General Exam Flashcards
What must you ensure you do before beginning your general assessment?
Introduce yourself
Explain procedure
Gain consent
Report distress
Wash hands
How would you begin your general assessment?
Full set of observations (blood pressure, respiration rate, oxygen saturations and blood glucose, temperature)
Consider ECG, ETCO2
Feel radial pulse for regularity
What should you assess a radial pulse for?
Regularity, rate and strength
What could a regularly irregular radial pulse indicate?
A heart block
What could an irregularly irregular radial pulse indicate?
Atrial fibrillation
What range would we expect to see when taking a patients blood sugars? What if it was out of range?
4-7 mmol/L
< 4 mmol/L indicates hypoglycaemia
> 11 mmol/L indicates hyperglycaemia
What range would we expect to see when taking a patients blood pressure? What if it was out of range?
120/80 is ideal target value
90/60 indicates hypotension
140/90 indicates hypertension
What range would we expect to see when taking a patients respiration rate? What if it was out of range?
12-20 regular even respirations
> 20 indicates tachypnoea
< 12 indicates bradypnoea
What range would we expect to see when taking a patients oxygen saturations? What if it was out of range?
92-100%
< 92% indicates hypoxia
What ranges would we expect to see when taking a patients temperature? What if it was out of range?
Normothermia is defined as 36.5 to 37.5 degrees celsius as stated in NICE guidelines, although some deviation is normal
Hypothermia is defined as a temperature of less than 35 degrees celsius
Pyrexia/hyperthermia is defined as a temp of more than 37.8 degrees celsius
What is the significance of collecting a full set of vital signs?
On their own they may not indicate a specific disease, however when used collectively and in conjunction with results from other assessments they can be useful
When assessing the general appearance of the patient, what should you consider?
Weight
Position
Colour
Odours
Pain
Alertness
What is the significance of a patient appearing underweight?
Could be a result of an eating disorder such as anorexia or conditions such as malnutrition and hyperthyroidism
What is the significance of a patient appearing overweight?
Could be due to a poor diet or hypothyroidism - increasing the risk of heart disease and diabetes
When assessing a patients posture what common conditions might you be observing for?
Underlying spinal disease ; scoliosis (sideways curvature of the spine), kyphosis (forwards curvature of the spine)
What is the significance of scoliosis and kyphosis on the body?
Both can have an impact on the cardiopulmonary function in the body
What are you observing for when assessing a patients colour?
Yellow
Flushed
Cyanosed
What could yellow skin indicate?
Sign of jaundice - can indicate liver disease
What can flushed and cyanosed skin be a sign of?
Hypoxia
What is the significance of observing any odours present with your patient?
Odours can indicate a person’s general hygiene and habits
Including the smell of cigarette smoke in a smoker, alcohol in potential alcohol dependency.
What are two common signs that a patient is in pain/discomfort?
Grimacing and fidgeting
What common conditions can reduce consciousness level?
UTI
Hypoglycaemia
Alcohol intoxication
How can you rule out concerns of confusion without having to assess a patient in depth?
You have been interacting with the patient, so far, they are alert and show no signs of confusion - reassess if changes present
When assessing the patients hands, what are you observing for?
Size
Cold
Warm
Sweaty
Tremor
Muscle wasting
Erythema
Contracture
What can abnormally large hands be an indication of?
Marfans syndrome
What should you be feeling for when assessing a patients hands?
That hands are warm and both an equal temperature
What could cold hands potentially indicate?
Low cardiac output
Raynauds disease
What is Raynaud’s disease, what causes it?
Raynaud’s is usually triggered by cold temperatures, anxiety or stress.
The condition occurs because your blood vessels go into a temporary spasm, which blocks the flow of blood.
This causes the affected area to change colour to white, then blue and then red, as the bloodflow returns.
What could warm hands potentially indicate?
High cardiac output, commonly due to anaemia
What could hands of unequal temperature indicate?
