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Year 2 Medicine > VS > Flashcards

VS Flashcards

1
Q

When undertaking general inspection of a patient, list the signs which could indicate underlying gastrointestinal pathology

A
  • Pallor
  • Abdominal distension
  • Jaundice
  • Cachexia
  • Obvious morbid obesity
  • Hyperpigmentation
  • Oedema
  • Hernias
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2
Q

What are the 6 F’s of abdominal distension?

A
  • Foetus
  • Flatus
  • Fluid
  • Fulminant mass
  • Fat
  • Faeces
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3
Q

Name common abdominal scars & operations related to them

A

> Inguinal - hernia repair

> McBurney’s - appendectomy

> Pfannenstiel - Caesarean section

> Midline laparotomy - Abdominal Aortic Aneurysm Repair

> Subcostal - open cholecystectomy

> Nephrectomy - kidney resection

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4
Q

Describe “asterixis” and what it could indicate in the context of a GI examination

A

Bilateral flapping tremor elicited by asking patient to extend arms + cock their wrists back

Could indicate hepatic encephalopathy, renal failure…

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5
Q

What are Kayser-Fleischer rings?

A

Clinical sign of Wilson’s disease

Abnormal copper processing in the liver results in dark circles encircling the iris

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6
Q

Which condition is associated with the formation of hyperpigmented macules in the mouth?

A

Peutz-Jeghers syndrome

Genetic disorder which results in GI polyps

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7
Q

Which signs found in the mouth would be indicative of gastrointestinal pathology?

A
  • Glossitis: smooth erythematous enlargement of tongue due to iron, B12, or folate deficiency
  • Angular stomatitis
  • Hyperpigmented macules
  • Oral candidiasis
  • Aphthous ulceration
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8
Q

What is the location of Virchow’s node and what could enlargement of said node imply?

A
  • Left supraclavicular fossa

- Malignancy, sarcoidosis, infection

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9
Q

Which signs found in the chest could indicate gastrointestinal pathology?

A
  • Spider naevi: cirrhosis; normal in pregnancy
  • Gynaecomastia: cirrhosis
  • Hair loss: iron deficiency anaemia, malnutrition
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10
Q

What is acanthosis nigricans and, if present, what could it indicate?

A

Hyperpigmentation and hyperkeratosis of axillary skin

Could indicate type II diabetes or GI malignancy

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11
Q

What do Cullen’s sign and Grey-Turner’s sign indicate?

A
  • Cullen’s sign
    Bruising around the umbilicus, late sign of haemorrhagic pancreatitis
  • Grey-Turner’s sign
    Bruising around the flank, late sign of haemorrhagic pancreatitis
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12
Q

What does caput medusae indicate?

A

Portal hypertension - complication of cirrhosis

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13
Q

Describe the correct order that should be followed when performing an abdominal examination

A
  1. Inspection with patient lying flat
  2. Ask patient if in any pain
  3. Start palpation away from site of pain (if present)
  4. Light palpation of all 9 areas
  5. Deep palpation of all 9 areas
  6. Use palpation to check for any organomegaly
  7. Use percussion to check for hepatosplenomegaly, bladder distension or shifting dullness
  8. Auscultation to check for bowel sounds & bruits
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14
Q

Which factors should be taken into account when assessing for enlargement of the liver?

A
  • Palpation and percussion of the liver should begin at the right iliac fossa
  • 1-fingerbreadth enlargement of the liver could be considered normal
  • Could be associated with asterixis
  • If a liver edge is felt you should exclude lung hyperinflation as a contributor
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15
Q

Which factors should be taken into account when assessing for enlargement of the spleen?

A
  • Palpation and percussion should start at the right iliac fossa
  • Massive enlargement can be found in patients with leukaemia
  • In a healthy adult it is normal to not be able to palpate the spleen when taking a deep breath in
  • Grade 4 enlargement means the spleen goes past the umbilicus
  • Very mild enlargement of the spleen usually can’t be detected during an abdominal examination
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16
Q

How long do you have to listen before considering that bowel sounds are absent?

A

1-3 minutes

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17
Q

Differentiate between normal and abnormal bowel sounds

A

Normal: borborygmus-type hyperactive bowel sounds

High-pitched: bowel obstruction

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18
Q

Following auscultation, which of the following would you say to the examiner that you would do to complete your GI exam?

