Examinations Flashcards
What is the general structure of an examination of a lump or ulcer?
Look
Feel
Move
Specific tests - transillumination/auscultation
Regional lymph nodes
What would you do to complete a respiratory examination?
Sputum sample, peak flow, sats, CXR
What would you do to complete a cardiovascular examination?
Femoral pulses, ophthalmoscopy, 12 lead ECG, lying and standing BP, sats
Which tuning fork do you use for vibration?
128Hz
What do you do in the coordination section of the upper limb neuro exam?
pronator drift, finger to nose test, finger to own nose with eyes closed, thumb to fingers, dysdiadokinesis, identify coin in hand
What do you do in the coordination section of the lower limb neuro examination?
Heel-shin test, gait, rhomberg’s test (eyes open, arms out in front, then eyes closed), ankle clonus
What would you do to complete an upper and lower limb neuro examination?
Pain and temperature sensation, nerve conduction studies if indicated, MRI brain/spine, vascular exam of the area
What tuning fork is used for hearing?
512Hz
What would would you do to complete a cranial nerve examination?
Jaw-jerk reflex, gag reflex, corneal reflex, colour vision, ophthalmoscopy, upper and lower limb neuro exam, cerebellar exam, pain and temperature sensation
What are the components of a cerebellar exam?
Speech (british constitution), finger to nose test, H test for nystagmus, dysdiadokinesia, ataxia, stance, heel to toe test, rhombergs
What is murphy’s sign?
Gallbladder inflammation - press on right costal margin during expiration - patient inspires and it is painful. Repeat on left side and there should be no pain
What are cullens and grey turners signs?
Cullens = bruising around the umbilicus, grey turners - bruising around the flanks
What would you do to complete an abdominal examination?
Inguinal lymph nodes, stool sample, hernial orifices, rectal examination, urinalysis, genitalia
What do you do in a GALS exam?
- screening questions
- inspection
- gait
- spine (lumbar spine flexion, neck lateral flexion)
- shoulders (hands behind head)
- wrist and hands (MCPs, fist, grip strength, finger to thumb)
- legs (knee flexion, internal and external rotation of the hip, patella tap)
- feet (squeeze MTPs)
How would you complete a gals examination?
Do a full examination of any areas that were highlighted as abnormal on the screening test. Do a neurological examination of that area and imaging if required
What is Thomas’s test?
Assessment of a fixed flexion deformity of the contralateral hip. Put hand under spine while lifting leg
What is Trendelenburg’s test?
Ask patient to stand on one leg and feel the hips and look for hip drop
What would you do to complete a hip/knee examination?
Neurological and vascular examination of the lower limb, appropriate imaging, msk exam of adjacent joints
What is McMurray’s test?
A test for a torn meniscus, straighten leg in external and internal rotation
What do you do in a spine examination?
- Look, feel spine
- cervical spine - up, down, left right, ear to shoulder
- thoracic - left and right rotation
- lumbar - flexion, extension, lateral flexion
- schober’s test (10cm above PSIS and 5cm below)
- percuss spine
- gait
- straight leg raise, bowstring test, femoral stretch test
How would you complete a spine examination?
Neurological examination of the upper and lower limbs, msk exam of adjacent joints
Which muscles abduct the arm?
first 15 - supraspinatus
15-90 - deltoid
90 + - serratus anterior and trapezius
What muscle does the lift-of test test for?
subscapularis
How would you complete a shoulder examination?
Msk exam of elbow and spine, neurological and vascular exam of the upper limb
What do you have to do in a hand examination?
-Look, feel hands and elbow, temp, muscles, joints
- sensation - dermatomes and nerves
- vascular - allen’s test, both pulses
- move - fingers, thumb wrist (active then passive)
- function - grip strength, pinch grip, precision
What median nerve special tests do you do?
- median nerve sensation
- thumb abduction - power
- tinels - tap
- phalens - upside down prayer - 1 min
- compression test
What ulnar nerve special tests do you do?
- ulnar nerve sensation
- cross middle and index finger
- pick up paper
- abduct fingers against resistance
What radial nerve special tests do you do?
- sensation in anatomical snuffbox
- wrist and finger dorsiflexion against resistance
How do you do a peripheral vascular examination?
- hands (radial, ulnar pulses, allen’s test)
- face: carotid pulses (listen then feel), eyes, lips, tongue
- examine abdomen and limbs
- palpate: aorta, femoral, popliteal, dorsalis pedis and posterior tibial pulses
- fine touch and cap refill in toes
- power in foot
- auscultate: carotids, subclavian, aorta, femoral arteries
- buerger’s test 2 mins
What is a buerger’s test?
Patient lying down, elevate legs to 45 degrees, hold for 2 mins, patient then hangs legs over the bed, look for colour changes
How would you complete a peripheral vascular examination?
Blood pressure in upper and lower limbs, sats, doppler, ankle-brachial pressure index (highest BP at ankle, divided by highest BP in arms)
How do you do a varicose vein examination?
- inspect legs standing and lying
- identify sapherofemoral junction (4cm lateral and inferior to public tubercle)
- cough test with finger over SFJ
- tap on SFJ
How would you complete a varicose vein examination?
Tourniquet test, perthes test, dopper US of leg, vascular and neuro exam of lower limb
What do you do in a thyroid examination?
Hands, tremor, pulses, forearm muscles
face - eyes from all angles, H test, visual acuity
inspect neck from front - water and tongue
palpate - trachea, thyroid, tongue, water
lymph nodes
percuss upper sternum
auscultate for bruits
proximal muscle weakness
ankle reflexes and oedema
How would you complete a thyroid examination?
Thyroid panel bloods, fundoscopy, CXR - thymoma
What do you do in a diabetic foot examination?
- gait, SHOES, feet and legs
- palpate bones and joints of the foot and ankle
- temperature
- pulses - knee, 2 feet
- capillary refill
- ankle reflex
- light touch, pressure, vibration and proprioception
How would you complete a diabetic foot examination?
pin prick and temp sensation, femoral pulses, neurological and vascular examination of the lower limb
How do you structure the presentation of findings?
Today I performed a … exam on … a … year old M/F, on general inspection they looked comfortable at rest. There was nothing around the bedside to indicate … pathology.
