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MBBS - Year 1 > Intro to clinical skills > Flashcards

Intro to clinical skills Flashcards

1
Q

Pulse depends on

A

Intermittent injection of blood from the heart into the aorta which alternately increases and decreases the pressure
Flexibility of the arterial wall which allows expansion with each injection of the blood and then recoil

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2
Q

Importance of the pulse

A

Can tell us about the heart through the force of contraction
the rate of heart contraction
Gives us clues to any outflow problems
Tells us circulating blood volume
Occasionally indicates state of blood vessels

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3
Q

When can a pulse be felt

A

Wherever an artery lies near the surface and over a bone or other firm background

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4
Q

Limb pulses

A 
Brachial artery 
Radial artery 
Femoral artery 
Popliteal artery 
Posterior Tibial artery 
Dorsalis Pedis artery
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5
Q

Brachial artery

A

At the bend of the elbow along the inner margin of biceps muscle, used to measure bp

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6
Q

Radial artery

A

At the outer aspect of the wrist, base of thumb

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7
Q

Brachial artery

A

Inner aspect of the wrist, equivalent to brachial

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8
Q

Popliteal artery

A

Behind the knee

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9
Q

Posterior Tibial artery

A

Behind medial malleolus

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10
Q

Dorsalis Pedis artery

A

On the dorsum of the foot along the line between 1st and 2nd toes

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11
Q

Head and Neck pulses

A

Common Carotid artery
Temporal artery
Facial artery

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12
Q

Examination of the pulse

A 
Rate 
Rhythm 
Character 
Auscultation
Strength 
Volume
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13
Q

Normal heart rates

A

New-born: 70-120 bpm
Infant: 80-160 bpm
Preschool child: 75-120 bpm
School child: 70-100 bpm

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14
Q

Reasons for fluctuation of temp

A

Diurnally
Exercise and eating
W/ menstruation
NOT w/ environment

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15
Q

Temp measuring sites

A 
Oral 
Axillary 
Rectal 
Tympanic 
Temporal
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16
Q

Hyperthermia/ pyrexia causes

A 
Infection 
Drugs 
Heat stroke 
Stroke
Autonomic and infl diseases 
Malignancy and Gout
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17
Q

Hypothermia causes

A 
Multifactorial 
Alcohol, drugs 
Hypoglycaemia, hypoadrenalism 
Infections (paradoxical - associated w/ poor prognosis)
Post-op
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18
Q

Method of taking bp

A

Apply cuff
Inflate cuff while palpating brachial artery
Deflate cuff while auscultating artery
Record systolic and diastolic to nearest 2 mmHg and debrief patient

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19
Q

Apply cuff

A

Expose arm and choose correct size
Centre cuff over brachial artery, 2-3 cm above pulse point
Tubes should be superior or slightly off centre

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20
Q

Inflate cuff

A

Close valve
Place finger on pulse (brachial or radial)
Pump air until pulse disappears
Pump another 20-30 mmHg

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21
Q

Deflate cuff

A

Replace fingers w/ stethoscope over pulse position

Listen for Korotkov sounds

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22
Q

Korotkov phases

A 
Tapping starts - systolic 
Tapping softer and swishing - auscultatory gap 
Tapping louder, sharper, clearer 
Tapping muffled 
Tapping disappears - diastolic
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23
Q

Taking history

A 
Presenting complaint 
History of presenting complaint 
Past medical history 
Drug history 
Allergies 
Social history 
Family history
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24
Q

Intro before taking history

A 
Introduce yourself (name and role)
Check patients name and dob
Explain what you want to do and gain consent
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25
Q

Systemic enquiry

A

Are you otherwise well?
Have you got any other symptoms
Problems w/ SAWTEM

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26
Q

SAWTEM

A 
Sleep
Appetite 
Weight 
Temp 
Energy 
Mood
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27
Q

Presentation of MSK disease

A 
Pain
Stiffness 
Deformity 
Swelling 
Paraesthesia 
Numbness
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28
Q

Principles of MSK examination

A

Look
Feel
Move

Assess do normal side first for comparison

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29
Q

Hip examination - Look

A 
Leg length discrepancy - measure true then apparent 
Muscle wasting 
Flexion deformity ---> OA
Scars overlying hips 
Lumbar lordosis 
Stance - straight or no 
Pelvic tilt - looking at iliac crests
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30
Q

