Year 3 Further Investigations Flashcards
Cardiovascular Examination
Measure blood pressure: to identify hypotension, hypertension or significant discrepancies between the two arms suggestive of aortic dissection.
Peripheral vascular examination: to identify peripheral vascular disease, which is common in patients with central cardiovascular pathology.
Record a 12-lead ECG: to look for evidence of arrhythmias or myocardial ischaemia.
Dipstick urine: to identify proteinuria or haematuria which can be associated with hypertension.
Bedside capillary blood glucose: to look for evidence of underlying diabetes mellitus, a significant risk factor for cardiovascular disease.
Perform fundoscopy: if there were concerns about malignant hypertension, fundoscopy would be performed to look for papilloedema.
Peripheral Vascular Examination
Blood pressure measurement: to identify significant discrepancies between the two arms suggestive of aortic dissection.
Cardiovascular examination: to complete assessment of the vascular system.
Ankle-brachial pressure index (ABPI) measurement: to further assess lower limb perfusion.
Upper and lower limb neurological examination: if gross neurological deficits were noted during the peripheral vascular examination.
Respiratory Examination
Check oxygen saturation (SpO2) and provide supplemental oxygen if indicated.
Check other vital signs including temperature and blood pressure.
Take a sputum sample.
Perform peak flow assessment if relevant (e.g. asthma)
Request a chest X-ray (if abnormalities were noted on examination)
Take an arterial blood gas if indicated
Perform a full cardiovascular examination if indicated (e.g. cor pulmonale)
Abdominal Examination
Check hernial orifices (e.g. if there are signs of bowel obstruction).
Perform a digital rectal examination (PR) (e.g. if there is suspicion of gastrointestinal bleeding).
Perform an examination of the external genitalia (e.g. to rule out testicular torsion as a cause of referred abdominal pain or an indirect inguinal hernia).
Ankle and Foot Examination
Neurovascular examination of both lower limbs.
Examination of the knee and hip joint.
Further imaging if indicated (e.g. X-ray and MRI).
Hand and Wrist Examination
Neurovascular examination of the upper limbs.
Examination of the elbow joint and shoulder joint.
Further imaging if indicated (e.g. X-ray and MRI).
Knee Examination
Neurovascular examination of both lower limbs.
Examination of the joints above and below (e.g. ankle and hip).
Further imaging if indicated (e.g. X-ray and MRI).
Shoulder Examination
Neurovascular examination of the upper limbs.
Examination of the joints above and below (cervical spine and elbow joint).
Further imaging if indicated (e.g. X-ray and MRI).
Hip Examination
Neurovascular examination of both lower limbs.
Examination of the joints above and below (lumbar spine and knee joint).
Further imaging if indicated (e.g. X-ray and MRI).
Spine Examination
Neurovascular examination of the upper and lower limbs.
Examination of the hip and shoulder joints.
Further imaging if indicated (e.g. X-ray/MRI).
Thyroid Examination
Thyroid function tests: these include TSH, T3 and T4.
ECG: should be performed if an irregular pulse was noted to rule out atrial fibrillation.
Further imaging: an ultrasound scan of the neck to further assess any thyroid lumps.
Diabetic Foot Examination
Bedside capillary blood glucose: if there is concern that the patient is currently hyperglycaemic or hypoglycaemic.
Serum HbA1c: to aid assessment of blood glucose control over the previous three months.
Lower limb neurological examination: if diabetic foot examination reveals neurological deficits.
Peripheral arterial examination: if diabetic foot examination identifies clinical signs suggestive of arterial disease.
Venous examination of the lower limbs: if diabetic foot examination identified clinical signs suggestive of venous disease.
Foot care advice: including regular podiatry input and appropriate footwear.
Calculation of diabetic foot risk using assessment tool: based on the clinical findings of the diabetic foot examination.
Renal Examination
Blood pressure measurement: if not already performed (do not perform on the side of an arteriovenous fistula).
Fundoscopy: to assess for evidence of retinopathy (e.g. diabetic, hypertensive).
Urinalysis: to screen for urinary tract infection and to assess for haematuria/proteinuria which is associated with glomerular disease.
24-hour urine collection: to assess various urinary compounds and assist in the calculation of protein-creatinine and/or albumin-creatinine ratio.
Urine culture: if a urinary tract infection is suspected.
U&Es: to assess renal function.
Bicarbonate: to assess for evidence of acidaemia.
Bone profile: to assess the levels of calcium, phosphate and PTH (to screen for secondary and tertiary hyperparathyroidism).
