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MBBS - Year 1 > Intro to clinical skills > Flashcards

Intro to clinical skills Flashcards

1
Q

Pulse depends on

A

Intermittent injection of blood from the heart into the aorta which alternately increases and decreases the pressure
Flexibility of the arterial wall which allows expansion with each injection of the blood and then recoil

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2
Q

Importance of the pulse

A

Can tell us about the heart through the force of contraction
the rate of heart contraction
Gives us clues to any outflow problems
Tells us circulating blood volume
Occasionally indicates state of blood vessels

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3
Q

When can a pulse be felt

A

Wherever an artery lies near the surface and over a bone or other firm background

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4
Q

Limb pulses

A 
Brachial artery 
Radial artery 
Femoral artery 
Popliteal artery 
Posterior Tibial artery 
Dorsalis Pedis artery
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5
Q

Brachial artery

A

At the bend of the elbow along the inner margin of biceps muscle, used to measure bp

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6
Q

Radial artery

A

At the outer aspect of the wrist, base of thumb

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7
Q

Brachial artery

A

Inner aspect of the wrist, equivalent to brachial

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8
Q

Popliteal artery

A

Behind the knee

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9
Q

Posterior Tibial artery

A

Behind medial malleolus

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10
Q

Dorsalis Pedis artery

A

On the dorsum of the foot along the line between 1st and 2nd toes

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11
Q

Head and Neck pulses

A

Common Carotid artery
Temporal artery
Facial artery

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12
Q

Examination of the pulse

A 
Rate 
Rhythm 
Character 
Auscultation
Strength 
Volume
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13
Q

Normal heart rates

A

New-born: 70-120 bpm
Infant: 80-160 bpm
Preschool child: 75-120 bpm
School child: 70-100 bpm

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14
Q

Reasons for fluctuation of temp

A

Diurnally
Exercise and eating
W/ menstruation
NOT w/ environment

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15
Q

Temp measuring sites

A 
Oral 
Axillary 
Rectal 
Tympanic 
Temporal
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16
Q

Hyperthermia/ pyrexia causes

A 
Infection 
Drugs 
Heat stroke 
Stroke
Autonomic and infl diseases 
Malignancy and Gout
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17
Q

Hypothermia causes

A 
Multifactorial 
Alcohol, drugs 
Hypoglycaemia, hypoadrenalism 
Infections (paradoxical - associated w/ poor prognosis)
Post-op
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18
Q

Method of taking bp

A

Apply cuff
Inflate cuff while palpating brachial artery
Deflate cuff while auscultating artery
Record systolic and diastolic to nearest 2 mmHg and debrief patient

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19
Q

Apply cuff

A

Expose arm and choose correct size
Centre cuff over brachial artery, 2-3 cm above pulse point
Tubes should be superior or slightly off centre

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20
Q

Inflate cuff

A

Close valve
Place finger on pulse (brachial or radial)
Pump air until pulse disappears
Pump another 20-30 mmHg

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21
Q

Deflate cuff

A

Replace fingers w/ stethoscope over pulse position

Listen for Korotkov sounds

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22
Q

Korotkov phases

A 
Tapping starts - systolic 
Tapping softer and swishing - auscultatory gap 
Tapping louder, sharper, clearer 
Tapping muffled 
Tapping disappears - diastolic
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23
Q

Taking history

A 
Presenting complaint 
History of presenting complaint 
Past medical history 
Drug history 
Allergies 
Social history 
Family history
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24
Q

