Normal exam Flashcards
Abdo exam
Look at patient
Hands and nails
- Stretch out fingers for dupuytrens
- Clubbing
- Asterixis 10 seconds while feel pulse
Arms
- Haemodyalisis / venesection
Face
- Conjuntiva
- Mouth - oral ulers
- Lymphadenopathy neck
- Sit forwards and look at back / sacral oedema
Chest
- spider naevi
- Lymphadenopathy axilla (can state this)
Abdo
- Take a moment to look at scars and trace them with finger
- Palpation on knees looking at patient soft then firm
- Liver size / precuss
- Spleen size / precuss
- Kidneys ballot
- AAA
- Shifting Dullness -> Inspect back for scars
Auscultate
- Bowel sounds / bruis [can use this time to think about findings]
Legs - oedema
Resp exam
Look
Can you take a full breath in and out
Can you give me a cough
Hands
- Including clubbing
- Asterixis and pulse
Head
- JVP
- Eyes
- mouth
- Lymphaedmopathy
Neck
- Trachea
Chest
- Scars
- Palpate apex and heaves
- Chest expansion upper and lower
- Precussion
- tactile vocal phremitus
- Auscultate
Back
- scars
- Sacral oedema
- Expansion
- precussion
- tactile vocal phremitus
- Auscultate
Legs - oedema
Cardio exam
Observe end of bed
- Malar rash - mitral stenosis
- Corrigans pulse - visible carotid
Hand + arm
- Spinter haemorhages
- Clubbing - congenital heart disease
- Palmar erythema - hyperdynamic system
- Radial harvest scar
- Pulse - irregular / radioradio delay
- I would like to assess radio-femoral delay
- Collapsing pulse
Head and neck
- JVP + hepatic reflex
- Conjunctival pallor
- Mouth central cyanosis
Chest
- Midline sternotomy scar / vavotomy scar / PPM / thoracotomy
- Pectus excavatum
- Palpate apex beat / heaves
Auscultate
- 4 valves while palpating carotid
- Lean to left and use bell to auscultate LOWER pitch sounds
- Sit forward Auscutate AR
- Auscultate carotids
Back
- Any scars
- Palpate sacrum
- Auscultate left lower scapula for PDA if continuous murmur heard
- Lung bases
Legs ask about pain
- Look for scars - harvest
- Pedal oedema
Cranial nerve exam
1 Olfactory- any change in sense of smell
2 Optic-
- Acuity - Snellen / read clock / read name badge
- Fundoscopy
- RAPD and Light pupil response
- Red desaturation
- assess visual fields - finger wiggle
3,4,6 Occulomotor, Troclear, abducens
- Eye movements H
- Accomodation
5 - trigeminal
- Sensation close to midline - (Cervical nerves may do lateral face)
- Grit teeth and palpate temples - V
- jaw jerk
7 - Facial
- Puff out cheeks - VII
- Squint eyes - VII
- Raise eyebrows - VII
- show teeth
State corneal blink reflex V and VII
8- Vestibulococlear
- Hearing
9 / 10 - Glossopharyngeal / Vagus
- Swallow
- Palatal movements - say AHH
- State gag reflex
11 accessory
- Shrug shoulders
- head turning
12 - Hypoglossal
- Stick out tongue (will stick toward lesion)
- Tongue in cheek
[Acutely Find Rapid Red Fields]
Cerebellar exam
Introduce with handshake
- Dysarthria / coordination / power
Head
- Head tremor
- Nystagmus
- Dysarthria - baby hippopotamus. British constitution
Arms
- Rebound phenomenom
- finger nose - intention tremor / past pointing
- Disdiadochokinesis
- Tone
Legs
- Heel-shin
- Tone
- reflex upper and lower (include plantars)
- Rhombergs - hopefully negative as more of a sensory ataxia
- Gait + heel toe
I would go on to examin the cranial nerves to assess for focal pathology in cerebellar fossa eg stroke / SOL / demyelination
I would assess the remainder of the limbs
