General Adult Flashcards
EPSEs
Medication history consider if dystonia and parkinsonism or Tardive dyskinesia
Start by asking about stiffness abnormal facial movements including if others have noticed anything, excess salivation, restlessness, shakiness
Get patient to hold hands out in front observe the tremor
Fingers to thumb test for Bradykinesia
Look at face and mouth abnormal lip movements asked to protrude tongue examine dentition
Examine tone in upper limbs one joint at the time -? Lead pipe cogwheeling or clasp knife
examine reflexes in upper limbs
Observed patient sitting in chair with palms on phis looking for akathesia
Lower limb tone and reflexes
Observe gait and also for Bradykinesia
Neuroleptic malignant syndrome
Can occur between hours and months but typically within days
Neuroleptic naive patients, high-potency antipsychotics,
Atypical antipsychotics more often causal, dehydrated patients, organic brain disease
Features (FARM)
Fever
Autonomic instability with tachycardia labile blood pressure tachypnoea a pallor and sweating
Rigidity (more than SS)
Mental Status changes
Also Excess salivation Nystagmus Mutism etc (dysarthria/dysphasia) Seizures
Blood test would include CK also full blood count (high WCC) UEs (high K+)
Proteinuria
Treatment is withdraw offending agent dopamine agonist such as bromocriptine
muscle relaxant such as dantrolene
Supportive ventilation including sedation with benzos and ICU if necessary
Serotonin syndrome
Can occur with Seretonergic drugs but classically with monoamine oxidase inhibitors and SSRIs together
Ataxia
Pyrexia
altered consciousness
Tremors
clonus and Hyperreflexia good for differentiating from NMS
Do not use bromocriptine ass will make worse in serotonin syndrome
Akathesia
Treatment is not procyclidine rather propanolol as first line then benzodiazepines
Thyroid exam
Excess tiredness cold intolerance weight gain loss of appetite
General observation looking for agitation and weight
Inspect hands look for tremor quality of nails and check pulse observing for tachycardia
Look up at head looking for Thinning hair, proptosis from front and side eye movements with ? lid lag
Inspects neck looking from front and side ask patient to swallow some water
Palpate
Palpate lymph notes
Percuss down onto sternum
Auscultate for Bruits (thyroid and carotid)
Lower limb for pre-tibial myxoedema ankle jerk
Cranial nerve exam
- Olfactory
Any changes with your smell recently? Check occlusions on the side by asking patient to occlude one and inhale with the other
- Optic
Snellen chart, Visual fields covering one eye at a time. Pupils for light and accommodation.
Fundoscopy
3.4.6 oculomotor, trochlear and abducens
H shape
5 Trigeminal
Sensation
Soft touch and pain in three areas side to side using sternum as base line
Motor
Check strength of Masseters and jaw jerk reflex
- Facial nerve
Furrow brow, raise eyebrows, squeeze eyes shut, blow cheeks out, taste
- Vestibulocochlear
Whispered words ?Rinne’s/Weber’s
?Nystagmus from oculocephalic reflex
9.10. Glossopharyngeal and Vagus
Uvula, cough and speech (ggg, ppp, ttt)
- Accessory
Shrug shoulders against resistance of observing sternocleidomastoid
- Hypoglossal
Tongue (in cheek and side to side)
Anxiety
Autonomic symptoms
Palpitations tachycardia hyperventilation sweating
Abdominal symptoms nausea abdominal pain diarrhoea
Mental symptoms
Derealisation, fear of losing control, dizzy or lightheaded
Fight or flight response -adrenaline and Noradrenaline
Imbalance of oxygen and carbon dioxide causes some symptoms like dizziness and nausea
Vicious circle
CBT can be very effective due to the link between force feelings and behaviours
Initially then relaxation exercises
Then identify a hierarchy of fears
Gradual graded exposure
Here and now
homework
Can take medication as well
Alcohol exam
General assessment of appearance
Look at hands for Palmer erythema Tremor tobacco stain.
Check pulse ?AF
Look at that for JVP and palpate liver if necessary
Face
Foetor hepaticus
Eyes jaundice
Dentition
Abdomen for spider naevi hepatomegaly caput Medusa ascites
Cerebella exam
Danish
DBT
CBT + individual and group
Focus on DSH in individual and hierarchy
Group
Distress tolerance
Interpersonal effectiveness
Core mindfulness
Emotional regulation
Psychodynamic
Past unconsciousness
Cognitive distortions
X6