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Final Osce > Examinations > Flashcards

Examinations Flashcards

1
Q

End of bed respiratory

A

Sputum pots
Oxygen/nebulisers/inhalers

Patient alert or drowsy, using accessory muscles, hypoxic

audible wheeze, stridor, cough

oedema

patient able to speak in sentences

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2
Q

Hands in respiratory

A

Clubbing - COPD
Palmar erythema - co2 retention
Tar staining - smoking
Fine tremor - salbutamol overuse
Flapping tremor - co2 retention

pulse

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3
Q

Inspection in respiratory

A

Inspect JVP

Inspect chest
- scars - sternotomy, lobectomy
- skeletal deformities - kyphosis, scoliosis, pectus excavatum, barrel chest
- air entry
- chest drains
- use of accessory muscles

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4
Q

Palpation in respiratory

A

Tracheal position

Chest expansion

Lymph nodes

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5
Q

Percussion in respiratory

A

Percuss over regions

Resonant - normal
Dull - consolidation, mass, ,lobar collapse
Stony Dull - pleural effusion
Hyper-resonant - air in lung space - pneumothorax

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6
Q

Auscultation in resp

A

Is breathing vesicular or bronchial, is air entry equal across lung fields, are there any added sounds

Fine crackles - fibrosis
Coarse crackles - consolidation or fluid
Wheeze
Stridor
Rubs

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7
Q

Vocal resonance findings

A

Normal

Increased = consolodation or lobar collapse
Decreased - pneumothorax, pleural effusion

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8
Q

Abdo end of bed

A

Patient alert, in pain, confused, restless, lying still

Sick bowl
Stoma
NG tube

jaundice
ascites
hernia
pallor
cachexia

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9
Q

Abdo exam hands and arms

A

pallor
dupytrens
koilonychia (anaemia or nutritional deficiencies)
leukonychia (hypoalbuminaemia)
palmar erythema (liver disease)
clubbing (IBD)
Asterixis

Pulse

Track marks
spider naevi (liver disease)
excoriations (jaundice)

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10
Q

Abdo exam face and neck

A

pallor or jaundice
xanthalasmata
glossitis or angular stomatitis
keyser-fleisher rings
oral candiasis
ulceration

supraclavicular lymph node
spider naevia

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11
Q

Abdo inspection

A

PATIENT MUST BE LYING FLAT

Abdo shape - scaphoid, distended?

5 Fs of abdo distension
- fat, faeces, flatus, fluid, fetus

Scars

Visible pulsatile massess

Stomas (ileostomy on left (patients right), colostomy on right (patients left)

Hernias

Caput medusea

Bruising

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12
Q

Abdo palpation

A

Palpate all regions superficially and deep

If mass is found
- shape, size, consistency, motility, location

Tenderness
Rigidity
Guarding

Hernias - are they reducable

Hepatomegaly - liver (hepatitis, leukaemia, haemolytic anaemia), spleen (haemolytic anaemia), kidneys (PKD, renal cell carcinoma)

Aorta - if fingers are pulled in then normal, if pushed away then enlarged

Bladder - warn patient prior

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13
Q

Abdo percussion

A

Liver and splenic edge

If ascites suspected then shifting dullness

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14
Q

Abdo auscultation

A

Bowel sounds
Aorta
Renal artery bruits
Rubs

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15
Q

How to end abdo exam

A

Thank patient
redress patient

examine any hernias, do PR and external genitalia exam if appropriate

summarise findings and plan management

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16
Q

Breast exam intro

A

Introduce self, check patient ID, explain procedure and gain consent, chaperone

Position patient sitting upright

Ask patient to remove all clothes from waist up, provide blanket for modesty

Ask patient about pain

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17
Q

Breast inspection

A

ask patient to rest hands on thighs to relax pec muscles

Look for
Asymmetry
Scars
Nipple changes - inversion or discharge, ask what is normal for patient
Skin changes - flaky skin, erythema, skin puckering or tethering, peau d’orange

Hands pushing into hips
- examine skin tethering
- masses
- nipples

Hands above and leans forward
- accentuates skin puckering and breast asymmetry

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18
Q

Breast palpation

A

Moving in concentric circles
- inspect for masses
- comment on location, size, shape, consistency, motility,
overlying skin changes
Inspect NAC for discharge
- colour, consistency and volume

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19
Q

Axillary exam

A

Inspect axilla for scars, masses, skin changes and lymph nodes

End examination

refer for rest of triple assessment

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20
Q

Cardio end of bed

A

Alert/drowsy/confused
Pain?
Hypoxic/cyanotic
SOB
Oedematous
Increased JVP
Pallor

Telemetry
ECG
GTN
Fluids

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21
Q

Cardio exam - hands and arms

A

Splinter haemorrhages, janeway lesions, oslers nodes (infective endocarditis)

Clubbing (congenital heart disease)

Xanthomata

Capillary refill time

Pulse - rate, rhythm, character both radial and brachial, radial radial delay

track marks

blood pressure

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22
Q

Cardio exam - neck

A

JVP

Carotid pulse

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23
Q

Cardio exam - precordium inspection

A

Scars - sternotomy, thoracotomy
Skeletal deformities
Pacemaker

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24
Q

Cardio exam - precordium palpation

A

Pacemaker
Apex beat
Thrills - across each valve for palpable murmur
Heaves - parallel to left sternal edge for palpable murmur