Hip examination - Feel

A 
Bony landmarks incl:
Iliac crest 
ASIS 
Greater trochanter 
Pubic tubercle
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31
Q

ASIS

A

Anterior Superior Iliac Spine

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32
Q

Hip examination - Move

A 
Abduction 
Adduction 
Flexion 
Extension 
Internal rotation 
External rotation 
Move leg against your hand w/ resistance - soft tissue injury if only pain w/ 
Trendelburg's test 
Thomas test
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33
Q

True leg length

A

ASIS to medial malleolus

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34
Q

Foot and ankle examination - Look

A

Observe feet, comparing for symmetry
Look at forefoot for nail changes or skin rashes
Look for alignment of the toes - hallux valgus of big toes or sublimation of joints
Callus formation
Patients footwear - asymmetrical wearing of the sole or upper

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35
Q

Foot and ankle examination - Look (w/ weight-bearing)

A

Toe alignment and whether in contact w/ ground
Foot arch position - look at midpoint (low arch resolves when on tip toes)
Achilles tendon thickening or swelling - hindfoot
Normal alignment of the hindfoot - varus/ valgus deformity

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36
Q

Foot and ankle examination - Feel

A

Bony landmarks
Palpate for tenderness
Squeeze MTP joints - discomfort?
Presence of a peripheral pulse - dorsalis pedis
Integrity of Achilles tendon - calf squeeze test

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37
Q

Bony landmarks in foot and ankle

A 
Lateral/ medial malleolus 
Calcaneus 
5th metatarsal bone
Medial longitudinal arch 
Joints
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38
Q

Foot and ankle examination -Move

A

Inversion and eversion at the subtalar joint
Dorsi and plantar flexion at big toe and ankle joint - restriction and/or crepitus
Passively invert and evert forefoot w/ heel fixed

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39
Q

Knee examination - Look

A 
Compare knees for symmetry and alignment 
Look at back of knees 
Normal posture 
Muscle wasting of quadriceps 
Gait 
Swelling and redness --> infl/infection
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40
Q

Valgus deformity

A

Leg deviated laterally

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41
Q

Varus deformity

A

Leg deviated medially

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42
Q

Types of swelling

A

Effusion
Soft tissue
Bony

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43
Q

Knee examination - Feel

A

Bony landmarks
Use resistance and look at dflexion and extension
Feel skin temp using back of hand, mid-thigh vs over knee
Palpate for tenderness along borders of patella
Feel behind knee for popliteal cyst
Sweep/ bulge test
Patellar tap
Ballotement test

Follow up w/ hip exam - hip arthritis can present as knee pain

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44
Q

Knee examination - Move

A

Active movement - full extension
Passive movement
Flex knee to 90 degrees and check stability of ligaments
Anterior draw test and posterior draw test
Asess medial and lateral collateral ligament stability

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45
Q

How do deaths occurs after an accident

A

Trimodal death distribution

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46
Q

Peaks in trimodal death distribution

A

1st peak - within seconds to minutes at accident site
2nd peak - within minutes to hours at Hosp
3rd peak - days to weeks in hosp icu

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47
Q

1st peak of trimodal death distribution

A 
Death due to laceration of the brain
Laceration of the brainstem 
Rupture of major vessels e.g. aorta 
Laceration of the spinal cord 
Rupture of heart
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48
Q

2nd peak of trimodal death distribution

A

Brain haemorrhage such as extradural and subdural
Haemothorax, tension pneumothorax, open pneumothorax
Pelvic fracture
Long bone fractures
Abdominal injuries e.g ruptured liver and spleen

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49
Q

Golden hour principles

A

Save life
Save limb
Save joint

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50
Q

3rd peak of trimodal death distribution

A 
ARDS
MODS
Renal failure 
Pneumonia 
Sepsis
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51
Q

ATLS

A 
Advanced Trauma Life Support 
A - airway w/ cervical spine control 
B - breathing w/ ventilation 
C - control of haemorrhage 
D - disability brain protection
E - exposure
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52
Q

SIRS

A

Systemic Infl response
Leads to leaky vessels –> multiple organ failure
Can last a few days or a few weeks
IL-6 is a proven marker

