Hospital @ Night Flashcards
What might lead to communication difficulties with a patient?
Hearing aids, dementia, language barrier, unconsciousness, oxygen/ventilation, speech or language difficulties
Scars.
a) Mercedes Benz
b) Median sternotomy - look where else?
c)
a) Liver transplant
b) CABG, open valve/aneurysm repair (also look in calves for saphenous vein harvest)
Murmurs.
a) Before approaching patient, think…?
b) Intensifying sound
c) Differentiating between AS/MR murmur
a) What am I expecting (always expect to hear a murmur), e.g. elderly - AS, MI - MR, endocarditis/Marfan’s - AR/MR
b) RILE: Right-sided (inspiration), Left-sided (expiration). Also getting them to stop breathing helps to hear it.
c) Radiation (carotids vs axilla), area, 2nd heart sound often quiet/inaudible with pansystolic but not with ejection systolic
Hernias.
a) Direct vs. indirect inguinal
b) Types
c) Tests to perform
a) Direct (through weakened abdominal wall), indirect (through inguinal canal, usually into groin)
b) Incisional, inguinal, femoral
c) Cough/sit up, reducible?
Rheumatoid hands.
a) If fixed flexion - also look for…?
a) Dupuytren’s and palmar erythema - alcoholic liver diseases
Bruising/ecchymosis.
a) Periumbilical
a) Possible due to SC heparin
Stomas.
a) Ileostomy vs colostomy
b) Assess what?
a) Site (RIF vs LIF), opening (spouted vs flushed), consistency of fluid
b) Health of spout, consistency and volume of fluid, surrounding skin
Imaging.
a) Brain MRI landmarks
b) If several brain lesions
c) CXR - spiculated mass?
a) Midbrain (Mickey Mouse), Pons (handbag - worn by ponces)
b) Think mets - look for primary
c) Malignancy
