Examinations Flashcards
Neurological Exam: According to Dr. C
Sitting: EOM, Facial, Open mouth (ahh), finger-nose, SCM/shrug
Standing: Arms (add/abd/ flex/ext), squat, walk on (toes/heels/ tandem), Romberg,
Sitting: Knee (flex/ext), plantar/dorsi, reflexes (bicep - 5/6, tricep - 7/8, knee - 3/4, Achilles - 1/2)
Lie down: hip (add/abd), ankle clonus, Babinski
PMR?
Watch out for Giant Cell Arteritis usually related - need to be aware of vision deficits start Prednisone right away then biopsy. Use ~60mg Prednisone.
For PMR look for fatiguability of the shoulder abduction
Approach to confusion
Drugs
Infection
Metabolic (including e-lyte abnormalities)
Structural
Need to fill out a death certificate?
Accidental - would they have died if this event hadn’t occurred? If there is trauma involved - like a fall - it is accidental
If people are concerned tell them you will consult coroner, and if death is not natural (other categories - accidental, murder, suicide, unknown)
Exam for a Headache?
Full NEURO exam, along with Romberg, and gate assessment
Pediatric interview?
Peeing
Intake
Sleeping
Stooling
Pre-birth - exposures, genetic concerns, GBS/ HIV, did they get normal prenatal care?
Peri-birth - term, delivery, how long in hospital?
Post-birth - any medical/surgical problems, immunizations and follow ups?
Admission Orders?
Admit - patient age, reason for admission, time span
Diagnosis
Diet - NPO, Full, diabetic, low salt etc
Activity - bed rest, with or without bathroom privilages, PT assessment?
Vitals - how often? Neurovitals?
Investigation - what imaging and blood work do we want
Drugs - usually - gravol/zofran, acetaminophen for pain and fever 500 PRN, bowel care, anticoagulants, O2 for sats above ____, Ativan standing if risk of seizures and a BPMH
CODE STATUS
Sexual Health Conversation?
5Ps Partners Practices Protection Past hx of STI Prevention of pregnancy
Can start by prefacing - I ask this to all of my patients, are you sexually active, do you have concerns, mention some common risk factors.
Have a new patient on way too many opioids?
Start with empathy. Take a through history. Be firm and clearly outline what your limits are to both yourself and your patient.
The hardest part will be convincing the patient to taper. But outline the success stories, figure out what is important and what they have given up because of the pain.
Look at the dosing regime. Shorten dosing schedule. Take urine drug screens (with consent). Start a good working relationship with pharmacist.
Start off with reducing dose by 25-50%. Stop PRNs, and switch to long acting. Switch route of medications/ type of drug if you suspect abuse. Taper by 10% per week, slowing as you get lower.
Re-explore alternative medications and other methodologies.
Writing referral letter?
Can give a quick summary, with desired intervention/ reason for referral.
Thank you for seeing this AGE, SEX, (who is known to you from related or unrelated complete) PRESENTING CONCERN. Relevant LABs and INVESTIGATIONS.
PHYSICAL EXAM RESULTS. OTHER RELEVANT HX.
I am referring for ____________________.
Thank you
Trans health resource?
Sherbourne Clinic - http://www.transforumquinte.ca/downloads/Guidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2019.pdf
Someone comes in with altered LOC
Coma cocktail = D50, thiamine, naloxone
Death in psychiatric facility, death in a jail, death in workplace
Call the coroner
Components of diabetic interview?
Eye exam, foot care/ peripheral neuropathy, comment on A1C, TSH, eFGR, smoking, diet and exercise, BP, up to date with vaccines, cholesterol, consider cardiac risk factors for further work up
Tips for Paras/Thoras
Loosen the catheter where it screws on to the needle first. Don’t skimp on freezing, esp. when it comes to the pleura and peritoneum. If it is too easy, you are in the cavity, freeze as you pull back
Canadian CT guidelines?
GCS less than 15, Vomiting, Basal skull fracture signs, depressed skull fracture, age >65
Psych Hx
Past medical (psychiatric) history and social history especially important and very comprehensive (past psychiatric diagnoses, past treatments, past traumas, incarcerations, previous suicide attempts) (relationships, living arrangements, employment including medical coverage, childhood, level of education, relationships with family members, etc).
Intoxicated patient
Separate them from their stuff - may contain toxin
Tox Hx?
What did they take When did they take How much did they take Has any come back up What else did they take Why did they take it
How reliable is it? Choose the worse one and act as if true.
Reasons to return?
Be specific and warn them that it might get worse before it gets better.
If they are unable to manage the pain at home
If they are unable to keep any fluids down/ take medications
If they are worsening/ no improvement within X days/hours
These are the alarm symptoms. This is how I expect the course to go.
Abdominal wall pain vs intra-abdominal?
Get them to clench, push down and then get them to relax - does the pain go away
Intubation advice
SLOWLY inch the laryngoscope down, lift up to back corner, lube the stylet lightly, and don’t slide it past the monkey’s eye, listen to the lungs, get the CO2 monitor on.
Approach to Trauma
A - Hello, what’s your name, what happened? Take a look in the mouth, inhalation?
B - is it equal at the chest, distress, palpate for tenderness, crepitus, look, listen - are there breath sounds? Equal? Anything else? Rate? SPO2
C - Fem pulses, heart sounds - yes? Distant? Major murmurs? Start 2 IVs, BP and on the monitor, type and cross 4L
D - pupils, GCS/ AVPU
E - strip, log roll, spine, DRE (bleed, tone, sensation)
Move to secondary - head to toe - don’t forget contacts, tampons, all the folds.
Setting a proximal phalanx fracture
Use a capped 18 gage or similar, place in the meeting place of the joints, at a perpendicular angle to the finger, press inwards as you lever the finger up and over the capped needle to provide a fulcrum
Shoulder reduction of a dislocation
Sedated pt. Take a sheet and tie it around your waist, slip the pt forearm up into the loop, so elbow is bent at 90 and hand is facing away from you. Take an open hand at the wrist to adjust the angle. Other hand is at the shoulder joint. Use your body weight to pull the shoulder down, and adjust angle as needed.
Make sure some else is applying counter traction.
Internal medicine case presentations
ID, PMHX, RFR, HPI, SocHx/FHx, PEx and Investigations, Plans
