ph exam

Question 1

THYROID

Answer 1

Question 2

MMSE MANIA

Question 3

BREAST

Question 4

WRIST

Answer 4

Question 5

KNEE

Answer 5

Question 6

LEG SWELLING /CALF PAIN

Answer 6

swelling: SEADS –HUN swelling erythema atrophy deformity scars Hair changes, ulcers, nail changesPalpation: TTCER: Temp (compare) Tenderness, C: calf circumference for the discrepancy, Effusions in joints? Rubor test: ( do this in all DM pts, PTs with Leg/ calf painnot MSK origin or CNS origin, probably Vascular origin if CAD R.F are positive)Observe color of both feet in supine (or in sitting). In supine, elevate one leg for 60 sec. Observe foot color: light pink is normal; chalky white or painful means arterial insufficiency. Then lower to dependent position and time the color return compared to the color of the non-elevated foot.No clinical importance of Homan’s sign

Question 7

BAC KPAIN

Answer 7

Beginning: For P.Ex, after proper handwashing, PPE, consent & draping, I will check : 1)vitals of pt 2)general appearance & level of distress Expose and compare both sides, looking for deformity, scars STEP 1: GAIT: normal, restricted ( walk on toes: S1 - plantar flexion) ( walk on heels: L5 Dorsiflexion test) INSPECTION OF BACK: SEADS ( swelling erythema, atrophy deformity, scars) PALPATION: TTCER (Temperature, Tenderness spinal & paraspinal, Sacroiliac for Ank. Spond, Crepitus: move back passively feeling lower back, Effusion( not common for back ) ROM ( Flexion, extension, lat flexion, rotation CHECK PERIPHERAL PULSES : POPLITEAL / D.P OR POST.TIB FOCUSED NEURO EXAM FOR MYOTOMES: - MOTOR: check for Tone & wasting 1)L-4 ( Bend knee and kick with resistance) compare both sides 2)L-5 (lift toe towards the sky, against resistance , compare) 3) S1 (Push as if on the gas pedal , compare) -SENSORY: L3,4,5 S1 ( SEE ATTACHMENT) REFLEXES : Knee: L3 L4, Ankle: S1, S2 PROVOCATIVE TESTING : SLR, CVA tenderness ( renal colic or infection) FOR ANKYLOSING SPONDYLITIS: -Occiput to wall distance : > 5 cm: is positive - Chest expansion : (normal is 2-5 cm) -Shober Test modified: mark at PSIS ( post sup iliac spine ), then mark 10 cm above and 5 cm below ask the pt to bend forward as much as they can. measure the top mark till PSIS line, if <15 cm: positive REMEMBER : DRE: To assess anal sphincter tone & saddle anesthesia for Cauda equina

Question 8

CVS

Question 9

HA fever high risk

Question 10

RESP

Question 11

HTN

Question 12

DIABETIC FOOT

Answer 12

Inspection: SEADS: check calves for swelling, look for ulcers or fungal infections Palpation: Charcot joints Check Motor, Sensory ( all sensation: check for Fine touch: sharp and dull, 2 point discrimination, Vibration with Tuning fork, joint positioning)Gait, Rhomberg !! and Rubor’s test while legs are raised (discoloration ?) let the legs hanging: change to red? Positive Rubor’s test Don’t forget to examine footwear (to check if it is supportive and protective)Mention a complete cardiovascular exam and eye exam too! Additional exams for a DM Pt: full cardiovascular/neuro exam including eye exam/fundoscopy

Question 13

LN GROUP AXILLA AND NECK

Question 14

DIZZY

Question 15

MMSE FOR DEPRESSION

Question 16

MMSE FOR PSYCOSE

Question 17

HIP

Question 18

CNS

Question 19

MULTIPLE SWELLINGS

Question 20

NECK

Answer 20

Question 21

GIT

Answer 21

Beginning: For P.Ex, after proper handwashing, PPE, consent & draping, I will check : 1)vitals of pt 2)general appearance & level of distress Generally looking at pt for signs of jaundice, pallor, fetor hepaticus FACE: eyes: jaundice, pallor, mouth: dehydration, ulcers HANDS: P-C-CR- ( pulses, clubbing, cap refill), Flapping tremor ABDOMEN: inspection: No abdominal distension, Abdominal wall moving equally with respiration. No SPP, No MCB ( scar, pulsations, peristalsis/ no masses, caput, bruising) AUSCULTATION: 4 areas, gut sounds are audible PALPATION SUPERFICIAL: Tenderness, rigidity DEEP PALPA: starting away from the pain, for masses, hepato-splenomegaly PERCUSSION: 1) for tenderness ( if tender: acute abdomen!) 2) for a Liver span SPECIAL TESTS: Mc burny , Rovsing’s, Psoas, Obturator for Appe, and Murphy for G.B -MOST IMP NOT TO FORGET: CVA Tenderness & DRE, genital and inguinal exam

Question 22

HA LOW RISK

Question 23

ANKLE

Question 24

MMSE FOR ANXITY

Question 25

SHOULDER

Question 26

TREMOR

Answer 26

Intro: Beginning: For P.Ex, after proper handwashing, PPE, consent & draping, I will check : 1)vitals of pt 2)general appearance & level of distress & Level of conscious CN2:optic: V.Acuity, color vision, FOV, Fundoscopy CN3,4,6 : PERLA , make H : EOM, nystagmus, convergence CN7 : Asymmet, smile, raise eyeb, puff, (taste ant 2/3 tongue MOTOR : U.L L.L ( wasting, tone : Spasticity vs rigidity, power) SENSORY: U.L L.L REFLEXES: BICEPS, KNEE, BABINSKI GAIT: 1 TIME ( hemiplegic in stroke, wide-based in cerebellar & concussion) PRONATOR DRIFT ( Stand with eyes closed & spread out arms) CEREBELLAR FUNCTION: may be positive in concussion - finger to nose test: ( no past pointing, intention tremor) - Heel to shin test: coordination - Dysdiodokokinesia both sides - speech slurring “ say British constitution PARKINSON’s: Bradykinesia, turning in blocks, cogwheel rigidity , micrographia RHOMBERG test : ( stand with feet apart, and close eyes) for peripheral neuropathy (OTHER TREMORS: hyperthyroid) I would like to finish with a complete mental state exam of my patient

Question 27

ELBOW

Question 28

MMSE FOR OCD

Question 29

ULCER

Answer 29

Question 30

MASS /LUMP

Answer 30

Question 31

Breast

Answer 31