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53
Q

CARS

A

Counter-regulatory anti-infl response

After trauma there’s a balance between SIRS and CARS

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54
Q

Terrible triad

A

Acidosis
Coagulopathy (platelet count <90,000)
Hypothermia (<32 degrees)

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55
Q

MODS

A

Multiple organ dysfunction syndrome

Can be fatal

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56
Q

ARDS

A

Adult respiratory distress syndrome

Can be fatal

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57
Q

Joint injections

A

Injecting steroid into a joint to reduce infl but also reduces function of immune system

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58
Q

Shingles

A

Reactivation of chicken pox virus, presents as v. red rash (blistering) and stays in one dermatome

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59
Q

Treatment of shingles

A

Aciclovir

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60
Q

Pneumonia

A

Infection of lung
Alveoli gets filled w/ WBCs and becomes consolidated
Can be fatal if suffering from other illnesses

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61
Q

Amoxicillin

A

Dosage of 250/300 mg TDS for a week to treat a chest infection

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62
Q

Tendonitis

A

Infl of tendons

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63
Q

Glucose in urine

A

Diabetes
Pregnancy
Leaky kidney

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64
Q

HBA 1C in urine (glycated hb)

A

If found do a blood test

Indicates sugar levels over last 3 months

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65
Q

Bilirubin in urine

A

Jaundice

Liver issues

66
Q

Life cycle of RBC’s

A

120 days

67
Q

Ketones in urine

A

Product of glycogen breakdown –> starvation

V dangerous if diabetic –> coma

68
Q

Proteinuria

A

Leaky kidney
Kidney problems
Would do a 24hr protein collection

69
Q

Blood in urine

A

Infection
Bladder and kidney/ ureter cancer
Trauma (internal damage to surface of kidney)
Kidney stones

70
Q

Nitrites in urine

A

Bacterial infection (usually Gram -ve)

71
Q

High pH of urine

A

Infection stones

72
Q

Low pH of urine

A

Uric acid stones

73
Q

Leucocytes in urine

A

Infection and cancers

74
Q

Bradycardia

A

Less than or equal to 50 bpm

75
Q

Tachycardia

A

More than 100 bpm

76
Q

Addn trauma associated w/ fractures

A

Soft tissue injuries

77
Q

Central pulses

A 
Carotid artery (neck)
Femoral
78
Q

Peripheral pulses

A

Radial

Brachial

79
Q

Types of reasons for heart rate increase

A

Pathological

Physiological

80
Q

Pathological reasons for hr increase

A

Shock
Anaemia
Hypoxia
Hyperparathyroidism

81
Q

Physiological reasons for hr increase

A

Exercise

Pregnancy

82
Q

Apnoea

A

Absence of breathing - respiratory arrest

83
Q

Dyspnoea

A

Symptom of difficulty in breathing

84
Q

Tachypnoea

A

An increased rate of breathing from any cause. Diff to hyperventilation

85
Q

Depth of breaths is increased in ..

A

Head injuries, ketoacidosis

86
Q

Depth of breaths in decreased in …

A

Opiate overdose, chest injury and disease

87
Q

Temp can be increased by

A

Fever/ illness/ infections etc
Brain injuries
Heat stroke/ exhaustion
W/ some drugs

88
Q

Temp can be decreased by

A

Hypothermia
Some drugs
Giving cold IV fluids quickly

89
Q

Casts

A

Tiny particles of ‘debris’ found when examine urine under microscope

90
Q

MSU

A

Mid stream urine

Assumes 1st part of voiding is contaminated w/ bacteria around genitalia and perineum

91
Q

Pyuria

A

Pus in urine

92
Q

Voiding

A

Passing urine

93
Q

Why we analyse urine

A

Detection of systemic diseases or pathology
Detection of renal disease/ injury
Detection of pregnancy
Screening for certain diseases

94
Q

Urinalysis stages

A

Macroscopic examination
Chemical examination
Microscopic examination

95
Q

Other ways to collect urine

A

24 hr urine collection
Catheter sample
Bag urine collection
Suprapubic bladder puncture

96
Q

If the sp gravity of the urine is high (> 1.02) …

A

The patient may be dehydrated - glycosuria
Diuretic use
Diabetes insipidus
Adrenal insufficiency

