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Phase 3 Exams > Exams > Flashcards

Exams Flashcards

1
Q

Peripheral CV

A

Gen obs incl vitals
Inspect: VULCER + ALI signs + Charcot foot
Palpate: cap refill, temp, oedema, SENSATION, pulses (incl radiofemoral)
Ausc: femoral, abdominal, renal
Special tests: Buerger’s, Trendelenberg’s, Perthes; ABI, motor, reflexes

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2
Q

Breast

A

tba

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3
Q

ENT

A

Ears: inspection, palpation, auroscopy, hearing
Nose: inspection, palpation (tenderness, swelling)
Throat: inspection, palpation (tongue, salivary glands, cervical LN)

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4
Q

Eyes

A

Inspection: ptosis, sclerae, exophthalmos, corneal ulceration
CN
Colour vision
Fundoscopy: ideally dilate; medium light, red reflex, find retina, find optic disc
Palpate orbits: tenderness
Preauricular node

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5
Q

Neuro CN

A 
Smell
Visual acuity, fields, fundoscopy
Pupils, eye movements
Corneal reflex
Facial sensation
Muscles: mastication, facial expression (incl Bell's phenomenon)
Hearing (inspect, 68, 100, Rinne's)
Hallpike manouevre
Palate, pseudogag, speech/cough, swallow water
Tongue
Neck mm
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6
Q

Neuro UL

A 
Observation
Shake hands
Inspection
Palpation
Tone
Power: incl ulnar and median nerve
Reflexes
Coordination: finger-nose, dysdiadochokinesis, rebound
Sensory
Other: nerve specific, other neuro areas
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7
Q

Neuro LL

A

Inspection
?Gait, Romberg’s
Palpation
Tone (incl clonus), power, reflexes, coordination
Sensory incl saddle anaesthesia, anal reflex
BACK: deformity, tenderness, SLR

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8
Q

Cerebellum

A 
Face: nystagmus, British constitution, 
UL: finger-nose, dysdiadochokinesis, rebound
LL: heel-shin, toe-finger, foot tapping
THEN
trunk: sit up with your arms crossed
pendular knee jerks
gait incl heel-toe

Consider

  • CN
  • fundi
  • Romberg’s
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9
Q

Skin

A

Look at all the skin, starting at the hands, going up to the head (AND NECK), trunk, legs, feet

on the way:

  • nails
  • hair and scalp
  • eyebrows
  • between the toes

Consider

  • LN
  • CV + neuro
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10
Q

Neuro Speech

A

Handedness and orientation
Free speech: describe my shirt
Comprehension: without language (following three/two step instructions)
Nominal speech
Repetition: no ifs, ands or buts
Cerebellar: dysarthria first (ppp, ttt, kkk) then the phrases

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11
Q

Central CV

A

Inspection: rheum things that predispose, dyspnoea
Hands: nails (clubbing, cap refill), xanthomata, pulse (incl radioradial, radiofemoral)
BP
Face: eyes, malar flush, mouth (cyanosis, dentition)
Neck: JVP and carotids
Prae: inspect, palpate, auscultate (incl dynamic manouevres)
Back: inspect, peripheral oedema, percuss for pleural effusion, ausc for LVF
Abdo: organomegaly/pulsatility, ascites, femoral arteries
Other: legs, urinalysis, fundi, temp (….all IE?!)

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12
Q

Resp

A

Gen obs
Vitals
Hands: ?intrinsic wasting + wrist tenderness, asterixis
Face: ?horner’s, hoarseness, Pemberton’s sign
Trachea
Chest: don’t forget cervical LN
Prae: resp and CV
Other: forced expiratory time, lower limb oedema/cyanosis, breasts?