Intro before taking history

A 
Introduce yourself (name and role)
Check patients name and dob
Explain what you want to do and gain consent
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25
Systemic enquiry
Are you otherwise well? Have you got any other symptoms Problems w/ SAWTEM
26
SAWTEM
``` Sleep Appetite Weight Temp Energy Mood ```
27
Presentation of MSK disease
``` Pain Stiffness Deformity Swelling Paraesthesia Numbness ```
28
Principles of MSK examination
Look Feel Move Assess do normal side first for comparison
29
Hip examination - Look
``` Leg length discrepancy - measure true then apparent Muscle wasting Flexion deformity ---> OA Scars overlying hips Lumbar lordosis Stance - straight or no Pelvic tilt - looking at iliac crests ```
30
Hip examination - Feel
``` Bony landmarks incl: Iliac crest ASIS Greater trochanter Pubic tubercle ```
31
ASIS
Anterior Superior Iliac Spine
32
Hip examination - Move
``` Abduction Adduction Flexion Extension Internal rotation External rotation Move leg against your hand w/ resistance - soft tissue injury if only pain w/ Trendelburg's test Thomas test ```
33
True leg length
ASIS to medial malleolus
34
Foot and ankle examination - Look
Observe feet, comparing for symmetry Look at forefoot for nail changes or skin rashes Look for alignment of the toes - hallux valgus of big toes or sublimation of joints Callus formation Patients footwear - asymmetrical wearing of the sole or upper
35
Foot and ankle examination - Look (w/ weight-bearing)
Toe alignment and whether in contact w/ ground Foot arch position - look at midpoint (low arch resolves when on tip toes) Achilles tendon thickening or swelling - hindfoot Normal alignment of the hindfoot - varus/ valgus deformity
36
Foot and ankle examination - Feel
Bony landmarks Palpate for tenderness Squeeze MTP joints - discomfort? Presence of a peripheral pulse - dorsalis pedis Integrity of Achilles tendon - calf squeeze test
37
Bony landmarks in foot and ankle
``` Lateral/ medial malleolus Calcaneus 5th metatarsal bone Medial longitudinal arch Joints ```
38
Foot and ankle examination -Move
Inversion and eversion at the subtalar joint Dorsi and plantar flexion at big toe and ankle joint - restriction and/or crepitus Passively invert and evert forefoot w/ heel fixed
39
Knee examination - Look
``` Compare knees for symmetry and alignment Look at back of knees Normal posture Muscle wasting of quadriceps Gait Swelling and redness --> infl/infection ```
40
Valgus deformity
Leg deviated laterally
41
Varus deformity
Leg deviated medially
42
Types of swelling
Effusion Soft tissue Bony
43
Knee examination - Feel
Bony landmarks Use resistance and look at dflexion and extension Feel skin temp using back of hand, mid-thigh vs over knee Palpate for tenderness along borders of patella Feel behind knee for popliteal cyst Sweep/ bulge test Patellar tap Ballotement test Follow up w/ hip exam - hip arthritis can present as knee pain
44
Knee examination - Move
Active movement - full extension Passive movement Flex knee to 90 degrees and check stability of ligaments Anterior draw test and posterior draw test Asess medial and lateral collateral ligament stability
45
How do deaths occurs after an accident
Trimodal death distribution
46
Peaks in trimodal death distribution
1st peak - within seconds to minutes at accident site 2nd peak - within minutes to hours at Hosp 3rd peak - days to weeks in hosp icu
47
1st peak of trimodal death distribution
``` Death due to laceration of the brain Laceration of the brainstem Rupture of major vessels e.g. aorta Laceration of the spinal cord Rupture of heart ```
48
2nd peak of trimodal death distribution
Brain haemorrhage such as extradural and subdural Haemothorax, tension pneumothorax, open pneumothorax Pelvic fracture Long bone fractures Abdominal injuries e.g ruptured liver and spleen
49
Golden hour principles
Save life Save limb Save joint
50
3rd peak of trimodal death distribution
``` ARDS MODS Renal failure Pneumonia Sepsis ```
51
ATLS
``` Advanced Trauma Life Support A - airway w/ cervical spine control B - breathing w/ ventilation C - control of haemorrhage D - disability brain protection E - exposure ```
52
SIRS
Systemic Infl response Leads to leaky vessels --> multiple organ failure Can last a few days or a few weeks IL-6 is a proven marker
53
CARS
Counter-regulatory anti-infl response | After trauma there's a balance between SIRS and CARS
54
Terrible triad
Acidosis Coagulopathy (platelet count <90,000) Hypothermia (<32 degrees)
55
MODS
Multiple organ dysfunction syndrome | Can be fatal
56
ARDS
Adult respiratory distress syndrome | Can be fatal
57
Joint injections
Injecting steroid into a joint to reduce infl but also reduces function of immune system
58
Shingles
Reactivation of chicken pox virus, presents as v. red rash (blistering) and stays in one dermatome
59
Treatment of shingles
Aciclovir
60
Pneumonia
Infection of lung Alveoli gets filled w/ WBCs and becomes consolidated Can be fatal if suffering from other illnesses
