CPA Flashcards
(125 cards)
1
Q
Introduce a cardiovascular exam
A
hand santiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct a cardiovascular examination which will involve…. ( a look, feel, listen to chest) is that okay?
Can i confirm your name and DOB
The examination will require you to be exposed from the waist upwards and sitting on the couch at a 45 degree angle, do you need any assistance ?
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know
2
Q
palpate the radial artery, calculate rate and rhythm
A
between tendon flexor carpi radialis and brachioradialis
3
Q
palpate the ulnar artery
A
between tendon flexor carpi ulnaris and fexor digitorum superficialis
4
Q
palpate the brachial artery
A
medial to biceps tendon
5
Q
palpate the common carotid artery
A
medial border of SCM and lateral border of thyroid cartilage
6
Q
palpate the apex beat
A
feel the beat first by moving axillary to mid clavicular then count the intercostal spaces middle finger should be in 5th ICS mid calvicular
7
Q
what can cause a displaced apex beat
A
cardiomegaly
8
Q
what can cause an absent apex beat
A
obesity, pleural effusion, pericardial effusion, emphysema
9
Q
palpate for heaves
A
left of patients sternum (parasternal)
10
Q
what is a heave
A
a precordial impulse
11
Q
why do we palpate for heaves
A
if feel the heel of hand raise its right ventricular hypertrophy
12
Q
palpate for thrills
A
hand horizontally at all four valves
13
Q
what is a thrill
A
a palpable murmur/vibration caused by turbulent blood flow through a valve
14
Q
palpate the head and neck arteries
A
carotid artery
superficial temporal : infront of ear tragus
subclavian
15
Q
palpate and name the four lower limb arteries
A
1) femoral artery- mid inguinal point
2) popliteal artery- knee at 30 degrees relax, thumbs on tibial tuberosity feel behind knee
3) posterior tibial pulse- posterior of medial mallelus, slightly under
4) dorsal pedis- slightly lateral to high point of big toe tendon (lateral to extensor hallicus longus)
16
Q
Describe the location of the four heart valves
A
Aortic: from right sternal border, 2nd ICS
Pulmonary: left sternal border, 2 ICS
Tricuspid: left Costosternal border, 5ICS
Mitral: left 5th ICS at Mid clavicular line
17
Q
What are the surface markings of the heart
A
Upper right : 1cm from right sternal border in 3rd CC
Lower right: 1cm from right sternal border 6th CC
Upper right: 2.5cm from left sternal border at the 2nd ICS by the 2nd CC
Lower right: in the left 5th ICS, until where the apex beat (usually mid clavicular line)
18
Q
Auscultate the heart
A
aortic, pulmonary, tricuspid and mitral
19
Q
aortic stenosis causes what murmur
A
ejection systolic
20
Q
What other pathologies can cause an ejection systolic murmur
A
aortic stenosis
Pulmonary stenosis
Aortic sclerosis
Atrial septal defect
Hypertrophic obstruction cardiomyopathy
21
Q
aortic regurgitation causes what murmur
A
early diastolic
22
Q
mitral regurgitation causes what murmur
A
pansystolic
23
Q
mitral stenosis causes what murmur
A
mid diastolic
24
Q
describe the borders of the heart
A
RU- 3CC 1cm right from sternal edge
RL- 6CC 1cm from sternal edge
LU- 2ICS/2CC 2.5cm from sternal edge
LL- 5ICS mid clavicular line at apex beat
25
Accentuation manoeuvre of aortic stenosis
Auscultate carotid artey using bell and ask patient to hold breath, will get radiation of ejection systolic murmur. slow rising pulse with a narrow pulse
26
What is the accentuation manoeuvre of aortic regurgitation
Auscultate over aortic area, ask patient to sit forward and breathe out
27
accentuation manoeuvre of mitral regurg and mitral stenosis
mitral regurgitation: over mitral area use diaphragm, LEFT LATERAL DECUBITUS POSITION (roll onto left hand side) breath in out and hold, should get louder with expiration, then tell to breathe normally and auscultate round axila to check for radiation
mitral radiation: using bell auscultate, LEFT LATERAL DECUBITUS ask to breathe in an out and hold
28
What are the two types of aortic dissection and how would they present
Type A- a tear in ascending aorta, presents with severe chest pain, both anterior and posterior
Type B- a tear in descending aorta, presents with back pain mostly, chest and abdominal pain after
29
Describe S1, S2, S3, S4
S1 is the mitral and tricuspid valves closing
S2 is the aortic and pulmonary valves closing
S3 rapid filling of ventricles- congestive heart failure
S4 forceful atrial contraction
30
introduce an abdominal examination
hand sanitiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct abdominal examination which will involve.... ( a look, feel, listen to tummy) is that okay?
