Exams- Full Flashcards
Cardio Exam
Expose + Position Wash Hands Inspect- ?marfans, dyspnoea Hands- clubbing, signs IE, cyanosis, xanthomata, anaemia Pulse + radio-radial BP- <40, >70 Eyes- arcus, pallor, xanthelasma Mouth- palate, dentition, cyanosis Neck- JVP, carotids CHEST Obs- scar, deformity, device Palpate- apex, heaves/thrills Ausc x 4 (start bell at mitral area) Murmur- insp/exp, carotid/axilla Positions(left lateral, sit up full expiration)- palpate, ausc Manouvres- valsalva, isometric Complete Back- percuss, auscultate, oedema Abdo- Liver Legs- Oedema Proceed - Peripheral pulses, - UA, temp for IE - Fundoscopy HTN IE Ask ECG, CXR, Echo
Respiratory Examination
Expose + Position Wash hands Sputum Mug Voice + Cough Hands- clubbing, cyanosis, staining, wasting, anaemia Finger Abduction HPOA Rep Rate + Pulse Asterixis Pembertons Forced Expiratory TIme Eyes- horners, anaemia Mouth-cyanosis Trachea- position, tug POSTERIOR CHEST Obs- scar, deformity, RTx Palpate- supraclav + cervical LNs, oedema, expansion (inc observe supraclav- upper lobe), fremitus (back + axilla) Percuss Ausc- BS + resonance ANTERIOR CHEST Obs Palpate- axilla LNs, expansion, fremitus Percuss Ausc- BS + resonance CV exam Reposition JVP Apex beat Auscultate Liver Peripheral oedema Proceed - Temperature chart - Fundi - CO2 If ?Ca or effusion- examine breasts, abdomen, rectum, LNs
Gastrointestinal Examination
Expose + Position Wash hands Observe- pigment, xanthomata Orientation/mental state Hands- clubbing, leukonychia, palmar erythema, duyuytrens, arthropathy Asterixis Arms- naevi, bruise, wasting, scratches Face Eyes-jaundice, anaemia, iritis, kayser-fleischer Parotids Mouth/lips/tongue/gums- stomatitis, leukoplakia, ulcer, pigment, gingivitis, gum hypertrophy, glossitis LNs- Cervical + axillary + supraclav Chest- gynaecomastia, hair, naevi Abdo Obs- scar, distension, veins, striae, bruising, masses. Deep in and out breath Feel - light, deep - Liver + percuss - Spleen + percuss - Kidneys + ballot Ascites Ausc - kidneys, spleen, liver, bowels, portal venous hum Groin- LNs, hernias Legs- bruise, oedema, neuro signs Proceed - rectal exam - UA - BP - CV exam - Neuro - Temp chart
Neck Exam
Expose + position Wash hands Voice Pembertons Observe neck front + side (scars, swelling, veins) Swallow POSTERIOR palpation- size, shape, consistency, borders (esp lower), mobility, nodules, pain LNs- cervical, supraclavicular ANTERIOR palpation Carotid pulse + pulse rate Trachea position SCM function Manubrium percussion Auscultate- thyroid, carotids PROCEED Hyperthyroid- - Eyes- exopthalmos (sclera below cornea) lid retraction (sclera above), conjunctival chemosis, Proptosis, Eye movements (lid lag, ophthalmoplegia) - Arms- tremor, nails (onycholysis, clubbing), palmar erythema, pulse rate + rhythm + collapsing, proximal strength, tap reflexes Legs- Pretibial myxoedema, vitiligo, proximal strength, reflexes Other- cardiac exam, abdo exam, If thyroidectomy scar- Chvosteks (facial nerve) Trousseaus (BP cuff) Hypothyroid -Hands- cyanosis, skin cold and dry, pallor palm - Arms- pulse, tinnel/phanels, delayed relaxation biceps jerk, proximal weakness - Eyes- oedema, eyebrow hairloss, xanthomata - Hair- alopecia - Sensorineural deafness - Legs- delayed ankle jerk, peripheral neuropathy, proximal weakness, cerebellar syndrome - Chest- pleural/pericardial effusions
Haem Exam