A
  • Inspect external genitalia in males: exclude inguino-scrotal herniae
  • Inspect hernial orifices in males & females
  • Digital rectal examination
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19
Q

Describe the steps that should be followed during a Digital Rectal Examination

A
  1. Explain procedure and obtain consent
  2. Offer chaperone
  3. Place patient in left lateral decubitus position
  4. Put on gloves, lubricate 1 index finger
  5. Inspect perianal area
  6. Ask patient to press down, insert gloved lubricated index finger
  7. Examine lateral and posterior rectal walls
  8. Examine anterior rectal wall/prostate
  9. Ask patient to squeeze finger to assess anal tone
  10. Withdraw finger and examine for blood/mucus
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20
Q

Match the following signs with genitourinary pathology

  • Palpable bladder
  • Positive renal punch sign
  • Loin pain and haematuria
  • Proteinuria and oedema
A
  • Palpable bladder: urinary retention
  • Positive renal punch sign: acute pyelonephritis
  • Loin pain and haematuria: renal stone
  • Proteinuria and oedema: nephrotic syndrome
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21
Q

Describe the steps required to perform urinalysis

A
  1. Don gloves and check patient details on sample
  2. Check expiry date of urine dipstick
  3. Check appearance of urine for colour & sediment and smell odour
  4. Hold stick correct way up and immerse in sample for 2 seconds
  5. Remove stick and tap stick on rim of sample bottle to remove excess
  6. Read stick correct way up against side of the chart
  7. Wait appropriate time to report each finding
  8. Dispose of stick and gloves appropriately
  9. Report exact findings
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22
Q

What would you look for when inspecting a patient during a neurological examination?

A
  • Fasciculations
  • Tremor
  • Muscle wasting
  • Posture
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23
Q

How would you assess for lower limb tone during a neurological examination?

A
  • Rotate foot at ankle then sudden extension
  • Lift leg at knee then drop to bed
  • Roll leg
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24
Q

Which movements would you perform to assess lower limb power during a neurological examination?

A
  • Dorsi/plantarflex the foot against resistance: ankle power
  • Invert foot at ankle: mid-foot power
  • Move heel towards bottom against resistance: knee flexion
  • Lift straight leg off bed against resistance: hip flexion
  • Push raised upper leg down: hip extension
  • Leg straightened at knee against resistance: knee extension
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25
Q

Differentiate between upper and lower motor neuron signs

A
  • UMN
    Increased/brisk reflexes
    Increased tone
    Clonus
  • LMN
    Decreased/absent reflexes
    Decreased tone
    Atrophy/muscle wasting
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26
Q

How would you elicit the plantar reflex? What does this indicate?

A
  • Stroke the lateral side of the foot with the point of the tendon hammer
  • Watch for the first movement of the toes
  • Normal response is plantar flexion

Extension: positive Babinski sign, pyramidal pathology

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27
Q

How would you elicit an ankle reflex?

A
  • Place patient’s foot and ankle at 90º
  • Strike Achilles tendon with tendon hammer
  • Watch for reflex & compare sides
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28
Q

How would you assess upper limb tone?

A
  • Quick pronation
  • Rotate elbow and wrist at the same time, vary speed
  • Rotate wrist for cogwheel rigidity (Parkinson’s)
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29
Q

How would you test power in the upper limbs?

A
  • With arms out and elbows bent slightly resist elbows being bent fully: elbow extension
  • Holding the forearm with wrist facing down ask patient to bend their wrist down against resistance: wrist flexion
  • Holding forearm ask patient to cock wrists back against resistance: wrist extension
  • With palms facing up & thumbs pointing upwards, resist thumb being bent down: thumb abduction
  • Ask patient to spread fingers and resist you closing them: finger abduction
  • With arms held to the side & elbow flexed to sternum, ask patient to resist arms being pushed down: shoulder abduction
  • Ask patient to grip 2 of your fingers: flexion at MCP joints
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30
Q

How would you test for upper limb reflexes?