Can i confirm your name and DOB
The examination will require you to be exposed from the waist upwards and lying flat on the couch , do you need any assistance ?
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know
31
On general inspection of the abdomen what are you looking for
skin abormalities, surgical scars, masses, hernias, asymmetry
respiration being diaphragmatic
obesity- sunken umbilicus
umbilical hernia would be distended and everted
32
palpate the abdomen and name the regions whilst
light palpation first then mention it may feel slightly uncomfortable so let me know if you want me to stop then deeper palpation, monitor face for pain
Regions: Right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, right lumbar, right iliac fossa, suprapubic/hypogastric, left iliac fossa
33
name the organs that are in each section of the abdomen
Right Hypochondriac- Liver, gallbladder, biliary system
Epigastric- Liver, stomach, pancreas, duodenum
Left Hypochondriac- pancreas spleen
Right lumbar- right kidney, ascending colon
Umbilicus- small intestine, transverse colon, abdominal aorta
Left lumbar- descending colon, left kidney
Right Iliac Fossa- appendix, caecum, right ovary
Suprapubic/Hypogastric- bladder, uterus
Left Iliac Fossa- sigmoid colon, left ovary
34
name some pathologies that can occur in each section of the abdomen
Right Hypochondriac- hepatitis, cholesystitis, cholangitis, gallstone, hepatomegaly
Epigastric- gastritis, GERD, pancreatitis
Left Hypochondriac - pancreatitis, splenic infarct, splenomegaly, splenic abscess
Right Flank- kidney stones, renal cancer, colitis
Umbilicus- small bowel obstruction, abdominal aortic anneurysm
Left flank- kidney stones, colitis, kidney infection (pylonephritis)
Right Iliac Fossa- appendicitis, ovarian torsion, colitis, ovarian cyst
Suprapubic/Hypogastric- UTI, STI, Pregnancy, ectopic pregnancy
Left Iliac Fossa- colitis, ovarian torsion or cyst, diverticulitis
35
palpate the liver
start from right iliac fossa, ask for deep breath in then push in, then out
36
three causes of hepatomegaly
viral hepatitis (hep A or hep B)
toxic hepatitis (med overdose)
alcohol associated hepatitis,
congestive heart failure
leukaemia, haemolytic anaemia
liver tumour/ liver cancer
37
palpate the spleen
right iliac fossa towards left costal margin
38
three causes of splenomegaly
haemolytic anaemia
splenic metasteses
congestive heart failure
endocarditis (bacterial infection)
portal hypertension due to cirrhosis
39
palpate the kidney
kidney balloting, left hand behind right flank then feel ontop with right hand
40
causes of kidney enlargement
bilateral- polycystic kidney disease, hydronephrosis, amyloidosis
unilateral- renal tumor
41
Describe the different signs seen on palpation and what they indicate
tenderness- minimal pressure over a wide area = peritonitis
Guarding- contracts voluntary when palpation causes pain
Rigidity- inflammation on parietal peritoneum, reflex contraction, involuntary guarding, dont see any abdominal movements during respiration
Rebound tenderness- localised or general peritonitis if abdonimal wall compressed slowly then released they get sharp stabbing pain
42
palpate the abdominal aorta
above the bellybutton, slight triangle shape push down, will be on patients left
43
when palpating the abdominal aorta what are you feeling for
non expansile and pulsatile, if expansile and pulsatile then abdominal aortic anneurysm
44
when does the abdominal aorta bifurcate and into what
L4
left and right common iliac artery
45
Name the planes of the abdomen and what they signify
Transpyloric plane- L1, pylorus of stomach, neck of pancreas, fundus of gallbladder, renal hilum, duodenojejunal flexure, end of spinal cord. Is midway between jugualr nothch and pubic symphysis/ lower end of sternal body and umbilicus
Subcostal plane- L3, inferior mesenteric artery begins, under 10th CC
