Lecture 1 - Week 1 - Intro To Clinical Reasoning And General Examination

Question 1

Clinical reasoning

Answer 1

The ability to sort through a cluster of features presented by a patient and accurately assign a diagnostic label with the development of an appropriate treatment Strategy as the end goal.

Question 2

Symptom analysis

Answer 2

1- Symptom 2- causes for symptoms 3- distinguishing features 4- explanations for features 5- questions help gather information

Question 3

Jargon

Answer 3

Special words or expressions used by a profession or group that are difficult for others to understand.

Question 4

Health literacy skills

Answer 4

Are the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.

Question 5

Some facts about health literacy

Answer 5

43% of adults in UK are below expected literacy level at the age of 16 so it’s important for Doctors to use language that patients can understand

Question 6

Key competencies of general physical examination

Answer 6

1- jaundice 
2- cyanosis 
3- Anaemia 
4- clubbing 
5- lymphadenopathy 
6- thyroid enlargement 
7- peripheral oedema 
8- hydrated status

Question 7

Hands examination 1- clubbing

Answer 7

1- change in nail fold angle 
2- softening nail bed
3- Rock nail 
4- Rounded tip 
5- longitudinal curvature

Question 8

Causes of clubbing

Answer 8

• pulmonary sepsis
• bronchial carcinoma
• bacterial endocarditis
• inflammatory bowel disease

Question 9

Hands 2- splinter haemorrhages

Answer 9

Tiny blood clots/spots running vertically under the nails . Occurs when capillaries along the nail bed are damaged and burst. Injury or trauma to the nail bed can cause this . Also underlying conditions I.e. Bacterial endocarditis, vasculitis , fungal infection of nail , diabetes, cholesterol etc

Question 10

Hands 3- Oslers nodes

Answer 10

Painful red raised lesions found on hands and feet associated with infective endocarditis , caused by immune complex deposition.

Question 11

Hands 4- palmar erythema

Answer 11

Reddening of the palms of the hands - commonly caused by - pregnancy ( physiological ) 
And pathological (liver disease and thryotoxocosis)

Question 12

Colour - pallor

Answer 12

Pallor - unhealthy pale appearance - cardinal sign of anaemia .

Question 13

Colour - cyanosis

Answer 13

• central (lips and tongue )
• peripheral (fingers and toes) - bluish discolouration to hands and feet - low oxygen levels in RBC

Bluish cast to the skin and mucous membranes ,

Central is caused by any severe respiratory disease I.e pneumonia , lung edema, , lung thromboembolism.

Peripheral - all common ones of central and reduced cardiac output , COPD , arterial obstruction , DVT etc

Question 14

Colour 3- jaundice

Answer 14

Yellowing of skin and eye
Too much bilirubin - yellow pigment

Causes could include :

• alcoholic liver disease
• bile duct obstruction
• cirrhosis
  Liver cancer
• Hepatitis

Etc etc

Question 15

Lymphadenopathy

Answer 15

Enlargement or disease of lymph nodes . Can be caused by infection, inflammation and malignancy.

• • cervical
• • occipital
• • supraclavicular
• -Axillary
• • femoral
• -Inguinal

Question 16

Thryoid gland

Answer 16

• examine from behind
• normally not palpable
• moves on swallowing
• enlargement
• irregularity

Question 17

Peripheral oedema

Answer 17

• Accumulation of interstitial fluid
• ankles
• sacrum
• press behind medial malleolus

Question 18

Hydration status

Answer 18

Mild/moderate

• inspect tongue and note whether mucosa is wet/ glistening
• look in the eyes - should be glistening and shiny - lost in dehydration

Marked
- loss of skin turgor - gently pinch a fold of skin on the neck or anterior chest wall.