97
Q

Common bacterial organisms causing UTI’s

A

E. coli - most common, Gram -ve
Profeus Mirabillis - Gram -ve
Staphylococcus - Gram +ve
Pseudomonas - Gram -ve

98
Q

Management of UTIs

A

Trimethropin 300mg QDS OD/ 3 days
Co-amoxiclav 250/125 mg TDS/ 3 days
Ciprofloxacin 250-500 mg BDS/ 3 days
Nitrofurantoin

99
Q

Official name of green prescription

A

Fp10

100
Q

Meaning of prn on a prescription

A

As required

101
Q

Meaning of ud on a prescription

A

As directed

102
Q

Omeprazole

A

Prescribed by acid reflux disease

20 mg OD

103
Q

Features of an anaphylactic reaction

A

Circulatory collapse
Airways obstruct
Fast heartbeat
Clammy skin

1 in every million suffer from immunisations

104
Q

Drugs administered for anaphylaxis

A

Adrenaline
Steroids
Anti-histamine
Oxygen

105
Q

Febrile convulsion

A

When a baby has a fit in response to having a fever

106
Q

Diseases vaccinated against at 2 months

A 
Diptheria 
Tetanus 
Pertuses 
Polio 
H. Influenza type B
Hep B 
Menigococcal B 
Rotavirus gastroenteritis
107
Q

Side effects of immunisations

A

Local infl
Myalgia
Fever
Rigors

108
Q

Myalgia

A

Pain in muscle

109
Q

Rigors

A

Episodes where temp rises v quickly whilst you have severe shivering

110
Q

General principles of look - examination

A 
Positioning is key 
Undress
Give them space 
Look from anteriorly, posteriorly and laterally at:
Skin 
Posture and symmetry 
Bony structures
Muscle bulk
111
Q

Examples of emergency conditions

A

Life-threatening injuries e.g multiple injuries
Limb-threatening injury e.g compartment syndrome
Problems that cause irreparable damage

112
Q

Examples of urgent conditions

A

Malignant tumours
Uncontrolled pain
Systemically unwell
Fractures – that aren’t life-threatening nor limb-threatening

113
Q

Pain history

A

SOCRATES

Site
Onset 
Character 
Radiation 
Associated symptoms 
Exacerbated/ relieved 
Scale
114
Q

Soft tissue history (tendons, ligaments)

A 
Precipitated by 
Swelling 
Crepitus 
Temp - higher over area 
Loss of function 
Description of occupation/ recreational activity
115
Q

Trauma history

A 
When 
How
What was done at time 
What is it like now
Ay other injuries 
Soft tissue symptoms 
NAI 
Classification
116
Q

Joints (non-traumatic) history

A 
Pain - usally in more than one joint 
Stiffness 
Deformity/ swelling 
Duration and evolution of symptoms 
Pattern of joints affected 
Aggravating and relieving factors 
Loss of function 
Systemic features
117
Q

Infl history

A 
Pain, swelling, stiffen 
NSAIDs
Pattern 
Onset 
Risk factors 
Sero-ve/ connective tissue disease symptoms
118
Q

Concepts of being professional

A 
Personal space 
Dignity 
Signposting and consent
Practice makes perfect 
Responsiveness and reflexivity 
Cultural awareness
119
Q

Personal space

A

Approx. 1.2m

Varies w/ context, culture, gender, age and from individual to individual

120
Q

Dignity

A

Appropriate exposure

Gowns/ curtains/ screens

121
Q

Signposting and consent

A

‘If it is ok with you, I’d like to examine you now’
‘Would you be able to lie on the bed and remove …?’
Signal your wishes and establish consent

122
Q

Things to avoid when examining

A 
Keyhole examinations
Making friends 
Engaging mouth before engaging brain 
Dirty clothes and equipment 
Bad breath and BO
123
Q

Active vs passive movement in an examination

A

Pain on passive suggests intra-articular pathology
Painful active movements which are less painful of passive movements suggests articular pain
Painful resisted movements may originate from the soft tissues e.g muscle/ tendon

