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OSCE PREP > Clinic1: General examination > Flashcards

Clinic1: General examination Flashcards

1
Q

How does the type of sound detected by the bell and the diaphragm vary?

A

bell - low frequency sounds
Diaphragm - high frequency sounds

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2
Q

What is the general routine for completing a clinical exam?

A

CHOICE
Consent - from patient
Hygeine and PPE
Offer assistance and privacy e.g chaperone
Instruct and inform - what is going to happen
Competence: position the patient correctly and in the right clothing
Elicit and present the relevant findings

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2
Q

What does IPPA stand for during a clinical examination?

A

The different tests you may want to run regardless of the system being investigated
Inspection
Palpation
Percussion
Ausultation

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3
Q

What areas of the body should be observed in the initial inspection?

A

Hands
Wrist and arms
Face
Necks

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3
Q

What are the difference components of the ‘end of the ned assessment’?

A

Appearance: BMI, extremities, hygiene, clothing,
Demeanour: anxious, depressed, confused
Speech: language level, confusion, shortness of breath
Faces: down syndrome
Posture and gait:
Colour: Pale (anaemic), blue (cyanosed) yellow (juandice), red (pyrexia/polycythaemia)
Monitoring: ECG, central line
Treatment: inhaler, PEG tube
Aids: walking sticks, hearing aids
Products: chest drain, cathether, sputum pot

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4
Q

What are the facial features of cushionoid?

A

Round moon face
Redness in colour
Often acne

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5
Q

What are the facial features of down syndrome?

A

Flattened facial features
Upwards slanting eyes

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6
Q

For an inspection of the hand what features should be looked at?

A

Abnormal movements
Dorsum of hand
Nails
Pamlar featurs
Musculoskeletal features

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7
Q

What abnormal features should be considered in the hands?

A

Tremor - parkinsons
Flap - when held like stop sign, indicates carbon dioxide retention or liver failure
Pain on supination

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8
Q

What features should be considered on the dorsum of the hand?

A

Digits
Nails
Webs

Pay attension to colour, wasting, brusing, lesions, freckiling and scars

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9
Q

What can be indicated from the nails of the hands?

A

Clubbing - congenital and many diseases
Koilonychia (spooning) - iron deficiency
Biting/trauma
Pitting - psoriasis
Splinter haemorrhages
Cyanosis
Leuconychia (white): protein deficiency, renal failure

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10
Q

What features can be seen on the palmar surface of a hand?

A

Compare both palms
Palmar erthyema (Liver or rheumatoid arthiritis)
Anemia on stretching palmar creases
Nodules on tendons
Aponeurosis thickening
Finger pulp
Scar
Temperature
Nail bed capillary refill time

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11
Q

What are the symptoms of osteoarthiritis in the hands?

A

Herdens nodes
Bouchard nodes

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12
Q

What are the features of rheumatoids arthiritis in the hands?

A

Swelling of the knuckles

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13
Q

What are the signs of gout in the hands?

A

Red, swollen and sore joints

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14
Q

What are the signs of psoriasis in the hands?

A

Scales or flakes of skin
Skin discolouration
Dry skin
Nail pitting

15
Q

What are the signs of sclerodema on the hands?

A

Thickening and swelling of fingers
Numb and tingling fingers when exposed to stress or cold

16
Q

What features should be examined in the wrist and arms?

A

Wrist: radial pulse, compare in both wrist

Liver disease: skin excoration, spider naevi, bruising

Antecubital fossa - track marks for IV drug use

Extensor aspect of arm: psoriatic plaques or rheumatoid nodules

Blood pressure

17
Q

What features should be looked at in the face?

A

Mask like - parkinsons

18
Q

What can features of the cheeks indicate?

A

Butterfly rash - Systemic lupus erthmatosis
Malar flush - mitral valve disease
High red colour in cheeks - polycythaemia
Slapped cheeks - fifth disease

19
Q

What diseases can be indentifed from the eyes?

A

Raised cholesterol - corneal arcus, xanthelasma in skin around eye
Anemia - conjuctive pallor
Jaundice - yellow sclera
Drooping under eyelid - ptosis
Lid lag and bulding - graves disease

20
Q

What diseases can be indicated by the nose?

A

Rhinophyma - rosacea
Septal perforation - cocaine

21
Q

What diseases can be indicated by the ears?

A

Temperature measurement Gouty tophi
Sun damage to outer helix - cancerous
Diagonal earlobe crease - coronary artery disease

22
Q

What should be looked for in the mouth to identify diseases?

A

Central cyanosis
Dehydration
Angular stomatisis
Dental caries
Breath smell
Telangiectasia

23
Q

What abnormalities may be spotted in the neck?

A

Thyroid goitre - midline swelling rises with swallowing
Thyroglossal cyst - midline swelling rising when protrude tongue
Lymph node enlargement - lymphoma, cancer, TB
Carotid artery - exaggerated pulse, expansile and pulsatile swelling
Raised - jugulovenous pressure
Tracheal deviation
Torticollis - abnormal head/neck tilt

24
Q

What are where are the different lymph nodes in the neck that should be palpated?

A
25
Q

What should be done in the cardiovascular system examination?

A

Listen for heart valves (APMT 2245)
Inspect for pacemaker scats
Palpate apex beat
Check back of chest for sacral oedma or pedal odema

26
Q

Where should the stethoscope be placed to listen to different heart valve sounds?

A

APTM2245

27
Q

What tests should be completed as part of the respiratory exam?

A

Lung sounds - compare left and right
Inspect chest shape and scars
Feel chest expansion
Percussion - comparing both sides
Should be done on the anterior and posterior

28
Q

Where should you listen for lung sounds to ensure coverage of all lobes of the lungs?

A
29
Q

How should you inspect the abdomen?

A

Inspect for distention, scars, hernias, caput medusae, straie etc
Palpate 9 areas superficially then deep
Percuss any masses and the bladder region
Auscultate for bowel sounds, aorta and renal arteries

30
Q

What features should be looked for in the lower leg?

A

Bowed legs of rickets
unilateral calf swelling (deep vein thrombosis)
Lymphoedema
Erythema nodosum (red and inflamed lesion along shin)
Ankle oedma
Gout
Flat feet
Ulcers

31
Q

What counts as skin lesions?

A

Rashes, scars, lumps and bumps.

32
Q

What needs to be recorded about skin lesions?

A

Site and symmetry
Shape
Size
Surface
Tender

33
Q

What does haemodynamically stable mean in a patient?

A

If the blood pressure and heart rate are stable

34
Q

What vital signs should be included in a general examination?

A

Blood pressure
Temperature
Radial pulse
Respiratory rate
Oxygen saturation
Manual and automated BP

35
Q
A

OSCE PREP (21 decks)

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