Supracristal- L4, birfurcation of aorta (bellybutton)
Intertubercular- L5, tubercle crest of ilium
Interspinous- S2, horizontal through anterior superior iliac spines (boundry between umbilical and hypogastric region)
46
percuss the liver
Percuss from right iliac fossa upwards, should change to dull note at costal border, keep percussing upwards until becomes resonant or go from upper 4th rib downwards after
47
what are the surface markings of the liver
Right 5th ribs at the midclavicular line
Left 5th rib ICS at the midclavicular line
Lower end of the sternum
Costal margin of the 10th rib at right mid axillary line
48
percuss the spleen
percuss from right iliac fossa diagonally to the left anterior axillary line
at 10th intercostal space ask to breathe in fully, percuss, breathe out fully percuss
49
What are the surface markings of the spleen
upper border: superior border of left ninth rib
lower border: superior border of left 11th rib
medially- at the left lateral border of erector spinae muscles, (5 cm from the midline)
laterally- left midaxillary line
50
percuss for ascites
percuss from midline to flank noting where becomes dull, ask to turn onto opposite side, wait 30 seconds and percuss again, if becomes resonant then fluid moved
51
What causes ascites
accumulation of fluid in the peritoneal cavity due to liver cirrhosis
decreased metabolism of aldosterone and ADH by liver leads to salt and water retention
liver produces less albumin which reduces oncotic pressure so fluid leaks out of vessels
52
auscultate bowel sounds
listen to two places slightly under bellybutton, should listen for 3-4 mins before coming to conclusion
53
what are you listening for when listening to the bowel
listening for gurgling from peristalsis
absent bowel sounds- paralytic ileus or peritonitis
intestinal obstruction- high pitched and frequent
54
What are the most common regions where stones reside
he ureteropelvic junction (UPJ)
the ureteral crossing of the iliac vessels
the ureterovesical junction (UVJ).
55
How would you diagnose urinary tract stones
Non contrast CT scan
56
If urinary tract stones were found how would you treat it
if smaller than 5mm let it pass, if larger then lithotripsy or stenting
57
auscultate the abdomen for bruits
right and left iliac arteries (under bellybutton)
abdominal aorta (above and left of bellybutton)
renal arteries (left and right of abdominal aorta
superior mesenteric arteries: epigastrum midline
liver tumour: over liver
58
what are the borders of the liver
upper border- right dome of diaphragm which is marked by right 5th rib and costal cartilage extends across lower end of sternum
oblique border- right costal margin mid axillary, through tip of the 9th and 8th CC (which is the junction between the costal margin and lateral border of rectus abdominus) to the 5th ICS in mid clavicular line
Right border - down anterior right axillary line
59
What are the surface markings of the gallbladder
where the transpyrloric plane intersects with the right midclavicular line
transpyloric plane which runs through the tips of 9th CC
mid clavicular line runs along the lateral border of rectus abdominis
60
what is the surface marking of the kidney
medial border is 4-5cm from posterior median line
superior border is 12th rib
inf 3-4cm above iliac crest
transpyloric plane runs through L1 (midpoint between inf angle of scapula and highst point of iliac crest is T12 then count one down)
61
what are the dimensions of the kidney
width: 5-7 cm
Height: 9-12 cm
62
what is the surface marking of the ureter
5cm lateral to posterior median line at L1 (transpyrloric plane)
through posterior superior iliac spine
63
Introduce a neurological exam
hand sanitiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct an examination of the upper and lower limb which will involve.... ( moving your arms and legs and testing sensation in those areas) is that okay?