Position, expose, wash hands Observe- pigment, jaundice Hands- nails, palm pallor Arms- bruising, scratch marks, vasculitis LNs- epitrochlear, axillary Eyes- jaundice, pallor, injected sclera polycythaemia, haemorrhage Mouth- gum hypertrophy, ulcers, candida, glossitis, stomatitis, Tonsils + adenoids POSTERIOR EXAM LNs- Cervical, supraclavicular Spine tenderness Hip Tenderness Abdominal Exam Inguinal nodes Legs- ulcers, sensation
Hand Exam
Position, expose, wash hands Observe-cushingoid, washes, aids, other joints Eyes- iritis/scleritis Elbows/arm movements- rash, nodules SCREEN- open and close hands (tendon ruptures, fixed flexion deformities) LOOK FEEL MOVE General- scars, redness, pain, swelling, deformity, synovitis, ROM —DORSAL Skin atrophy/bruise, rashes, vasculitis, sclerodactyly, sausi fingers, muscle wasting Nails- psoriatic changes Wrist+ ulnar styloid pain MCs- MCPJs- (ulnar deviation, volar subluxation), PIPJ/DIPJ- (swan neck, boutonniere, z shape thumb)(bouchards PIP, heberdens DIP) —PALMAR Scars, erythema, muscle wasting, palmar tendon crepitus Special tests - Phalens Tinnels Function - Undoing button - Key grip - Grip strength - Opposition strength Neuro - Median nerve- sensation thumb, power thumb abduction - Ulnar nerve- sensation pinky finger, power finger abduction Proceed- other joints, further neuro ax, rash ax, lungs, heart, spleen ask- XR, serological tests
Cranial Nerve Exam
Expose, position, wash hands Obs- scars, neurofibromata, facial asymmetry, ptosis, skew, Dx facies Smell Eyes= 6 (3, 4, 6) - Acuity - Fields + blind spot - Colour vision - Fundoscopy (4)- retina, vessels, optic nerve, macula - Pupils (4)- shape/size, direct, consensual, RAPD, accommodation - Eye movements (3)- screen, cross, saccades Face sensation (5) - sensation x 3- (pain only= pontine, light touch only= medullary/upper cervical) - Corneal reflex - Muscles mastication - Jaw jerk Face movement (7) = 4 (2 eyes, 2 mouth) Ears (8) - screen, webers, rinne= 256 Throat (9 + 10) - uvula +/- gag - hoarseness, cough Shoulders (11) - SCM, Trap Tongue (12)
Upper Limb Neuro Exam
Expose, position, wash hands Obs- facies, obvs stroke, abno movements, cafe au lait Neck- scars Arms/shoulder girdle- wasting, fascic, tremor Screen + pronator drift- arms out, palms extended, eyes closed Palpate- muscle bulk, thickened nerve (ulnar elbow, median and radial wrist) Tone Reflexes x 3 + hoffman (flick ext, flexion thumb= positive) Power -Shoulder ab(5/6) ad(6-8) -Elbow flex (5/6) Ext (7/8) -Wrist flex (6/7) Ext (7/8) - FInger flex (7/8) Ext (7/8) abduction (8/1) (ulnar- finger ab/adduction, median thumb abduction) Coordination- finger nose, rapid alternating Sensation Pain, Temp, Vibration (128), Proprioception C4= shoulder C5= upper arm lateral C6= thumb C7= middle C8= pinky T1= upper arm medial ulnar=pinky median= middle finger radial= base of thumb
Lower Limb Neuro
Expose, position, wash hands Obs- facies, obvs stroke, abno movements, cafe au lait, IDC, pes cavus. Aids Gait- normal, heel toe (cerebellar), toe (S1), heel (L4/5), squat to stand, Rhomberg Palpate muscle bulk, nerves Tone + clonus if increased Reflexes Power Hip- flex, ext, abd, add Knee- flex, ext Ankle- flex, ext, inv, ev Toe flex Hip Flex L2- tie your shoe Knee Ext L3- Kick your knee Dorsiflex L4- heel to floor Toe ext- L5- Toe to sky Knee flex S1- kick your bum Coordination- heel shin, toe finger, tap feet Sens- pin prick, temperature, vibration, proprioception Groin L1, Lateral thigh L2, Medial Thigh L3, Medial Leg L4, Lateral Leg L5, Pinky toe S1