61
Amoxicillin
Dosage of 250/300 mg TDS for a week to treat a chest infection
62
Tendonitis
Infl of tendons
63
Glucose in urine
Diabetes Pregnancy Leaky kidney
64
HBA 1C in urine (glycated hb)
If found do a blood test | Indicates sugar levels over last 3 months
65
Bilirubin in urine
Jaundice | Liver issues
66
Life cycle of RBC's
120 days
67
Ketones in urine
Product of glycogen breakdown --> starvation | V dangerous if diabetic --> coma
68
Proteinuria
Leaky kidney Kidney problems Would do a 24hr protein collection
69
Blood in urine
Infection Bladder and kidney/ ureter cancer Trauma (internal damage to surface of kidney) Kidney stones
70
Nitrites in urine
Bacterial infection (usually Gram -ve)
71
High pH of urine
Infection stones
72
Low pH of urine
Uric acid stones
73
Leucocytes in urine
Infection and cancers
74
Bradycardia
Less than or equal to 50 bpm
75
Tachycardia
More than 100 bpm
76
Addn trauma associated w/ fractures
Soft tissue injuries
77
Central pulses
``` Carotid artery (neck) Femoral ```
78
Peripheral pulses
Radial | Brachial
79
Types of reasons for heart rate increase
Pathological | Physiological
80
Pathological reasons for hr increase
Shock Anaemia Hypoxia Hyperparathyroidism
81
Physiological reasons for hr increase
Exercise | Pregnancy
82
Apnoea
Absence of breathing - respiratory arrest
83
Dyspnoea
Symptom of difficulty in breathing
84
Tachypnoea
An increased rate of breathing from any cause. Diff to hyperventilation
85
Depth of breaths is increased in ..
Head injuries, ketoacidosis
86
Depth of breaths in decreased in ...
Opiate overdose, chest injury and disease
87
Temp can be increased by
Fever/ illness/ infections etc Brain injuries Heat stroke/ exhaustion W/ some drugs
88
Temp can be decreased by
Hypothermia Some drugs Giving cold IV fluids quickly
89
Casts
Tiny particles of 'debris' found when examine urine under microscope
90
MSU
Mid stream urine | Assumes 1st part of voiding is contaminated w/ bacteria around genitalia and perineum
91
Pyuria
Pus in urine
92
Voiding
Passing urine
93
Why we analyse urine
Detection of systemic diseases or pathology Detection of renal disease/ injury Detection of pregnancy Screening for certain diseases
94
Urinalysis stages
Macroscopic examination Chemical examination Microscopic examination
95
Other ways to collect urine
24 hr urine collection Catheter sample Bag urine collection Suprapubic bladder puncture
96
If the sp gravity of the urine is high (> 1.02) ...
The patient may be dehydrated - glycosuria Diuretic use Diabetes insipidus Adrenal insufficiency
97
Common bacterial organisms causing UTI's
E. coli - most common, Gram -ve Profeus Mirabillis - Gram -ve Staphylococcus - Gram +ve Pseudomonas - Gram -ve
98
Management of UTIs
Trimethropin 300mg QDS OD/ 3 days Co-amoxiclav 250/125 mg TDS/ 3 days Ciprofloxacin 250-500 mg BDS/ 3 days Nitrofurantoin
99
Official name of green prescription
Fp10
100
Meaning of prn on a prescription
As required
101
Meaning of ud on a prescription
As directed
102
Omeprazole
Prescribed by acid reflux disease | 20 mg OD
103
Features of an anaphylactic reaction
Circulatory collapse Airways obstruct Fast heartbeat Clammy skin 1 in every million suffer from immunisations
104
Drugs administered for anaphylaxis
Adrenaline Steroids Anti-histamine Oxygen
105
Febrile convulsion
When a baby has a fit in response to having a fever
106
Diseases vaccinated against at 2 months
``` Diptheria Tetanus Pertuses Polio H. Influenza type B Hep B Menigococcal B Rotavirus gastroenteritis ```
107
Side effects of immunisations
Local infl Myalgia Fever Rigors
108
Myalgia
Pain in muscle
109
Rigors
Episodes where temp rises v quickly whilst you have severe shivering
110
General principles of look - examination
``` Positioning is key Undress Give them space Look from anteriorly, posteriorly and laterally at: Skin Posture and symmetry Bony structures Muscle bulk ```
111
Examples of emergency conditions
Life-threatening injuries e.g multiple injuries Limb-threatening injury e.g compartment syndrome Problems that cause irreparable damage
112
Examples of urgent conditions
Malignant tumours Uncontrolled pain Systemically unwell Fractures – that aren’t life-threatening nor limb-threatening
113
Pain history
SOCRATES ``` Site Onset Character Radiation Associated symptoms Exacerbated/ relieved Scale ```
114
Soft tissue history (tendons, ligaments)
``` Precipitated by Swelling Crepitus Temp - higher over area Loss of function Description of occupation/ recreational activity ```
115
Trauma history
``` When How What was done at time What is it like now Ay other injuries Soft tissue symptoms NAI Classification ```
116
Joints (non-traumatic) history
``` Pain - usally in more than one joint Stiffness Deformity/ swelling Duration and evolution of symptoms Pattern of joints affected Aggravating and relieving factors Loss of function Systemic features ```
117
Infl history
``` Pain, swelling, stiffen NSAIDs Pattern Onset Risk factors Sero-ve/ connective tissue disease symptoms ```