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13
Q

Gastro

A

Gen obs
Hands: liver (incl clubbing), palmar, asterixis
Arms: bruising, excor
Face: eyes, mouth (infection, deficiencies + fetor), parotidomegaly
Prae: veins, gynaecomastia
Abdo: inspect, AUSC, palpate, percuss (liver, spleen) incl shifting dullness
Groin: LN, ?hernia
Lower legs: oedema
PR:
position (L lateral with knees up)
inspect incl when straining
palpate: saddle anaesthesia, wink reflex, anal tone; feel anteriorly and get them to strain (?rectocoele), go in deep and then slowly withdraw, get them to squeeze as you withdraw
INSPECT GLOVE

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14
Q

Liver

A

Gen obs
ORIENTATION
Hands: clubbing, leukonychia, koilonychia, Muerke’s lines, palmar erythema/crease pallor
Arms: asterixis, bruising, acanthosis nigricans
Face: eyes, parotidomegaly, tongue (deficiency), fetor
L supraclavicular node
Prae: veins, gynaecomastia
Abdo: caput medusae, tenderness, organomegaly (?pulsatile), ascites
Legs: oedema

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15
Q

Renal

A

Goals: look for

1) medical consequences: AEIOU (mostly anaemia, fluid overload and uraemia)
2) medical treatments: AV fistula, vascath, transplant
3) potential ~causes: prostate, urinalysis, BP, fundoscopy

Gen obs: uraemic tinge, wasting, unwell
VITALS: BP (sitting, standing)
Hands: leukonychia, pallor
Arm: FISTULA, asterixis, excoriations, bruising, myopathy
Face: pallor, rash
Neck: JVP, carotid bruit, vascath/scar
Abdo: inspect (scar), palpate (incl ballot kidneys, feel in pelvis for third kidney, bladder), ascites, LN
PR: prostate
Chest, lower legs, back (nephrectomy scar, oedema)
Urinalysis, fundoscopy

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16
Q

Gynae

A

Abdo: inspect, palpate, ausc
Bimanual: inspect, palpate incl CET
Speculum: smear if necessary

17
Q

Obs

A

Gen obs: gait, distension, pallor
Inspection: striae, scars
Palpation: fundal height, presenting part, station, lie, fetal heart
Urinalysis, BP

18
Q

Hernia

A

vad stolt jag ar!!

(standing)
Gen obs
Inspect: surg scars, lumps, hernia (with and without cough)
Palpate: with and without cough

(lying)
same except try to reduce

Check scrotum

19
Q

Testicular/uro

A

Gen obs (eg parotidomegaly)
Inspect while standing, then lying: scars, oedema, inflammation
Penis (incl glans): ?ulcers, ?discharge
Testis: palpate - ?size, consistency, axis, tenderness, mass (can you get above it, is it separate from the testis/epididymis, is it hard or soft, is it transilluminable)
Epididymis
Vas deferens
Spermatic cord: ?varicocoele

20
Q

Haem

A

Gen obs: weight, bruising, ulceration/rashes, cyanosis/plethora, jaundice, scratch marks
Hands: nails, palmar crease pallor, pulse
Epitrochlear, axillary nodes
Face: scleral icterus/injection, conjunctival pallor; atrophic glossitis/angular stomatitis, ulceration/infection, gum hypertrophy
Cervical and supraclavicular nodes
Bone (spine, sternum, clavicle, shoulders): ?tenderness
Abdo: organs
Inguinal nodes
Testes
Lower limbs: vasculitis, bruising

signs of pancytopaenia/cytosis
signs of causes: deficiencies (, cancer)

21
Q

Hip

A

Gen obs: incl gait
Look: scars, deformity (incl external rotation)
Feel: just distal to inguinal lig midpoint
Move: flexion, extension (Thomas’s test), rotation, abduction, adduction
**proper extension on back
Special tests: leg length (ASIS to medial malleolus; umbilicus to medial malleolus), SLR, Trendelenberg

22
Q

Knee

A

Gen obs: incl gait, varus/valgus
Look: skin/joint/muscle
Feel: skin/joint (line and patella), muscle
**Special tests: patellar tap, bulge sign
Move: flex-ex
Special tests: ant/posterior draw; MCL/LCL, McMurray’s, patellar apprehension

ON BACK: Baker’s cyst, ?Apley grind

23
Q

Shoulder

A 
Gen obs
Look: skin/joint/muscle
Feel: all along bones and joint margin
Move: active then passive
Special tests: 
- joint - apprehension
-biceps: flex against resistance
- supraspinatus: beer can
- infraspinatus and teres minor: pushing out against high-fiving self
- subscapularis: lift-off
24
Q