A
  • Biceps: biceps tendon in antecubital fossa
  • Triceps: tendon proximal to elbow
  • Supinator: tendon at base of wrist on radial side
  • Jendrassik reinforcement manoeuver: to strengthen reflex ask patient to clench their teeth
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31
Q

Unilateral headache with associated photophobia and nausea would indicate:

A

Migraine

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32
Q

Shuffling gait, tremor and cogwheel rigidity would indicate:

A

Parkinson’s disease

33
Q

Describe the scale used to assess muscle power

A

MRC Scale

5 - normal power
4 - movement overcomes gravity and added resistance
3 - movement overcomes gravity but not added resistance
2 - moves but not against gravity
1 - muscle contraction visible but no movement of joint
0 - no muscle contraction observed

34
Q

How would you test movements of the cervical spine?

A
  • Extension: ask patient to tilt head back as far as possible
  • Forward flexion: ask patient to put chin to their chest
  • Lateral flexion: ask patient to put their ear to each shoulder
  • Rotation: ask patient to look over each shoulder
35
Q

How would you test movements of the thoracic and lumbar spine?

A
  • Thoracic
    Rotation: sitting down with arms crossed turn to right and left
  • Lumbar
    Forward flexion: bend down and touch toes
    Extension: lean back as far as possible
    Lateral flexion: run hand down lateral side of each leg
36
Q

What is straight leg raising (SLR)?

A

Test for sciatica (nerve entrapment, lumbar disc prolapse)

Raise leg straight off bed and dorsiflex foot - elicits pain in sciatica

Positive SLR - Lasegue’s sign

Relieved by flexion of the knee

37
Q

What observations should be made during inspection of the hip?

A
  • Swelling
  • Muscle wasting
  • Scars
  • Leg shortening
38
Q

Name the points of measurement used for

A) True leg length

B) Apparent leg length

A

A) Anterior superior iliac spine - medial malleolus

B) Xiphisternum - medial malleolus

39
Q

What is Thomas’ Test?

A

Special test used in REMS of the hip

Used to detect a fixed flexion deformity in the contralateral hip

Place hand under patient’s lumbar spine and flex the hip (spine will be flattened against bed)

In cases of fixed flexion deformity, affected leg will lift off bed/bend at knee

40
Q

Which special tests are used in REMS of the knee?

A
  • McMurray’s test: meniscal tear
  • Lachman’s test: ACL damage
  • Anterior (ACL damage) and posterior drawer (PCL damage) tests
  • Lateral collateral ligament assessment (varum stress test)
  • Medial collateral ligament assessment (valgus stress test)
41
Q

What is the Trendelenberg test?

A
  • Assesses weakness in hip abductors (gluteal muscles)
  • Ask patient to stand on one leg at a time
  • Pelvis level falling on non-weight-bearing side - positive Trendelenberg sign
42
Q

What would you look for during inspection of the knee?

A
  • Deformity
  • Swelling
  • Scars
  • Erythema
  • Muscle wasting
  • Symmetry
  • Varus/valgus
43
Q

What is a Baker’s cyst?

A

Fluid in the popliteal fossa

44
Q

How would you assess for the presence of fluid in the knee?

A
  • Patellar tap: large effusion
    Slide one hand down thigh to push fluid out of the suprapatellar pouch
    Push firmly on patella
    Positive: patella bounces and taps off femur
  • Cross-fluctutation test: small effusion
    Push fluid up medial aspect of knee (into joint cavity and suprapatellar pouch)
    Stroke down later aspect - watch for a small bulge of fluid in medial aspect of knee
45
Q

What could tenderness over the tibial tuberosity signify?

A

Osgood-Schlatter disease

46
Q

Which pulses would you assess in the foot?

A
  • Posterior tibial

- Dorsalis pedis

47
Q

What are the features of finger clubbing, and which cardiac conditions can cause it?

A

Distortion of nailbed angle (flattened)
Loss of Schamroth’s window
Increased fluctuation of nailbed
Rounded fingertips

Cardiac conditions:

  • Infective endocarditis
  • Congenital cyanotic heart disease
48
Q

During a cardiovascular examination, which signs would you be looking for during general inspection?

A
  • Cyanosis
  • Pallor
  • Shortness of breath
  • Oedema
49
Q

Which signs would you be looking for in a patient’s hands during a cardiovascular examination?