124
Q

Types of gait

A

Antalgic gait - pain, don’t spend long on one leg
Trendelenburg gait
Waddling

125
Q

What does a Trendelenburg gait indicate

A

Weakness of abductors

126
Q

What does waddling suggest

A

Proximal muscle wasting

127
Q

What are you looking for in skin in an examination

A 
Rashes 
Redness 
Bruising 
Muscle wasting 
Scar 
Deformity
128
Q

Testing flexion in a hip examination

A

Flexing knee to 90 degrees

Passively flex and then push knee to chest

129
Q

Testing adduction in a hip examination

A

Bring leg over the other

130
Q

Testing extension in a hip examination

A

Place hand under ankle and ask patient to push your hand into the bed

131
Q

Testing rotation in a hip examination

A

With knee flexed, invert the knee (internal) and then evert the knee (external)

132
Q

Thomas’ test

A

Place your opposite hand under back of patient and flex knee until its at the chest - should feel hand being squashed if normal

133
Q

Testing abduction in a hip examination

A

Ask patient to abduct leg - hold pelvis still with opposite hand when doing passively

134
Q

What does the Thomas’ test identify

A

Fixed flexion deformity

135
Q

Apparent leg length

A

Umbilicus to medial malleolus

136
Q

What is the medial malleolus connected to

A

Tibia

137
Q

What is the lateral malleolus connected to

A

Fibula

138
Q

Sweep test

A

Empty the suprapatellar pouch
Stroke the medial side of the knee joint to move any excess fluid across to the lateral side of the joint then do the lateral side

139
Q

Patellar tap

A

Empty supra patellar pouch

Tap patella

140
Q

How to empty the suprapatellar pouch

A

By sliding your left hand down the thigh to the upper border of the patella

141
Q

Ballotement test

A

Force fluid out of suprapatellar pouch

Push patellar down into femur using two hands

142
Q

Hyperextension of knee

A

Pushing hand under knee into bed

143
Q

How do you examine the integrity of the MCL and LCL

A

Place your hand under the knee and the other on the ankle and move L and R
Looking for hard end point

144
Q

How do you examine the integrity of the ACL and PCL

A

Anterior and Posterior draw test

Sit on foot and place hands under hamstrings and pull knee forward/ backwards

145
Q

Hallux valgus

A

Bunions

Big toe drifting laterally

146
Q

Bony landmarks in knee

A 
Femoral condyles 
Joint line 
Patella
Tibial tuberosity 
Tibial plateau 
Head of fibula
147
Q

Examination of Ankle and Wrist - Look

A 
Muscle bulk 
Scars 
Redness
Position of wrist 
Swelling and deformity of joints 
Thenar and hypothenar eminences
148
Q

Examination of Ankle and wrist - Feel

A 
Heat 
Joint swelling 
Wrist joints 
Radius and ulnar styloid processes 
Psiform 
Scaphoid
Finger joints: MCP, PIP, DIP
149
Q

Examination of Ankle and Wrist - Move

A 
Flexion and extension 
Abduction and adduction 
Finger extension and flexion 
Flexion and Extension of individual fingers at MCP, DIP, PIP
Abduction and adduction of fingers 
Same for thumbs and opposition
150
Q

Tachypnoea

A

Rapid breathing, 20+ breaths/min

151
Q

Hyperventilation

A

Inappropriate, rapid breathing

152
Q

Types of sites pulse can be measured at

A

Peripheral e.g. brachial

Core e.g. temporal

153
Q

Examples of causes of tachycardia

A

Exercise
Hypertension
Anaemia
Hyperthyroidism

154
Q

Examples of causes of bradycardia

A

Drugs e.g. beta blockers
Sleep
Hypothyroidism
Hypothermia

155
Q

Diagnostic parameter for chronic hypertension

A

Bp over 140/90 in 3 consecutive readings taken sitting down and 30 mins apart

156
Q

EWS and NEWS2

A 
Looks at:
Airway 
Breathing 
Circulation 
Disability (consciousness )
Exposure (temp)

Urine output should also be considered

157
Q

Things to look at in a respiratory assessment aside from respiratory rate

A

Chest expansion
Oxygen sats
Sternum/ intercostal muscle recession

158
Q

Examples of causes of increased respiratory rate

A 
Exercise
Stress/ anxiety 
Shock 
Hypoxia 
Diabetic ketoacidosis
159
Q

Measuring oxygen sats

A

Place finger probe on opposite hand use total bp

Can also use earlobe probe if patient has nail polish

160
Q

Where do the most accurate temp values come from

A

Oral and tympanic

MBBS - Year 1 (93 decks)

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