Exams Flashcards
Peripheral CV
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
Breast
tba
ENT
Ears: inspection, palpation, auroscopy, hearing
Nose: inspection, palpation (tenderness, swelling)
Throat: inspection, palpation (tongue, salivary glands, cervical LN)
Eyes
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
Neuro CN
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
Neuro UL
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
Neuro LL
Inspection
?Gait, Romberg’s
Palpation
Tone (incl clonus), power, reflexes, coordination
Sensory incl saddle anaesthesia, anal reflex
BACK: deformity, tenderness, SLR
Cerebellum
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
Skin
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
Neuro Speech
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
Central CV
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?!)
Resp
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?
Gastro
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
Liver
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
Renal
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
Gynae
Abdo: inspect, palpate, ausc
Bimanual: inspect, palpate incl CET
Speculum: smear if necessary
Obs
Gen obs: gait, distension, pallor
Inspection: striae, scars
Palpation: fundal height, presenting part, station, lie, fetal heart
Urinalysis, BP
Hernia
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
Testicular/uro
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
Haem
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)
Hip
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
Knee
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
Shoulder
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
Hands
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
Thyroid
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
DM
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
Neuro higher centres
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
Hydration
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
Spine
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
AV Fistula
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
MSE
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
Baby check
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
