Differentials PE Flashcards

Question

Pre eclampsia exam

Answer 1

1. Hand - Temperature - Pulse - CRT - Palm paleness 2. Arm - Bruises - BP 3. Eye - Icterus - Pallor - Fundoscopy 4. Heart - Murmur 5. Abdomen - RUQ tenderness - Uterine tenderness - FH - FHR - Lie and presentation 6. Lower extremities - Edema - Pitting / non pitting - Reflexes - ankle - Clonus

Answer 2

WIPE 3-Inspection (4 positions all sitting) sitting with her hands on her thighs relaxed -asymmetry (if you noticed any gross asymmetry ask if it is latest or not). -Scars (lumpectomy, mastectomy). -skin changes: erythema ex. Infection/malignancy puckering or dimpling of the skin ex breast cancer peau d’orange ex aggressive breast cancer -visible lump or not (if you can see it then you need to talk about the site, size and others in the exam unlikely you will see it) -nipples (retraction, distortion, ulceration, discharge) Hands on hip pressing inwards -if lump visible (look if it is moving or fixed) Both hands behind her head -puckering or dimpling become more evident -lower side of breast clearly -if any lymph nodes in the armpits Hands still behind head and ask the patient to lean forward -if lump falling forward with lump tissue (again if not then it is attached to chest wall indicating malignancy) 4-palpation -wear gloves -if you could lie down on the bed for me and ask her to raise the hand of the side that will be examined and put it behind the head (for example if you start with left breast ask her to raise her left hand and put it behind her head). -ask about pain then start with the normal breast first. -palpate in a spiral way starting from the nipple then proceeding outwards and always make sure to palpate the axillary tail. -then go to the abnormal breast the same maneuver and if you found a lump leave it complete the whole breast the go back to it. -Lump examination Site and size -site is in what quadrant and the distance away from the nipples. -size is to take a tape measure and find the length and width Surface and border -surface if even or not (smooth or nodular) -border if regular or irregular Consistency and tenderness -consistency if soft, firm or hard -tenderness Mobility and fluctuation - ask the patient to squeeze her nipples - palpate the lymph nodes of the axilla and the neck - recover the dummy with the sheet

Answer 3

Examination 1-G/A - Active, alert - No signs of respiratory distress - No bruises, pink, jaundice, rash 2- Auscultate the chest and heart sounds while sitting in mum’s lap. Then put on the couch 3- Hands -Dorsum: nails, cyanosis, syndactyly, polydactyly -Palm: no single palmar crease, Grasp reflex -Pulse: regular, RR delay, RF delay 4- Arms -Tone, movement -palpate clavicles 5-Head and Face -Fontanelle (bulging or depression) and sutures -Eyes (epicanthic fold, squint, pallor, jaundice, red conjunctivae, Fundoscopy red reflex, ) -Nose (shape and discharge) -mouth (cleft lip, cleft palate, tongue, cyanosis, Rooting reflex, suckling reflex with gloves) -Ears (ear tag, low set ears, otoscopy) -Mandible (prognathia, retrognathia). (You will just say normal jaw position.) Note/ with fundoscopy use just its torch and point to the eyes as red reflex in babies very obvious with just light so no need to look through the fundoscope. 6-Neck -swelling, web neck, trachea position 7-Chest -Deformity, wide spaced nipples 8-Abdomen -LOOK (distension, umbilicus) -FEEL (organomegaly) -Hernia orifices 9-Pelvis and Lower limbs -Asymmetrical creases -Barlow and Ortolani (DDH) = hip stability tests -Tone and movements of the legs 10-Feet -club foot, nails, space between 1st and 2nd toe 11-Back passage and Genitalia (Take consent from mum plus wear gloves) -Imperforated anus, opening of urethral meatus, testicles - Hypospadia, Epispadia, Undescended testis (male ) -Ambiguous genitalia, clitoromegaly (female) 12-Back -tuft of hair, swelling 13-Moro reflex 14-Ask for Growth Chart ( weight, length, head circumference) Comment for mum *Your baby is well and nothing to be worried about *Encourage immunisation *Continue breast feeding *

Answer 4

``` GA - Alert and active - Dyspnea - Cyanosis - Nasal flaring - Use of accessory muscle - Audible breathing sound ○ Wheeze ○ Stridor ``` Hand - Temp - CRT - Pulse - BP ``` Eyes - Look ○ Alignment and symmetry of eye ○ Redness ○ Swelling § Note the location of swelling § Any tenderness § Change of temperature ○ Discharge - Feel ○ Tenderness ○ Hardness of eye ○ Temperature - Move ○ Extraocular eye movement ○ Any blurring of vision ○ Pain on movement ○ Double vision - Visual Acuity - Visual field - Vision color - Accomodation - Pupillary reflex - Ophthalmoscope Ears - Discharge - Redness - Otoscope ○ Redness/ bulging at TM Nose - Erythema - Discharge - Tenderness Mouth - Dental hygiene - Swelling - Tenderness Neck - Cervical LN Chest Auscultate ```

Answer 5

``` 1-WIPE -wash hands -Introduce yourself -permission and consent -exposure 2-Gait -walking (symmetry, broad based gait, antalgic gait) -turning (slow or quick) -tandem gait -walk on toes -walk on heels -Romberg test 3-Look (SSSDW) -scars, missing toes or limbs -skin (color, ulcers, caluses, atrophic changes like shiny skin and hair loss) -swelling -deformity (charcot joints) -muscle wasting note/ in the exam most likely to be all normal 4-Feel (TCP+ MVPR) -Temperature -capillary refill time -pulses (dorsalis and posterior tibial) note/ in the exam most likely be normal -again cotton wool/ pinprick or monofilament (I think in the exam there will be cotton wool/pinprick). -vibration -proprioception -reflexes note/ in the exam there will be loss of sensation and vibration up to…. 5-Tone, power and coordination (I think we need to do them but again after inspection, sensation and reflexes) ``` 6-I would like to complete my examination by doing -upper limb neuro exam -cranial nerve exam -cerebellar signs -chronic liver disease signs 7-rewash hands and thanks the patient and the examiner

Answer 6

``` 1-general inspection -raccoon eyes, battle signs, Ottorrhea, rhinorrhea. -trauma, injury, bruising, rash. -insulin injections especially on tummy / IV drug injection sites on arms 2-Vital signs 3-Neck -stiffness 4-Eyes -pupil size and shape -light reflex -corneal reflex -fundoscopy 5-Ears -otoscopy 6-Chest -breathing pattern -heart sounds 7-abdomen -insulin injection -other aspects 8-Neuro: tone and reflex 9-office tests -BSL -ECG ```

Differentials PE Flashcards

(30 cards)