior draw test

65
Q

MSK Elbow - look

A

Scars, swelling, bony deformities, muscle wasting, redness, bruising

Body habitus, carrying angle, psoriatic plaques, fixed flexion deformities

66
Q

MSK elbow - Feel

A

Temperature

Olecranon process
Medial epicondyle (golfer’s elbow)
Lateral epicondyle (tennis elbow)
Radial head
Biceps tendon

67
Q

MSK elbow - move

A

passive and active - flexion, extension, supination and pronation

68
Q

What is the test for medial epicondilitis ?

A

Feel medial epicondyle with one hand then ask patient to flex wrist against restistance

69
Q

What is the test for lateral epicondylitis?

A

Feel lateral epicondyle with one hand and then ask patient to extend wrist against resistance

70
Q

Look - wrist and hand

A

Swelling, bruising, erythema, bony prominences, muscle wasting, psoriatic changes, oncholysis and nail pitting

Signs of rheumatoid arthritis - z thumb, boutinneres, swan neck deformites

Signs of osteoarthritis - bouchards and heberdens

71
Q

Feel - wrist and hands

A

Temperature
Palpate each joint bimanually
Feel for muscle wasting

Sensation and thenar and hypothenar eminence

MCP Squeeze
Anatomical snuffbox

72
Q

Move - wrist and hand

A

Active and passive flexion and extension

Squeeze my fingers

Pincer grip

Pick up a small object

73
Q

What is Tinels test?

A

Positive if patient feels tingling over thumb and medial section of index and middle finger = medial nerve compression

74
Q

What is phalens test?

A

Push dorsal aspect of hands together = pain equals carpal tunnel

75
Q

MSK shoulder - look

A

Look for any shoulder asymmetry
Bruising
Redness
Swelling
Rashes
Muscle wasting
Scars
Scoliosis
Winged Scapula

76
Q

MSK shoulder - feel

A

Shoulder joint
- AC joint
- SC joint
- Acromion
- Clavicle
- Coracoid process of scapula
- Head of humerus
- Greater tubercle of humerus
- Spine of scapula

77
Q

MSK Shoulder - Move

A

Active and passive
- extension, flexion, adduction, abduction, external rotation, internal rotation, scapular rotation

78
Q

MSK Spine - look

A

Deformities

Cervical and lumbar lordosis
Thoracic kyphosis

Swelling
Bruises
Body habitus

Gait

79
Q

MSK Spine - Feel

A

Down spinous processes and paraspinal muscles

80
Q

MSK Spine - Move

A

Cervical spine
- flexion, extension, lateral flexion, rotation

Thoracic spine
- rotation

Lumbar spine
- flexion
- extension
- lateral flexion

Sciatic nerve test

Final Osce (4 decks)

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