Examination Flashcards

Question

Liver exam - chest

Answer 1

Spider naevi Gynocomastia Hair distribution

Answer 2

Scars, distension Striae, caput medusa, stoma Palpate 9 regions superficial and deep Palpate liver and spleen for enlargement Ballot kidneys Feel for AAA - expansile pulsatile mass Percuss liver, spleen, shifting dullness, bladder Auscultate: bowel sounds, bruits

Answer 3

Oedema To complete - genitalia, PR, hernias

Answer 4

General inspection of pt and bedside Standing first and then lying Ask them to cough / bear down Look for swelling / observe inguinal ring and femoral canal Describe lump - site, size, shape, skin, extension into scrotum Compare sides Ask for any pain before starting palpation

Answer 5

Ask about pain before starting Support the patient with one hand, and use the other to examine the lump Consistency Temperature Surface Tender Fluctuant Cough impulse Reducible or irreducible Note - you can't palpate above the upper border of a hernia Once reduced - place fingers over deep inguinal ring - if when coughing, it remains reduced, likely direct, if reappears, then indirect.

Answer 6

Resonance and bowel sounds = likely containing loops of bowel

Answer 7

Through deep ring and out superficial ring Lateral to inferior epigastric Into scrotum

Answer 8

Through Hesselbach's triangle (lateral border = inferior epigastric, medial border = rectus, through weakness in conjoint tendon Medial to inferior epigastric

Answer 9

Through femoral canal Medial to femoral artery and vein

Answer 10

Floor = inguinal ligament Roof = transversus abdominis and internal oblique muscles Anterior = external oblique muscle Posterior border = transversalis fascia laterally and conjoint tendon medially

Answer 11

Observe subcutaneous veins, note varicosities Observe intradermal veins Scars from previous surgery Oedema (poor venous flow) Venous eczema and hair loss Pigmentation and haemosiderin deposition Lipodermatosclerosis Ulceration - position, shape, size, edge (sloping, punched out, rolled, undermined), base (healthy, sloughy, avascular, purulent, necrotic, underlying structures visible), depth, discharge, surrounding cellulitis / health of surrounding skin

Answer 12

Colour - purpuric or gangrene Line of demarcation Trophic changes e.g. dry skin, scale, nail changes

Answer 13

Cough impulse at saphenofemoral junction Feel length of veins Lie patient down - Palpate ulcers - ? hot compared to limb, tender, relationship to surrounding structures - Feel for perforators - TAP TEST = tapping over SFJ and feeling percussion travelling down leg into region of varicosities

Answer 14

Temperature - cool Pulses - femoral, popliteal, posterior tibial, dorsalis pedis

Answer 15

Femoral artery bruit

Answer 16

Sensation to light touch, pin prick, vibration, position Reflexes

Answer 17

Tourniquet test - Brodie-Trendelenburg test - To assess valvular incompetence if varicose veins are present - Empty superficial veins - lift leg + milk + apply tourniquet at level below and stand - High up > if veins refill the incompetence below the SFJ (2.5cm below and lateral to PT) - Above knee (adductor canal perforators) - Below knee (saphenopopliteal junction) Buergers test: Elevate leg and watch soles to see at what angle pallor develops (<20 degrees indicates ischaemia). Then lower leg and observe over time to return to pink colour - longer if ischaemic and then develops reactive hyperaemia Venous refill: Elevate for 3mins then lower leg - should see venous refill within 30s Perthes test: to assess patency of deep venous system prior to varicose vein surgery. TOurniquet at level of SFJ and ask patient to mobilise - if superficial veins collapse then deep veins patent.

Answer 18

Femoral and inguinal LNs Regional pulses Abdomen for masses Testes for masses, varicosity PR / PV for pelvic masses

Answer 19

FBC, U&E, ESR, CRP Wound swab ABPI Doppler BSL HbA1c

Answer 20

Stripping SF / SP ligation Tie perforators Injection sclerotherapy

Answer 21

Healing ulcer Usually shallow Typical of a venous ulcer

Answer 22

Vertical edge, rapid depth and sloughing of the full thickness skin without attempt at repair Typical of neuropathic / vasculitis ulcers. Historically syphilitic ulcers - now rare

Answer 23

occur when infection supervenes in subcutaneous tissue - eg pressure sores

Answer 24

Develops when there is slow growth of tissue at the edge of the ulcer. Almost pathognomonic of BCC

Answer 25

Develops when tissue at the edge of the ulcer is growing quickly and spillign over normal skin. Usually SCC.