Hands

A

Gen obs: weight, eye signs, obvious deformity etc
Look: skin/joints/muscle - dorsum, MCPJ, PIPJ, nails
Feel: wrists, MCPJ, PIPJ
Move: active movement
Function: grip strength, key grip, opposition, practical things
Special tests: CTS, palmar crease pallor, palmar tendon crepitus

Elsewhere: elbows, other joints, ?systemic

25
Q

Thyroid

A

Gen obs: mood/energy/weight/dress

Peripheral signs:

  • hands: tremor, nails, peripheral cyanosis, palmar erythema/pallor, pulse, sensation (CTS), prox myopathy, reflexes
  • eyes: Graves (proptosis and consequences incl visual field defects), thyroid ophthalmopathy (lid retraction, lid lag)
  • gynaecomastia, ?CCF
  • pretibial myxoedema

Inspection: scars, veins, goitre (better seen in extension) - w swallowing, tongue out
Palpation (from behind without and while swallowing and then in front): thyroid +/- nodule (size, shape, consistency, tenderness, mobility), LN
Percussion: ?retrosternal
Auscultation: over each lobe ?bruit

26
Q

DM

A

Gen obs: obesity, dehydration (osmotic diuresis), endo facies (Cushings, acromegaly)
LEGS
-inspection: incl injection in thighs, diabetic amyotrophy, toe deformities, Charcot’s joints (early sign - loss of medial and longitudinal arches)
-palpation: cap refill, pulses, injection sites; neuro exam
Upper limbs: postural BP, acanthosis nigricans
Face: visual acuity + fields, pupil reflexes (?Argyll-Robertson), eye movements, fundoscopy, mouth candida, carotid bruit
Abdo: ?hepatomegaly (metabolic syndrome)
Urinalysis

27
Q

Neuro higher centres

A

Gen obs
Orientation
and handedness
Speech
Parietal lobe: Gerstmann’s syndrome, neglect (visual, tactile, spatial), constructional apraxia
Temporal lobe: short and long term memory - flowers, date of WWII
Frontal lobe: primitive reflexes, interpret a proverb, smell, gait, fundi
visual fields

28
Q

Hydration

A

Vitals: BP (and HR) - lying, sitting, standing
Arms: cap refill, dry axillae
Neck: JVP
Face: sunken eyes, dry mucous membranes, dry tongue
Chest: hyperdynamic apex beat, bibasal creps, sacral oedema
Legs: oedema
Weight

29
Q

Spine

A

Gen obs
Look (PA and lat): symmetry, alignment
Feel: spinal and paraspinal tenderness
Move: flex-ex, lateral bending, rotation (on a stool)
Special tests: Schober’s test, SLR, sacroilitis (push ASIS apart, push on dimples of Venus)

Other: lower limb neuro

30
Q

AV Fistula

A

Gen obs
Inspect: scars, inflammation, collateral veins, downstream ischaemia, arm elevation test
Palpate: thrill, augmentation
Ausc: soft bruit

complications

  • inflammation
  • stenosis: no venous pulsation on venous occlusion (augmentation test), high pitched thrill
  • steal: downstream ischaemia
  • obstruction: fistula doesn’t collapse on arm elevation
31
Q

MSE

A

Appearance
Attitude: cooperative/ friendly/ trusting/ rapport
Behaviour: psychomotor, restlessness
Mood: euthymic/ dysphoric/ apathetic/ angry/ euphoric/ apprehensive/ alexithymic
Affect: intensity, range, lability, mood congruence, reactive/appropriate to conversation
Speech (fluency, tone (part of prosody), loudness, amount, spontaneity)
Thought process (loosening of associations, flight of ideas, tangentiality, derailment), content (delusions, phobias, paranoia)
Cognition: alertness, orientation, memory
Perception: derealisation, hallucination, illusion
Insight
Judgement (can they look after themselves after they’re out): what would you do if you were in a burning building; what would you do if you saw an envelope on the ground

32
Q

Baby check

A

Observe: tone, resp distress
Ausc: heart
Skull: fontanelles, sutures
Head: ears, nasal septum, cleft palate and sucking reflex; red reflex
Arms: palmar crease, right number of fingers, grasp reflex
Abdo: masses, umbilicus, genitalia (incl descended testes), femoral pulses
Legs: Barlow and Ortolani, creases, toes
Back: spine, perforate anus
Moro reflex

Phase 3 Exams (13 decks)

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