Physical Examination Flashcards
Pseudo-parkinsonism
Incidence: 20%
RFs: more common in older women
Onset: gradual onset after a few weeks
Symptoms: akinesia, rigidity and tremor
Management: reduce dose, change to 2nd gen
Acute dystonia
Incidence: 10%
RFs: young men, antipsychotic naive
Onset: few hours
Symptoms: oculogyric crisis, torticollis, grimacing, trismus, exaggerated posturing
Management: IM procyclidine 5-10mg
Akithisia
Incidence: 25-50%
RFs: rapid increase in antipsychotic dose
Onset: most commonly after day 5
Symptoms: irritability and restlessness
Management: procyclidine or propranolol
Tardive dyskinesia
Incidence: 5% at 1 year, 20% of chronic Rx
Risk factors: elderly women, organic brain disease, long exposure to antipsychotics, affective disorder, Hx of EPSEs
Symptoms: lip smacking, chewing, tongue protrusion, pelvic thrusting
Management: change to 2nd gen, vitamin E
Cerebellar Exam
Inspect
Gait - straight line and heel to toe walk
Rombergs: Stand still, feet together, arms at side, close eye - +ve if unsteady when closed eyes
Head: speech - repeat british constitution and baby hippopotamus
Nystagmus: eye movements
Arms: Tone, dysdiadochokinesia, Finger to nose
Legs: Reflexes, heel to shin test
Thyroid Exam
Relevant hx: energy, weight/appetite, mood, temp. intolerance, bowels, libido, skin/hair appearnce, changes in cycle.
Inspect including: exopthalmos (side and above), skin changes, hair loss, weight changes.
Hands - sweating, onycholysis, thyroid acropachy.
Pulse
Look for tremor.
Eye movements: H
Lid Lag: follow finger quickly from top to bottom.
Inspect neck
Ask to swallow.
Palpate gland from behind.
Ask to swallow
Cervical lymph nodes.
Auscultate thyroid.
Reflexs
Proximal myopathy - stand from chair arms crossed.
Pretibial myxoedmea
Signs CHF (legs/auscultate lung bases.
EPSE Exam
Hands on knees - look for tremor.
Then hands out facing down - place paper if available on hands.
Tone, power, co-ordination + cogwheeling.
Hypomimia- ask pt to open mouth looking for abnormal tongue movements + pooling of saliva.
Stand - no obvious akathesia. Ask to hold hands out at side, then let arms fall freely
Fundoscopy
History: onset, duration, severity, progression, associated symptoms, triggers.
La Belle Indifference: lack of concern.
Assess secondary gains, mood, risk.
Focus on distant obect.
Use right eye for right eye.
Check red reflex
Follow red reflex into eye towards nasal.
Assess optic disc and retinal vessels
Assess macula by asking to look directly at light.
Describe to patient what looking for
Snellen chart, ishihara plates, refelxes to complete.
Cardiology Exam
45 degress
Inspection:
Inspect including around bed
Hands + wrists - cap refil, clubbing, radial pusle 15 secs, radio-radial delay, collapsing pulse.
Face - malar flush, conjuntival palor, mouth - arch or poor dentiotion.
Neck: JVP relax left, lean. Palpate carotids 1 at a time.
Scars.
anterior chest: Apex beat, heaves/thrills.
4 valve locations.
MS: Roll onto left and auscultate apex.
MR: Axilla using diaphragm.
AS: Carotids in full expiration
AR: Forward, full expiration L parasternal 3rd intercostal.
Percuss for pleural effusions + ausculatate for creps
Ankle oedema.
Offer ECG< Fundoscopy, peripheral pulses, BP
Respiratory Exam
Inspection: cyanosis, inability to speak full sentences, acessoary muscles, scars, asymmetry, cough
Palpate:
Trachea, apex beat, cervical lymph nodes.
Chest expansion
Percussion
Auscultation
Vocal resonance (99).
Scaral oedema, peripheral oedema.
Abdominal Exam
Inpsect:
Appropriate comments to patient not examiner - ‘you appear to be in a lot of pain’.
Distention, mass, dressing, scar, track marks, excoriation, gynaecomastic, nail changes.
Palpate - light palapation 9 regions. Deep palpation 9 regions.
Tenderness , rebound, guarding, masses.
Liver + spleed + kidneys + Abdomianl aorta.
Percuss liver, spleen, shifting dullness.
Aucultate bowel sounds + aortic + renal bruits.
PNS Exam
Wash hands
Confirms details
Consent
Offers chaperone
Inspect
Tone
Power
Reflexes
Co-ordinatiion
Sensation (light, vibration, proprioception, pain).
Gait
CNS Exam
I: Smell change
II: Snellen chart, neglect, fields, Pupils, fundoscopy
III IV VI: H movement
V: 3 x sensation + power of mandible + jaw clenching
VII: Facial asymmetry + eyebrows, screw eyes, frown, bear teeth, puff cheeks + ?taste problems
VIII: Whisper in each ear. Webers + RInne’s
IX: Uvula, not gag reflex
X: Cough + Swallow
XI: Shrug, turn head L+R, SCM muslce
XII: Tounge out, side to side.
ECG interpretation
Rhythm
Rate
Axis
QRS
QTc
ST&T