Consider trauma that may have impaired circulation
What is hyperhidrosis?
common condition in which a person sweats excessively, often affects the hands
What could hyperhidrosis of the hands indicate?
Hyperhidrosis can result from thyroid issues
But in a clinical situation sweating can be due to anxiety
Which 2 ways can you assess for tremor of the hands?
Ask patient to hold hands out as if they were trying to stop a bus - flapping tremor
Ask patient to hold both hands out with palms facing downwards
How would you assess for flapping tremor?
Ask patient to hold hands out as if they were trying to stop a bus
A positive result would be if the hands flap backwards and forwards
What can a flapping tremor be a sign of?
CO2 retention for instance in COPD
What can tremors of the hands be a sign of?
Can have numerous causes, notably; parkinsons, anxiety and alcohol withdrawal
Where would we look for muscle wasting of the hands?
Muscle atrophy at the hypo and hyperthenar eminences (palms of hands)
What is muscle atrophy of the palms of the hands a sign of?
Commonly associated with ageing, although can be a sign of carpal tunnel syndrome
What is palmar erythema?
a skin condition that makes the palms of your hands turn red
What is palmar erythema often linked too?
Pregnancy and liver disease
What condition can be seen here?
Dupuytren’s contracture
What is Dupuytren’s contracture?
A hand deformity that usually develops over years.
The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin - eventually creating a thick cord that can pull one or more fingers into a bent position
When is Dupuytren’s contracture often seen?
Patients with alcohol-related liver disease and patients with impaired glucose-tolerance
What are you looking for when observing a patients nails?
Shape
Contour
Condition
Colour/discolouration
Clubbing
Pitting
Splinter haemorrhages
What specific abnormalities should you observe for on a patients nails?
Splinter haemorrhage
Spoon nails
Leukonychia
Clubbing
What abnormality of the nails can be observed here?
Splinter haemorrhage
What abnormality of the nails can be observed here?
Spoon nails
What abnormality of the nails can be observed here?
Leukonychia
What abnormality of the nails can be observed here?
Pitting
What abnormality of the nails can be observed here?
Clubbing
What are spoon nails often a result of?
iron deficiency or anaemia
What can splinter haemorrhages be indicative of?
bacterial endocarditis
Why do leukonychia occur?
zinc deficiency
What causes pitting of the nails?
can be a sign of eczema and joint inflammation.
How do you test for clubbing?
Ask patient to rest index finger nails against each other
If clubbing is not present you should be able to see a diamond shaped window between the nails
What is clubbing of the nails often suggestive of?
COPD and CO2 retention
When inspecting/palpating the joints and tendons of the hand and forearm, what are you assessing for?
symmetrical, asymmetrical, swelling or nodes on fingers or tendons, deviation, posture, deformity, xanthomas
When feeling the patients hand/wrist joints and tendons, what are you check for?
Any pain
Making sure they appear symmetrical with no deformities
When feeling the fingers, what landmarks are we observing?
Feel down each finger to check the metacarpals, phalanges and proximal and distal interphalangeal joints
If nodes are observed in the distal interphalangeal joint, what are they called?
Heberden’s nodes
If nodes are observed in the proximal interphalangeal joint, what are they called?
Bouchard’s nodes
What are Heberdens and Bouchard’s nodes indicative of?
osteoarthritis
What is xanthomas of the hands?
fatty, yellow subcutaneous lesions
When is xanthomas commonly observed?
Seen in those with high cholesterol - risk factor for heart disease
Aside from nodes in the fingers, what else are we assessing for that is a common sign of arthritis?
ulnar or radial deviation
If no history, but deviation present - consider trauma
What is ulnar/radial deviation?
Refers to the movement of the wrist from side to side
These movements flex the hand toward either the radial or ulnar bone in the arm. The action is a flexion movement reducing the angle of the joint of the wrist and the respective bone of the arm.
What should you assess when looking at the skin?