Answer 26

Scars Swelling Skin changes Muscle wasting - supraspinatus, infraspinatus, deltoid Deformity Scoliosis

Answer 27

Start at medial clavicle, along to ACJ, biceps tendon, deltoid, scapula spine, infra-supra fossa Distally - sensation - axillary, median, radial, ulna Pulses

Answer 28

Active - ab, ad, ext, flex, internal and external rotation Hands behind head Passive - ? improvement ? crepitus Power

Answer 29

Empty can = supraspinatus Painful arc Lift off = subscap External rotation = infraspinatus and teres minor Impingement tests - Neer's (passive flexion) - Hawkins-Kennedy - 90 degrees flexed shoulder, elbow, then passive medial rotation Instability = apprehension test - arm abducted elbow flexed 90/90, and push shoulder joint forward

Answer 30

Lateral and medial stress testing Tennis elbow - lateral epicondylitis - pain with resisted wrist extension Golfers elbow - medial epicondylitis - pain with resisted wrist flexion

Answer 31

Trendelenburg (when standing) - weakness of hip abductors Thomas test - hand under lower back, lift one leg, if other hip flexes / knee bends - fixed flexion deformity

Answer 32

MCL / LCL ACL / PCL - anterior and posterior drawer test Lachmans tests Meniscal grind Patella apprehension test

Answer 33

Wasting Scars Skin changes

Answer 34

Muscle bulk Sensation - medial nerve (index) compared to ulna (little) and radial (dorsal)

Answer 35

Median nerve muscles Abductor pollicis brevis Opponens Compare sides

Answer 36

Tinel's = percussion over carpal tunnel Phalen's = flex wrist and hold for one minute Positive if symptoms are reproducible

Answer 37

Skin changes or infection Swellings Lacerations Normal cascade of fingers Abnormal positioning of fingers / hand Scars

Answer 38

All areas / joints for tenderness and fluctuance Perfusion of each digit: Cap refill Colour Turgor

Answer 39

Form fist for gross assessment of function FPL FDP FDS Extensors (lag or droop)

Answer 40

Sensation Then finish with LA injection and re-examine movement and explore wound

Answer 41

MN - Pronator teres, FCR, Palmaris longus AIN - FDP IF MF, FPL, PQ Palmar branch (before carpal tunnel) - skin over thenar muscles Muscular recurrent branch (after flexor retinaculum) - thenar muscles

Answer 42

Supplies FDP RF LF, FCU Gives off: Dorsal branch - sensation to dorsal surface of RF and LF Superficial palmar branch - palmar surface of LF and RF and hypothenar eminence Deep branch of hand - motor to 3 hypothenar eminence muscle, all interossei, add pollicis, 2 ulnar lumbricals

Answer 43

Postures - Upper lesion - arm adducted and internally rotated at shoulder, pronated and extended at elbow - Lower lesion - deficit of small muscles - claw hand, unopposed wrist extensors, hyperextension of MCP and flexion of IPJs due to loss of hand intrinsic muscles Open injury Muscle wasting Horner's syndrome and serratus anterior / scapula winging (proximal lesion - preganglionic involving sympathetic trunk)

Answer 44

C5 - deltoid shoulder abduction C6 - elbow flexion C7 - Elbow extension and wrist flexion C8 - Finger flexion T1 - finger abduction Reflexes Distal pulses (often have an associated arterial injury)

Answer 45

Swelling Deformity Scars Skin changes

Answer 46

Medial condyle, medial joint line Ulnar nerve Biceps tendon Lateral epicondyle, lateral joint line Radio-capitellar joint - palpate while supinating and pronating Olecranon

Answer 47

Active flexion, extension, supination, pronation Compare sides

Examination Flashcards

(71 cards)