Examinations Flashcards
What is the correct inhaler technique?
MDI technique without a spacer:
Remove the cap
Shake the inhaler (depending on the type)
Sit or stand up straight
Lift the chin slightly
Fully exhale
Make a tight seal around the inhaler between the lips
Take a steady breath in whilst pressing the canister
Continue breathing for 3 – 4 seconds after pressing the canister
Hold the breath for 10 seconds or as long as comfortably possible
Wait 30 seconds before giving a further dose
Rinse the mouth after using a steroid inhaler
MDI technique with a spacer:
Assemble the spacer
Shake the inhaler (depending on the type)
Attach the inhaler to the correct end
Sit or stand up straight
Lift the chin slightly
Make a seal around the spacer mouthpiece or place the mask over the face
Spray the dose into the spacer
Take steady breaths in and out 5 times until the mist is fully inhaled
What scars may you see that are significant on the chest of a patient?
When examining a patient that you think may have coronary artery disease, check for a midline sternotomy scar (previous CABG), scars around the brachial and femoral arteries (previous PCI) and along the inner calves (saphenous vein harvesting scar)
What may you see on examination for a patient with a renal transplant
A hockey stick scar and donor kidney felt in iliac fossa if have had renal transplant.
Plus SE of immunosupressants:
Immunosuppressants often cause seborrhoeic warts and skin cancers (look for scars from skin cancer removal)
Tacrolimus causes a tremor
Cyclosporine causes gum hypertrophy
Steroids cause features of Cushing’s syndrome
Summarise the difference between Weber’s and Rinne’s test
Weber’s: In centre of forehead, in sensironeural HL sound is louder in normal ear. In conductive HL sound is louder in affected.
Rinne’s: Beside ear and on mastoid process, in sensironeural HL is louder in air (RInne’s positive), in conductive HL is louder on bone (Rinne’s negative)