Colour
Texture
Temperature
Hair distribution
Aside from colour, texture, temperature and hair distribution of skin, what should you also assess for?
Sweating
Dryness
Lesions
Elasticity
Turgor
What could thinning of the skin indicate?
Cushing’s Syndrome
Long term steroid use
What could thickening and dryness of the skin indicate?
Hypothyroidism
What can rashes/lesions be a sign of?
Infection
Allergy
When are spider naevi often observed?
Liver disease
Can be normal in pregnancy
What are spider naevi?
small, broken beds of capillaries, observed under the skin
How do you test skin turgor?
Pinch the skin on the back of the hand
Skin should immediately spring back down - if it remains tented it can be a sign of dehydration
What can inappropriate or excessive hair distribution indicate?
Endocrine problems such as; PCOS in females and commonly Cushings Syndrome in males
When checking the lips and tongue, what are we assessing?
Check lips and tongue for cyanosis
Assess the tongue for size, moisture, dryness, colour, smoothness
You notice that a patients lips are blue, what could this indicate?
Cyanosis often suggests hypoxia
You notice that a patients lips are dry, what could this indicate?
Dehydration
What are you assessing for when looking at the tongue?
Assess texture, colour and size
What could a white coloured tongue indicate?
Thrush
What could a large swollen tongue indicate?
Allergy
You notice a patients tongue is large and swollen, why is this concerning?
Increases risk of airway occlusion
How should the ducal mucosa/gums of the patient look?
Moist with good colour
You notice a patients gums appear pale, what could this indicate?
Anaemia
Dehydration
When looking at the back of the throat, what are we observing for?
Swelling and/or redness particularly around the tonsils
What would swelling and/or redness around the tonsils often indicate?
tonsilitis
What should you be observing for when looking at a patients teeth?
No obvious erosion to the teeth or teeth loss
What could excessive erosion of the teeth indicate?
gastro-oesophageal reflux disease (GORD) commonly causes excessive erosion of the teeth due to increased acidity
What main thing are we assessing for regarding a patients breath?
Fruity smelling teeth
Faecel smell
What can fruity smelling teeth indicate?
indicates the presence of ketones - sweet pear drop smell
Often associated with diabetic ketoacidosis (DKA)
When assessing the eyes, what are we observing for?
exophthalmos - bulging
redness/lesions
conjunctiva for anaemia
sclera for jaundice
cornea - corneal arcus
xanthelasma
What is exophthalmos?
medical term for a bulging or protruding eyeball or eyeballs
What is often the cause of exophthalmos?
Caused by both hyper and hypothyroidism
You note redness and lesions when observing a patients eyes, what could this indicate?
Infection
What colour should conjunctiva be in a healthy patient?
pink
How would you check a patients conjunctiva for excessive pallor?
Pull patients eye lid down
If found to be pink this is a normal finding
You note excessive palor of a patients conjunctiva, what could this indicate?
Anaemia
Where is the sclera?
the white outer layer of the eyeball
What are we observing for when assessing a patients sclera?
Any yellowing - the sclera should be white in healthy patients
What could yellowing of the sclera indicate?
Jaundice, commonly seen in liver disease
What causes the yellowing of the sclera?
Jaundice - occurs when excess amounts of bilirubin circulating in the blood stream dissolve into the skin and surrounding tissues
When observing the corneas of a patient what abnormal finding are we looking for?
Observe for corneal arcus - characterised by a grey/white ring around the eye of the patient
When is corneal arcus often observed?
Common sign of ageing in those over 60
Also observed in patients with high cholesterol due to excess lipid deposits
How should you conclude a general assessment?
Summarise and conclude your findings
Base decision for next examination based on a combination of history taking and general assessment findings
What can be observed in this photo?
xanthelasma
What is xanthelasma?
yellow growths that appears on or by the corners of your eyelids next to your nose, these are due to a build up of cholesterol
