Physical exams Flashcards
How could you begin a cardio exam?
Present yourself, General inspection (P)
Chaperone, comfort, pain? (CCP)
Remember the cat can jive
Radial pulse
Temp
Cap test
Clubbing
JVP + Hepatojugular reflex
Heaves and thrill dance
Murmurs dance
summarise = abulatory monitoring, resp exam, BP, pulse oximeter, spygmamommeter, (POS)
What to do when taking a history?
NAME, AGE, Present
What?
When?
Why?
How?
SOCRATES
BUFTASS - Blood, unintentional weight, fever, temp changes, appetite, sweating, secretions
Past conditions
Drugs - allergies
Family related
Social - work
Systems - visual changes, headache, mood, sleep, eating, waterworks, bowel movements, chest pain, breathing, movement, sensation
What should you ask in a urinary history?
Frequency
Output
Urgency
Nocturia
Dribbling
Dysuria
Blood
(at)
LUTS
Appearance
Smell
Temperature
Jendrassik’s manoeurve
Ask the patient to grit their teeth or clench their hands whilst testing reflexes.
How do you examine the thyroid?
WIPE
Permission - expose chest
Questions - lump, duration, travel
General inspection
PANTS - pulse, acropachy, nails, temperature, swearing
HOLES - hair loss, opthalmoplegia, lid retraction, exopthalmos,
TONGUE - can they stick it out. Swallow with water.
Lump - feel
Lymph nodes
Thyroid bruit listen
Stand and get out of chair with arms - proximal myopathy (hyperthyroidism)
Check shins for pre-tibial myxedma (hyperthyroidism)
Finish and thank
Further tests T4/ TSH
In what condition do you get pre-tibial myxoedma?
Hyperthyroidism
How can you assess tremor in thyroid disease?
Lay paper on hands
If the person sticks tongue out and there is movement what can that suggest?
Thyroglossal cyst
What are the stages of a vascular exam?
Introduce
General exam
Arms
Pulses
Carotids
Abdomen
Legs
Special test
What are the stages of cannulation?
Name and date of birth
WIPE
Allergies
Gather equipment: dressing, swabs, pre filled saline, gloves, needle, tourniquet
Saline flush kit
Inspect vein
Tourniquet
Sharp scratch and secure from below
Withdraw introducer
Advance cannula
Remove tourniquet
Bandage
Flush
Label
What are the tests for a diabetic foot exam?
Inspect
Toes
Redness/ rashes
Ulcers
Skin change
Texture
Erythema
Dorsum and plantar surfaces checked
Pulse
Capillary refill
Temperature
Reflexes
Special tests - monofilament, vibration, soft touch, proprioception
Walk and Foot wear
Thanks
To complete:
BM.
neurovascular assessment
advise on foot care
What are some changes seen in venous insufficiency?
Hemosiderin
Ulcers
Reverse bottle signs
Swelling
Trophic changes
What are the signs of aortic regurgitation?
De Musset Sign
Mullers sign
Corrigans collapsing pulse
Quinke sign
What are the signs of aortic stenonis?
- Slow rising carotid pulse
- Narrow pulse pressure
- Heaving, non-displaced apex beat (can be displaced if there is left ventricular hypertrophy)
- Ejection systolic murmur
- Heard best at the second intercostal space on the right
- Can be described as “harsh”
- Transmitted well to the carotids
- Soft S2 heart sound
- Ejection click may be heard in some cases (early systolic)
What is the signs of mitral stenosis?
- Mitral facies (malar flush) - cutaneous vasodilation due to carbon dioxide retention
- Low volume pulse
- Atrial fibrillation
- Elevated JVP (prominent ‘a’ wave due to raised right atrial pressure, or absent ‘a’ wave in AF)
- Tapping, non-displaced apex beat (palpable S1)
- R ventricular heave (suggestive of pulmonary hypertension)
- Inspiratory crepitations (pulmonary oedema) and other signs of right heart failure