Examination Musts Flashcards
(27 cards)
Parkinson’s
Face - expressionless
Gait - shuffling stooped, reduced arm swing
Handwriting - small
Bradykinesia
Cogwheel rigidity with distraction
To rule out
- vertical upward gaze (PSP)
- lying standing BP (MSA)
- cerebellar signs (MSA)
- MOCA (lewy body)
Muscular dystrophy
Face - frontal balding, ptosis
Cataracts, eyelid myotonia, dysarthria
Palpate for pacemaker
Obtain ECG and do full cardio for cardiomyopathy
Grip myotonia
Percussion myotonia
Distal arm muscle weakness and wasting and reduced reflexes
Examine external genitalia for testicular atrophy
Check BM for DM
Speech assessment
Dysarthria - bulbar/pseudobulbar, cerebellar
“Pa pa p, Ta ta ta, ka ka ka”
Dysphasia - expressive, receptive
3 step commands - open your mouth, with your right hand touch your nose, with your right hand touch your nose then your left ear
Word finding ability = Name objects (<18 in 1 minute)
Test repetition = no ifs, ands or buts
Upper limb screening
Pronator drift
Rebound phenomenon
Finger nose ataxia
Grip myotonia (count to 5 then let go)
Winging scapula (fascioscapulohumeral MD)
How to check INO
If notice INO, do convergence to determine if CN 3 palsy
How to check INO
If notice INO, do convergence to determine if CN 3 palsy
How to determine brisk reflex
Hit once hard to elicit reflex
Hit 2nd time soft to see if can elicit.
Look at spread to other reflexes
Description of weakness
UMN
- pyramidal (spasticity) - arm flexors stronger than extensor, leg extensor stronger than flexors
- extrapyramidal (rigidity) - check for Parkinsonism
LMN
- flaccid hemiparasis (anterior horn > nerve root > plexopathy > peripheral nerve > NMJ > myopathy)
Sensory deficit patterns
Glove and stocking (axonal sensory loss)
Patchy (mononeuritis multiplex, demyelinating neuropathy)
Localising pyramidal weakness
Anywhere along corticospinal tract
Cerebral cortex (stroke, parasaggital meningioma)
Pontine lesion (both UMN and LMN)
Spinal cord
Diabetic foot exam
Feel foot pulse, popliteal, femoral
Check for ulcers in between toes and heel
Check callus
Check amputated toes
Check hair
Retinitis pigmentosa other exam
Hearing
Heart sounds
Ataxia differentiation
Cerebellar = normal proprioception
Sensory = abnormal proprioception distally
Multiple sclerosis exam
Cerebellar exam
Optic nerve (RAPD) - test by shining light directly on eye for 2 seconds then shine on another eye for 2 seconds
Eye movement for RAPD
How to find out macular sparing?
Ask pt cover eye and look directly at your face and if any part of face missing e.g. half of face missing = not macular sparing
Abdominal exam musts
Look at arms for RRT
Assess fluid status
Look carefully at abdomen for scars
Subcostal scar can be horizontal and should think about liver transplant but not always esp if no signs of chronic liver disease
Neurological sign (tremor) in the context of abdomen exam should think about Wilson’s disease and look for liver biopsy scar
Hand exam + others
Look
- pitting nails
- rashes (gottron)
- psoriasis
- grip myotonia
- fine finger movement
- elbows for rheumatoid nodules
- phallens test for wrist ROM
- prayer sign for wrist ROM
Feel
- palpate each joint
- temperature
- feel for duputryen contracture
Others
- consider auscultation lung for fibrosis and or effusion
- consider proximal muscle weakness
Visual field defect localisation
If monocular visual field defect = lesion in front of chiasm e.g. SOL, Inflammation, infection, ischaemic
If binocular visual field defect = lesion on or behind chiasm
- bitemporal hemianopia = chiasm
- homonymous hemianopia = MCA
- homonymous hemianopia with macular sparing = posterior stroke
- superior homonymous quadrantanopia = temporal lobe
Lower limb screening
Gait
Examine foot standing
Rombergs test
No mass under J shape scar in iliac fossa
Renal transplant atrophy
Renal transplant failure and removal
Too much fat overlying
Differential for ejection systolic murmur which does not radiate to carotids
- If aortic area + loud S2 = Tissue valve (TAVI)
- If pulmonary area + RVH + loud S2 +/- thrill = pulmonary HTN
Respiratory exam screening test
Cough at bedside
Look at bedside for cough assist device e.g. acapella device
How to differentiate ICD from pacemaker?
Pacemaker is button device
ICD is long under skin
Reason for no device under infraclavicular scar
Access for ECMO
Explant due to site infection