Can i confirm your name and DOB
The examination will require exposure of your arm and legs, and you sitting upright at 45 degrees is that okeh
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know
64
assess the tone of the upper limb
ask patient to relax arm
circumduct the shoulder joint, support hand and elbow
flex and extend elbow
circumduct wrist
65
if there is an upper motor neurone lesion what would you find upon examination
pyramidal tract lesion/ UMN
spasticity, hypertonia
66
if there is hypotonia/rigidity in the arm what is this a sign of
extrapyramidal tract/ LMN
67
assess the power of the upper limb, whilst saying what myotome and muscles are being worked
shoulder - abduction C5- stop from pushing down- deltoid
shoulder- adduction C6/7- stop from pushing up- teres major, latissumus dorsi, pec major
elbow- flextion C5/6- stop me from pushing forearm away- biceps brachii
elbow- extension C7- stop from pushing towards- triceps brachii
wrist- flexion C6/7- flex wrist down, stop from pulling up- flexors of the wrist (flexor carpi ulnaris, flexor carpi radialis
wrist extension: C7- wrists back, stop from pushing down
68
how is power scored
MRC Muscle Power Scale : scale of 0-5
0- no movement
1- flicker of movement
2- voluntary movement cant overcome gravity
3- voluntary can overcome gravity
4- voluntary can overcome resistance
5- normal strength
69
test the reflexes of the upper limb and name what nerve is being tested
relax fully
biceps- C5, C6- place finger over bicep tendon and tap
triceps- C7, C8- rest arm at 90 flexion, find tendon tap
supinator- C6- brachioradialis tendon, 4 inch from tumb base
70
lesions to the UMN and LMN would have what effect on relexes
UMN- hyperreflexia
LMN- areflexia
71
test the sensation of the upper limb and state which dermatome is being tested
demonstrate normal sensation on the sternum with eyes closed, then say you will do this on both arms, say yes if you can feel. alternate between two arms
c3- clavicle bit
c4- deltoid
c5- bicep
c6- thumb
c7- middle finger
c8- pinkie
t1- medial epicondyle
t2- axilla
72
assess the tone of the lower limb
ask patient to relax leg
leg roll
leg lift (life at knee joint)
ankle clonus- dorsiflex the foot quickly
73
asses power of leg
as patient to perform these movements
hip flexion- stop from moving down ( psoas major and iliacus, femoral nerve)
hip extension- patient pushes against the couch, exmainer pulls up (gluteus maximus, inferior gluteal nerve)
hip abduction- stop from pushing in (gluteus medius and minimus, superior gluteal nerve)
hip adduction- stop from pushing out (adductor longus, adductor brevis, adductor magnus, obturator nerve)
lift leg slightly up and hold
knee flexion- patient pushes leg towards ankle
knee extension- patient kicks out
74
what test is used to check the hip abductors
Trendelenburg test
when right foot is raised the left abductor is tested- glut med and min
75
assess knee joint and say which muscles and nerves are being tested
extension- patient kicks out whilst applying downward pressure (test quadriceps and femoral nerve)
knee flexion- patient pushes leg towards ankle whilst pulling outwards (hamstrings and sciatic nerve)