A

Infective endocarditis:

  • Splinter haemorrhages
  • Janeway lesions
  • Osler’s nodes
  • Finger clubbing
  • Palmar pallor
  • Peripheral cyanosis
  • Capillary refill time
  • Tendon xanthomata (familial hypercholesterolemia)
  • Tar staining: smoking
50
Q

How would you assess a patient’s pulse?

A
  • Rate: normal is 60-100bpm, <60bpm is sinus bradycardia
  • Rhythm: regular, regularly irregular (e.g. 2nd degree heart block), irregularly irregular (atrial fibrillation)
  • Volume: strong (anaemia, fever, hyperthyroidism); weak (shock)
  • Character: collapsing (aortic regurgitation), slow-rising (aortic stenosis)
    Lift arm up and check pulse (ask if shoulder pain first)

Condition of the vessel wall should also be felt e.g. hardened in haemodialysis

51
Q

What is the JVP and how is it measured & accentuated?

A
  • JVP or jugular venous pressure is an estimate of the pressure in the superior vena cava (estimate of right atrial pressure or central venous pressure)
  • Located between 2 heads of sternocleidomastoid, ask patient to tilt head 45º
  • Measured from manubriosternal joint
  • Accentuated by pressing on liver (hepatojugular reflux)
  • Rise of >4cm is positive JVP
  • Causes: heart failure, heart block, valvular disease
52
Q

Which signs would you be looking for in a patient’s eyes during a cardiovascular examination?

A
  • Xanthelasma: familial hypercholesterolaemia
  • Corneal arcus: familial hypercholesterolaemia (non-pathological in older people)
  • Conjunctival pallor: could indicate anaemia
53
Q

What is malar flush and what does it indicate?

A

Malar flush is a plum-red discolouration of the cheeks indicating mitral stenosis

54
Q

Which mouth signs can be linked to cardiovascular disease?

A
  • Central cyanosis (tongue)
  • Peripheral cyanosis (around lips)
  • High arched palate: Marfan’s syndrome
  • Angular stomatitis
  • State of dentition: important in endocarditis
55
Q

Name surgeries which match the following scars

  • Sternotomy
  • Left thoracotomy
  • Posterolateral thoracotomy
  • Left subclavicular
  • Clamshell incision
  • Left mid-axillary
A
  • Sternotomy: CABG or open valve surgery
  • Left thoracotomy: coarctation repair
  • Posterolateral thoracotomy: lung surgery e.g. lobectomy
  • Left subclavicular: pacemaker insertion
  • Clamshell incision: transplant or trauma
  • Left mid-axillary: subcutaneous cardioverter defibrillator
56
Q

Describe the steps involved in palpation during a cardiovascular examination

A
  1. Palpate apex beat
    Furtherst lateral and inferior point of pulsation
    Should be 5th intercostal space left midaxillary line
    If displaced could indicate cardiac enlargement
  2. Feel for palpable murmurs (thrills) over each valve
  3. Feel for heaves (can suggest hypertrophy)
    Right-sided heave: left parasternal border, hand will lift off chest
    Left-sided heave: forceful pulsation with hand placed over cardiac apex
57
Q

Which side of the stethoscope is preferred to listen to mitral stenosis?

A

Bell - low-pitched sounds

58
Q

Describe accentuation manoeuvres for mitral regurgitation and aortic regurgitation

A

Aortic regurgitation: ask patient to sit forward and exhale

Mitral regurgitation: ask patient to roll onto left side and exhale

59
Q

Which heart murmur might radiate to:

a) the carotids
b) the axilla

A

a) aortic stenosis

b) mitral regurgitation

60
Q

What could crackles at the lung bases indicate in the context of a cardiovascular examination?

A

Crackles at the lung bases could indicate pulmonary oedema as a consequence of heart failure

61
Q

Which signs would you be looking out for during inspection in the context of a respiratory examination?

A
  • Cachexia
  • Dyspnoea/tachypnoea
  • Cyanosis
  • Cough
  • Wheeze
  • Stridor
62
Q

Which signs would you be looking for in the hands in the context of a respiratory examination?

A
  • Tar staining: smoking
  • Thin skin/bruising: steroid use
  • Finger clubbing: lung cancer, cystic fibrosis, pulmonary fibrosis
  • Fine tremor: long-term beta 2 agonist use e.g. salbutamol
  • Asterixis: respiratory failure due to CO2 retention
  • Palmar pallor/erythema
  • Peripheral cyanosis
63
Q

What are the features of Horner’s syndrome?