118
Concepts of being professional
``` Personal space Dignity Signposting and consent Practice makes perfect Responsiveness and reflexivity Cultural awareness ```
119
Personal space
Approx. 1.2m | Varies w/ context, culture, gender, age and from individual to individual
120
Dignity
Appropriate exposure | Gowns/ curtains/ screens
121
Signposting and consent
'If it is ok with you, I'd like to examine you now’ 'Would you be able to lie on the bed and remove …?’ Signal your wishes and establish consent
122
Things to avoid when examining
``` Keyhole examinations Making friends Engaging mouth before engaging brain Dirty clothes and equipment Bad breath and BO ```
123
Active vs passive movement in an examination
Pain on passive suggests intra-articular pathology Painful active movements which are less painful of passive movements suggests articular pain Painful resisted movements may originate from the soft tissues e.g muscle/ tendon
124
Types of gait
Antalgic gait - pain, don't spend long on one leg Trendelenburg gait Waddling
125
What does a Trendelenburg gait indicate
Weakness of abductors
126
What does waddling suggest
Proximal muscle wasting
127
What are you looking for in skin in an examination
``` Rashes Redness Bruising Muscle wasting Scar Deformity ```
128
Testing flexion in a hip examination
Flexing knee to 90 degrees | Passively flex and then push knee to chest
129
Testing adduction in a hip examination
Bring leg over the other
130
Testing extension in a hip examination
Place hand under ankle and ask patient to push your hand into the bed
131
Testing rotation in a hip examination
With knee flexed, invert the knee (internal) and then evert the knee (external)
132
Thomas' test
Place your opposite hand under back of patient and flex knee until its at the chest - should feel hand being squashed if normal
133
Testing abduction in a hip examination
Ask patient to abduct leg - hold pelvis still with opposite hand when doing passively
134
What does the Thomas' test identify
Fixed flexion deformity
135
Apparent leg length
Umbilicus to medial malleolus
136
What is the medial malleolus connected to
Tibia
137
What is the lateral malleolus connected to
Fibula
138
Sweep test
Empty the suprapatellar pouch Stroke the medial side of the knee joint to move any excess fluid across to the lateral side of the joint then do the lateral side
139
Patellar tap
Empty supra patellar pouch | Tap patella
140
How to empty the suprapatellar pouch
By sliding your left hand down the thigh to the upper border of the patella
141
Ballotement test
Force fluid out of suprapatellar pouch | Push patellar down into femur using two hands
142
Hyperextension of knee
Pushing hand under knee into bed
143
How do you examine the integrity of the MCL and LCL
Place your hand under the knee and the other on the ankle and move L and R Looking for hard end point
144
How do you examine the integrity of the ACL and PCL
Anterior and Posterior draw test Sit on foot and place hands under hamstrings and pull knee forward/ backwards
145
Hallux valgus
Bunions | Big toe drifting laterally
146
Bony landmarks in knee
``` Femoral condyles Joint line Patella Tibial tuberosity Tibial plateau Head of fibula ```
147
Examination of Ankle and Wrist - Look
``` Muscle bulk Scars Redness Position of wrist Swelling and deformity of joints Thenar and hypothenar eminences ```
148
Examination of Ankle and wrist - Feel
``` Heat Joint swelling Wrist joints Radius and ulnar styloid processes Psiform Scaphoid Finger joints: MCP, PIP, DIP ```
149
Examination of Ankle and Wrist - Move
``` Flexion and extension Abduction and adduction Finger extension and flexion Flexion and Extension of individual fingers at MCP, DIP, PIP Abduction and adduction of fingers Same for thumbs and opposition ```
150
Tachypnoea
Rapid breathing, 20+ breaths/min
151
Hyperventilation
Inappropriate, rapid breathing
152
Types of sites pulse can be measured at
Peripheral e.g. brachial | Core e.g. temporal
153
Examples of causes of tachycardia
Exercise Hypertension Anaemia Hyperthyroidism
154
Examples of causes of bradycardia
Drugs e.g. beta blockers Sleep Hypothyroidism Hypothermia
155
Diagnostic parameter for chronic hypertension
Bp over 140/90 in 3 consecutive readings taken sitting down and 30 mins apart
156
EWS and NEWS2
``` Looks at: Airway Breathing Circulation Disability (consciousness ) Exposure (temp) ``` Urine output should also be considered
157
Things to look at in a respiratory assessment aside from respiratory rate
Chest expansion Oxygen sats Sternum/ intercostal muscle recession
158
Examples of causes of increased respiratory rate
``` Exercise Stress/ anxiety Shock Hypoxia Diabetic ketoacidosis ```
159
Measuring oxygen sats
Place finger probe on opposite hand use total bp | Can also use earlobe probe if patient has nail polish
160
Where do the most accurate temp values come from
Oral and tympanic

MBBS - Year 1 (93 decks)

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