76
assess ankle joint and say which muscles and nerves are being tested
dorsiflexion- push foot down- tibialis anterior, externsor hallicus longus, extensor digitorum longus. deep fibular nerve
plantarflexion- push foot up- tibial nerve S1-2
inversion- place hand laterally
eversion- place hand medially
77
what joint does inversion and eversion take place at
subtalar joint
78
asses the reflexes in the lower limb and say what nerves are being tested
Knee jerk reflex- patellar reflex tendon, L3, L4, patients legs hanging off bed, do Jendrassik manoeuvre (clench teeth and pull hands)
ankle jerk reflex- S1,S2, at achilles tendon, hip slightly abducted knee flexed and ankle dorsiflexed, tap tendon
79
Describe the different nerve lesions of the lower body and what motor and sensory loss this would result in
Femoral nerve: quadraceps paralysis/knee weakness and anterior thigh and medial thigh, leg and foot have sensory loss
Obturator nerve: adductor paralysis (cant sit cross legged), pain on medial thigh as usually from a tumour in pelvis
Common fibular nerve: foot extensors and evertors paralysed- foot drop. loos of sensation on anterior and lateral side of leg, dorsum of foot
Tibial nerve: hamstrings and all posterior muscles of leg, sole of foot too. foot in dorsiflexed and everted position. sole of foot loses sensation
sciatic nerve: hamstrings and all ,uscle below the knee paralysed, knee flexion affected. foot drop (in plantarflexion). Can only feel the medial side of leg and foot the saphenous nerve area
80
What is sciatica caused by
pain radiating from posterior back into buttock, into posterior thigh and leg
L5-S1 sciatic nerve compressed by herniated lumbar intervertebral disk
81
What are the borders of the femoral triangle
Inguinal ligament
Adductur longus
Sartorius
82
assess the dermatomes of the lower limb and state which dermatome is being tested
ALTERNATE BETWEEN LEFT AND RIGHT
l1- top of thigh
l2- just below
l3- medial knee
l4- medial side of leg and big toe
l5 lateral side of calf and three middle toes
s1- little toe and lateral half of posterior leg
s2- medial half of posterior leg
83
what is it called when venous drainage becomes blocked due to pressure in the leg, how would this present, what are the causes and what is the treatment
compartment syndrome where pressure in muscle compartment so high it blocks venous drainage which can cause muscle ischaemia and death
presentation- pain, muscel tenderness and swelling, movement painful (6P- pallor, pulselessness, paralysis, perishingly cold, pain, paraesthesia)
cause- fractures, burns, infections, prolonged limb compression
treatment - relieve ressure, open fasciotomy where skin and deep fascia opened along the length of the muscle compartment to relieve pressure
84
introduce a respiratory exam
hand sanitiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct a respiratory examination which will involve.... ( having a look, feel and listen to your chest) is that okay?
Can i confirm your name and DOB
The examination will require you to be exposed from the waist upwards and sitting at a 45 degree angle on the couch, do you need any assistance ?
