Limited set of examinations for symptoms

Question 1

Appropriate exam for dyspnoea

Answer 1

Respiratory rate

Heart rate

Blood pressure

Oxygen saturation

Temperature

Asterixis (hypercapnoea)

Conjunctival pallor (anaemia), icterus

Mouth (mucous membranes, cyanosis)

JVP (dehydration/overload, tricuspid/pulmonary regurgitation) Expansion (pneumothorax)

Chest percussion (effusion, pneumothorax)

Auscultation (crepitations, reduced AE, wheeze, bronchial breathing) Resonance (effusion, consolidation)

Palpitation of apex beat, thrills

Parasternal heave Auscultation for murmurs

Palpation of abdomen, ascites, hepatomegaly, hepatic impulse

Calves for pitting oedema, tenderness

Question 2

Examination for chest pain

Answer 2

Heart rate, radioradial and radiofemoral delays Respiratory rate Blood pressure Conjunctival pallor JVP, chest auscultation/percussion/resonance, peripheral oedema Parasternal heave Abdominal exam for ascites, HSM, hepatic impulse Palpation of sternum and costocondral joints for costocondritis Subcutaneous emphysema (Boorheave’s)

Question 3

Examination for infection

Answer 3

General inspection for rashes temperature and trend Blood pressure, heart rate, respiratory rate Neck for stiffness Eyes for icterus and conjunctival pallor Chest auscultation for bronchial breathing, creps, wheeze Heart auscultation for systolic and diastolic murmurs Cervical lymphadenopathy Abdomen for tenderness, masses, hepatosplenomegaly, axillary and inguinal lymphadenopathy Spinal vertebral palpation Movement of large and small joints, including hips Sacroiliac tenderness Rectum for abscesses Urine dipstick

Question 4

Examination for cancer

Answer 4

Conjunctival pallor for anaemia, icterus Lymphadenopathy for masses Respiratory exam Wrists for hypertrophic osteopathy Distal upper limb exam for pancoast tumour Abdominal examination for masses, including liver Breast examination for masses Spinal tenderness for metastases Neurological examination for spinal cord compression, chemotherapy SEs, brain mets, paraneoplastic syndromes Pemberton’s sign for SVC compression

Question 5

Thyroid examination

Answer 5

General inspection (moon facies, buffalo hump, large hands, frontal bossing, thyroid stare) Heart rate Respiratory rate Nails for onycholysis, palmar eythema Conjunctivae for pallor Lid lag Lid retraction Conjuctival oedema, conjunctivitis, corneal ulceration (thyroid eye disease) Eye examination for ophthalmoplegia (thyroid eye disease) Fundoscopy for nerve stretching/optic atrophy Periorbital oedema (hypothyroidism) Tongue swelling (hypothyroidism/acromegaly) xanthelesma (hyperlipidaemia/hypothyroid/acromegaly) Thyroid exam - swallow, palpation auscultation Tendon reflexes and power for proximal myopathy

Question 6

Reduced conscious state

Answer 6

BSL GCS - Command, sternal rub, trapezoid squeeze, supraorbital squeeze BP, HR, RR, sats

Heart sounds (Aortic regurge, stenosis, tamponade)

Radioradial and radiofemoral delay (Dissection)

JVP (hypovolaemia, sepsis, tamponade)

Pupils - (ICH, opioids, pontine haemorrhage)

Conjunctivae - pallor, icterus

Neck stiffness (menigoencephalitis)

Tone, reflexes plantars (stroke, seizure, CNS infection)

Abdomen (peritonism, AAA)

Urine output ABG - acidosis, lactate CXR CT-B MRI-B, LP, EEG Cortisol, TFTs (addisonian, myxodematous crisis)