A

Invasion of sympathetic chain by pancoast lung tumour leads to:

  • Ptosis: drooping eyelid
  • Miosis: constricted pupil
  • Enophtalmos
  • Reduced/increased hemifacial sweating depending on extent of invasion into sympathetic chain
64
Q

What are the features associated with consolidation?

A
  • Dull percussion note
  • Bronchial breathing
  • Reduced chest wall movement on affected side
  • No mediastinal displacement
  • Increased vocal resonance
  • Crepitations
65
Q

What are the features associated with a pneumothorax?

A
  • Normal or hyperresonant percussion note
  • Reduced or absent breath sounds
  • Mediastinal displacement to contralateral side if large
  • Reduced vocal resonance
  • Reduced chest wall movement on affected side
66
Q

What are the features associated with a pleural effusion?

A
  • Stony dull percussion note
  • Reduced chest wall movement on affected side
  • Reduced vocal resonance
  • Reduced breath sounds
  • Mediastinal displacement towards opposite side if large
  • May be pleural rub
67
Q

What are the features associated with COPD

A
  • Reduced chest wall movement on both sides
  • Normal or hyperresonant percussion note
  • Prolonged expiration
  • Vocal resonance normal or reduced
  • No mediastinal displacement
  • Rhonchi and coarse crepitations
68
Q

What are the features of asthma?

A
  • Normal or hyperresonant percussion note
  • Prolonged expiration or absent if severe
  • Normal vocal resonance
  • Reduced chest wall movement on both sides
  • No mediastinal displacement
  • Rhonchi
69
Q

What are the features of lung collapse?

A
  • Reduced chest wall movement on affected side
  • Reduced or absent breath sounds
  • Reduced or absent vocal resonance
  • Mediastinal displacement towards affected side
  • Dull percussion note
70
Q

What is a normal respiratory rate?

A

12-20 breaths per minute

71
Q

Which chest abnormality can reduce lung capacity?

A

Pectus excavatum

72
Q

Describe the procedure which should be followed when measuring Peak Expiratory Flow Rate (PEFR)

A
  1. Hold peak flow meter horizontally
  2. Patient seated
  3. Forced maximum expiration
  4. Best of 3 readings
  5. Depengs on age, sex, height and ethnicity
73
Q

Which clinical features might be found in a patient with Chronic Obstructive Pulmonary Disease (COPD), not including findings during auscultation?

A
  • Reduced FEV1
  • Increased antero-posterior chest dimension (barrel chest)
  • Cough with mucus production (yellow/green)
  • Smoking history
  • May be associated with alpha 1 antitrypsin deficiency
74
Q

Which clinical features might be found in a patient with asthma, not including findings during auscultation?

A
  • Dyspnoea upon exertion is common during an exacerbation
  • Reduced FEV1 in an attack, significantly improved with bronchodilators
  • Associated with eczema
  • Nocturnal cough
  • At-home monitoring with PEFR
75
Q

What is Romberg’s test?

A

Ask patient to stand with arms by their sides & eyes closed

Tests for sensory ataxia - overly reliant on visual input to maintain balance

Positive if patient loses their balance

76
Q

Describe how palpation should be carried out in the context of a respiratory examination

A
  1. Tracheal position (assess for tracheal deviation)
  2. Cricosternal distance (normally 3-4 finger breadths)
  3. Apex beat
  4. Chest expansion (normally 3-5cm)
  5. Vocal fremitus
77
Q

When would whispered pectoriloquy be used during a respiratory examination?

A

To confirm the finding of bronchial breathing over an area of consolidation

Ask patient to say 111 or 99, should sound louder over area of consolidation

78
Q

What is the normal range for hyperextension of the knee?

A

< 10º, more indicates hypermobility

79
Q

What would you be looking for during inspection of the foot?

A
  • Arch (high arch, flat foot)
  • Toe clawing
  • Hallux valgus
  • Callus formation
  • Swelling
  • Symmetry
  • Skin rashes
  • Nail changes (psoriasis)

Year 2 Medicine (6 decks)

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