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know
85
assess the repiratory rate
looking at the chest wall movement check the respiratory rate, pretend to check radial
express in breaths per minute
86
palpate the trachea
warn may be uncomfortable, lean back and relax
push upwards and backwards
87
displacement of the trachea signifies what
displacement towards the lung lesion- upper lobe collapse, upper lobe fibrosis, pneumectomy, (goes to wherever is less pressure/air/collapse)
displacement away from side of lesion pleural effusion, tension pneumothorax, chest expansion
88
what level does the trachea bifurcate at
sternal angle, T4/5
89
assess chest expansion
place hands below 5th and 6th ribs, thumbs meet at anterior midline ask to take DEEP breathe in, fingers should move more than 5cm
repeat posterior at T10
90
what lobes does anterior chest expansion test for, and what lobes for posterior
Anterior: left lungs upper and middle lobes, right lungs upper lobe
Posterior- left and right lungs lower/inferior lobes
91
what do unilateral and bilateral decreases in chest expansion signify
bilateral- asthma or COPD
unilateral- pneumothorax, pleural effusion, collapsed lung, consolidation
92
percuss the anterior and posterior chest
switch between L and R as go down
apex of lung
2 ICS (superior lobe0
4 ICS (middle lobe) can do at acilla
6 ICS- (inferior lobe) below breast
mid axillary line
BACK: ask to roll sholders forward or cross arms (scapulae has to be rotated anteriorally)
apex- trapezius level
spine of scapulae (superior lobe)
level of 10th rib (inf lobe)
mid axillary line
93
what conditions would cause hyperresonance
pneumothorax, hollow bowels, COPD
more air space
94
what conditions would cause hyporesonance
pleural effusion (stoney/dull) , lung tumour, consolidation, collapsed lung (other three flat/dull)
95
what are the two types of sounds heard on auscultation, describe their character and where can you hear them
Bronchial- high pitch as air turbulence heard without filtering as no alveolar tissue. can hear over manubrium, trachea, suprasternal notch and between c7-t3 on back
character- hollow and high pitches, expiratory phase more, pause between inspiration ann expiration, these sounds heard over pathological areas (like consolidation or collapsed lung as no alveolar tissue)
Vesicular- low pitch where normal lung tissue is
character- inspiratory sound in lobar and segmental airway, expiratory in central airway, more in inspiratory phase, no pause
lower intensity vesicular sounds can be because of asthma and chronic bronchitis
96
auscultate the chest
same areas just with diaphragm ALTERNATE
Apex (above clavicle use bell)
2nd ICS
4th ICS or below right axilla
6th ICS
mid axillary
apex
2nd ICS
10th/11th rib
mid axillary
97
assess tactile vocal fremitus
ask patient to say 99 and put hand over each area
98
what is a decrease in tactile vocal fremitus caused by
decrease in density (more air) pneumothorax, COPD or pleural effusion
99
what is a increase in tactile vocal fremitus caused by
consolidation, tumour tissue
100
palpate the lymph nodes
patient must be sitting up, examine from behind
submental(chin), submandibular (angle of mandible)
preauricular, postauricular, occipital
superior deep cervical, inferior deep cervical, supraclavicular nodes
101
what are the causes of cervical lymphadenopathy
lung cancer metastisising
tuberculosis
sarcoidosis
resp tract infection
102
how would a patient with CA pneumonia present and what would you look for on a scan
sharp pain on deep inspiration
dullness where affected on percussion
which has crackles instead of vesicular sound in affected area
look for:
consolidat: denser than air : pus, haemorrhage
air bronchograms: small airways still filled with air looking very dark over the very white surrounding
silhoette sign: loss of normal border/blunting
103
what is the triangle of safety for chest drains
lateral edge of pec major
base of axilla
5th ICS
lateral edge of latissimus dorsi
104
what is the surface marking of the lungs
ANTERIORALLY
1 inch above medial 1/3rd of clavicle
medial edge of sternum and body
rib 6 mid clvicular line
approximately under xiphosternal joint
left lung cardiac notch between rib 4-6
POSTERIALLY
spine of C7
mid point between: posterior medial line and scapular line
10th rib mid axillary
105
what is the surface marking of the lung pleura
1 inch above medial 1/3rd of clavicle
medial edge of sternum and body
rib 8 mid clavicular line
tip of 9th rib where lateral border of rectus abdominus meets the 9th CC
POSTERIALLY
spine of C7
mid point between: posterior medial line and scapular line
10th rib costal margin
106
Describe what levels are the lung fissures
Left horizontal fissure : rib 4 mid clavicular
Left oblique fissure : rib 6 mid clavicular
Right oblique fissure: rib 6 mid clavicular
POSTERIALLY
oblique fissures at T3
107
introduce a musculoskeletal examination
hand sanitiser
Hi my name is , I am a 2nd year medical student at Imperial and have been asked to conduct an examination of your leg which will involve.... moving your leg and feeling around your knee is that okay?