Upper limb exam
Expose
Observe
- Look at back of neck for cervical surgical scar
- Scars, fasiculations, tremor
- Outstretch both arms - tremor
- Peudoathetosis* / Pronator drift / rebound
Tone
- Wrist / arm while ditracting (eg move other arm up and down)
Power
- C5 deltoid - Elbows up like a chicken
- C6 / C7 Biceps Triceps - Boxer
- C7/8 Wrist flexion
- C7 - wrist extension
- T1 - Fingers
- myotonia grab hands release quick
Reflexes - can increase with teeth grit
- Hold hands like 2 cans
- Suppinator C6 (+5)
- Biceps C5 (+6)
- Hold their arm across chest - Triceps C7
Coordination
- Finger nose
- Disdiadochokinesis
Sensation - always start on chest
- Soft touch - Dorsal collum (cotton wool)
- Pain - Spinothalamic - pin prick
- Vibration - dosal collum - on bones [ONLY move up arm if they cant feel more distally]
- Propioception - dorsal column [Move up if they can’t do it distally]
*involuntary, writhing movements when eyes shut = sensory ataxia
Lower limb exam
Observe
- SWIFT
- Scars, Wasting, Involuntary movements, Fasiculations, Tremor
Tone
- Slow and fast
- Clonus
Power
- Hip flexion / extension L1/2
- Knee flexion L5-S2 / extension L3/4
- Ankle dorsiflexion - L4
- Big to extension - L5
Coordination
- Heel shin
Reflexes
- Knee L3/4
- Ankle - extend foot and hit below toes S1/2
- Plantar
Sensation - always start on chest
- Soft touch - Dorsal collum (cotton wool)
- Pain - Spinothalamic - pin prick
- Vibration - dosal collum - on bones [ONLY move up arm if they cant feel more distally]
- Propioception - dorsal column [Move up if they can’t do it distally]
Stand up
- Lower back exam for surgical scars
- Rhombergs
- Gait
- Heel toe
Hand Exam
Look at face
eg Exopthalmos / scleroderma / cushingoid
Observe
- Wasting of small muscles Eg disuse / mnd / t1
- Thenar wasting - median nerve palsy, hypothenar - ulnar palsy
- Look at elbows psoriasis / rheum nodules / calcinosis
Sensation
- Dematomes
Function
- Write with a pen
- Do up button
Movement
- Grip strength
- Pincer movement with all fingers
- Thumb up (median nerve)
Prayer sign
Reverse prayer
Thyroid exam
Inspect
- Goitre
Hands
- Tremor eg paper on top
- Insepect eg clubbing
- Pulse for AF
Eyes
- Look from all angles. Exopthalmos when you can see white of eye from all angles
- Lid lag - follow finger up and down (positive if upper lid lags behind eye movement on downward gaze)
- Eye movements
Neck
- Inspect
- Lymphnodes
- Palpate thyroid
- Take swallow while palpating
- Feel neck while stick out tongue
Auscultate
Lower limbs
- Inspect pretibial myxodema
- Reflexes
Thyroid exam
Hands
- Tremor eg paper on top
- Sweaty
- Insepect eg clubbing
- Pulse for AF
Eyes
- look from side
- Any redness / Swelling
- Lid retraction
- Eye movements
Vision
Snellen chart
Fundoscopy
Neck
- Throidectomy scar
- feel for lump
- feel when swallows / sticks tongue out
-Any tenderness
- Auscultate for bruis
Shins
- Pre tibial myoxdema (often like orange peel)
- Deep tendon reflexes
Connective tissue disease exam
Gait
-Stand against wall to see scoliosis
Hands
- Ask to pull fiingers back to test mobility
- Pull skin on back of hands to assess stretch
- Hands round wrist - aracnodactyly
Arms
-Waterhammer pulse
Eyes
- Fundoscopy - lens dislocation etc
Hearing
- Webber / rinnes
Mouth
- High arched palate
Chest
- Expansion and scoliosis
- Pectus excavatum
- Heart murmurs esp AR / MR
Look at legs