Can i confirm your name and DOB
The examination will require you to be exposed mid thigh downwards and sitting on the couch at 45 degree angle, do you need any assistance ?
The examiner will act as a chaperone today
Before we begin, are you in any pain?
if you experience any pain please let me know
108
what are you looking at the knee for
scars
wasting of muscle - maybe a LMN lesion or pain from arthritis causes disuse
knee deformities- valgus- knock knees or varus- bow legged
109
assess the temperature
use back of hands, above, on and below patellar. both hands on both knees
110
If the knee is very warm what could it be
septic arthritis, osteoarthritis
111
palpate the knee
feel patella, medial and lateral joint lines, tibial tuberosity, head of fibula, feel around the popliteal fossa
112
swelling in the popliteal fossa causes what
bakers cyst
113
what is an effusion
excess synovial fluid
114
perform the tap method, what does it test for
ensure patients knee is extended
slide non dominant hand down thigh to empty suprapatellar pouch then press firmly on patella with dominant hand
test for moderate effusion - would feel a tap
115
perform the sweep method
ensure patients knee is extended
sweep upwards on medial side with non dominant, keep in place then used dominant hand to sweep down
test for small effusion, would see a bulge of fluid appearing on medial side of knee
116
assess patients range of motion
ask patient to bed right knee in and straighten, bend left knee and straighten (0-140 degrees) look at pain
117
What muscles are responsible for flexion and extension of the knee
Flexion: hamstrings: biceps femoris, semitendinosus, semimembranosus
Extension: quadriceps: vastus medius, vastus lateralis, vastus intermedius, rectus femoris
118
assess patients range of motion when relaxed
flex and ectend patients legs to maximum
lift patientswhole leg by ankle when relaxed
10 degrees of hyperextension is normal
119
perform the anterior draw test and posterior sag test
flex patients leg to 90 degrees, check and look for posterior sag (posterior subluxation of the tibia on the femur)
this creates a flase positive anterior drawer sign
hands behind upper tibia and thumbs on tibial tuberosity, pull tibia anteriorly
more than 1.5 cm suggest an ACL pathology
120
test the medial collateral ligament
flex leg at 30 degree, hand on lateral aspect of lower thigh, other on medial aspect of upper calf, apply valgus stress
121
test lateral collateral ligament
122
What imaging is always used for knee
MRI
123
Describe the clinical response to different NEWS2 Score categories
0- monitor every 12 hours, cont NEWS monitoring
1-4 pts: every 4-6 hours , inform registered nurse who will assess and decide whether escalation necessary
3pts on a single parameter: every hour, registered nurse to inform medical team caring for patient, who will review and escalate if needed
5 or more: every hour, reigstered nurse immediately informed medical team caring for patient, reg nurse requests urgent assessment by clinician or team trained in car of acute illness, clinical care in environment with monitoring facilities
7 or more: continuous monitoring, registered nurse immediately informed medical team caring for patient-specialist registrar level, emergency assessment by team with critical care competencies including practicioners with airway management skills, consider tranfer to level 2 or 3 clinical care facility, higher dependence or ICU, clinical care in environment with monitoring facilities
124
What is the basic structure of SBAR
SItuation: I am LB a (role), i am calling abount (patient x, DOB, Hospital number) from (department x) because I am conserned that (NEWS 2 worsening, specific concerning vitals)
Background: Patient X was admitted on -- with (presenting complaint). They have had (meds/surgery whatever management or investigation). Since then (obs change, NEWS change specific parameters).
Assessment: suspected clinical diagnosis, report what has been administered. OR i am not sure what the problem is but I am concerned that patient x is deteriorating
Recommendation: i recommend (according to NEWS the frequency of monitoring, clnical team, escalation of care) and i would like you to come have a look.
Is there anything I need to do in the meantime
125
How to complete an exam
The examination is over, thank you for your time.
Do you need any help with getting dressed