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25
Cardio exam - precordium auscultation
Palpate carotid pulse whilst listening across each valve Listen with diaphragm and bell MURMURS - Carotid arteries for bruits - ask patient to hold breath(Aortic stenosis) - Lean forward (aortic regurg) - Lie on left - listen at mitral valve and then out towards axilla for bruits (mitral regurg). Listen at mitral valve with bell for mitral stenosis
26
Neuro upper limb general inspection
Scarring Wasting Involuntary movements Fasiculations Tremors
27
Neuro upper limb pronator drift interpretation
Patient should hold hands infront of them with palms facing upwards If hands drift, then pronator drift is positive, indicating a UMN lesion
28
Neuro upper limb tone findings
Move patients arm for them, whilst they relax their upper limbs. Move all joints. Spacistity is velocity dependant - increased tone with speed Rigidity - tone is the same regardless of speed
29
Testing shoulder abduction
Dont let me push your arm down
30
Testing shoulder adduction
Dont let me pull your arms away from your sides
31
Testing elbow flexion
Dont let me pull your arms away
32
Testing elbow extension
Dont let me push you away
33
Testing wrist flexion
Try and push my hand down
34
Testing wrist extension
Try and push my hand up
35
Testing finger extension
Dont let me push them down
36
Testing finger abduction
Do not let me push your fingers together
37
What would a UMN and LMN lesion look like in the upper limbs >
Upper - extensors weaker than flexors Lower - focal weakness
38
MRC Scale
0 - no contraction 1 - flicker or trace of contraction 2 - active movement with gravity eliminated 3 - active movement agains gravity only 4 - active movement against gravity and resistance 5 - normal
39
Nerves of reflexes in upper limbs
Biceps and brachioradialis - C5/C6 Triceps - C7
40
What do reflexes look like in upper and motor neurone lesions?
UMN - hyperreflexia LMN - hyporeflexia
41
What tracts are tested in sensation?
Spinothalamic and dorsal column Soft touch - both Pin prick - spinothalamic Vibration sense - dorsal column Proprioception - dorsal columns
42
Dermatomes of upper limbs
c5 - regimental badge c6 -Thumb c7 - middle finger c8 - little finger T1 - medial aspect of arm
43
Testing upper limb coordination
Finger to nose Dysdiadokinesia
44
Lower limb neuro examination
Scars Wasting Involuntary Movement Fasiculations Tremor
45
Assessing Gait
Assess walking normally, heel to toe walking, rombergs test
46
How to test tone in lower limbs ?
Clonus and leg rolling
47
Testing power in hip flexion and extending
Flexion - dont let me push leg fown Extension - push my hand down
48
Testing power in knee extension and flexion
Flexion - pull me towards Extension - push me away
49
Testing power in dorsi and plantarflexion
Dorsiflexion - dont let me push down Plantarflexion - push my hand down
50
Testing power in toes
Dont let me push big toe down
51
UMN vs LMN in lower limbs when testing power
UMN - flexors weaker than extensors LMN - focal
52
Nerves for reflexes in lower limb
Knee jerk (l3,l4) Ankle jerk (s1) Plantar reflex - babinskis sign (l5, s1)
53
Dermatomes for lower limb
l1 - inguinal l2 - anterior thigh l3 - medial aspect of thigh l4 - lower leg and ankle l5 - big toe s1 - little toe
54
How to test co-ordination in lower limbs
Heel shin test
55
End of bed hip exam
Patient in pain Leg obviously deformed Walking aids Wheelchair Gait (if walking into room/from bed to chair)
56
Hip Exam - Look
Expose hip adequately Bruising Swelling Erythema Quadriceps muscle wasting External or interal rotation Skin changes Body habitus
57
Hip exam - feel
Temperature of joint Feel hip joint Leg length discrepancy
58
Assessing leg length discrepancy
Apparent - medial malleolus to the umbilicus True - medial malleolus to ASIS
59
MSK Hip - Move
Active hip flexion - knee to chest Active hip extension - straighten leg out Passively flex, extend, adduct, abduct, externally and internally rotate Thomas's test - if positive, fixed flexion deformities Trendelenberg's test- hip abductor weakness
60
What does trendeleberg gait indicate?
Unilateral hip abductor weakness = l5 radiculopathy or gluteal nerve lesion
61
What does a waddling gait indicate?
Myopathies such as Duchenne's
62
MSK Knee - look
Assess body habitus, walking aids and gait Bruising Redness Swelling Psoriatic plaques Popliteal cysts valgus and varus deformities
63
MSK knee Feel
With knee extended - temp of joint - patella, joint spaces - quadriceps bulk - tibia With knee flexed - joint lines - patella - popliteal fossa ?Effusion - sweep test - patellar tap Look for posterior sag
64
MSK Knee - move
Active knee flexion and extension Passive knee flexion and extension Anterior draw test Posterior draw test
65
MSK Elbow - look
Scars, swelling, bony deformities, muscle wasting, redness, bruising Body habitus, carrying angle, psoriatic plaques, fixed flexion deformities
66
MSK elbow - Feel
Temperature Olecranon process Medial epicondyle (golfer's elbow) Lateral epicondyle (tennis elbow) Radial head Biceps tendon
67
MSK elbow - move
passive and active - flexion, extension, supination and pronation
68
What is the test for medial epicondilitis ?
Feel medial epicondyle with one hand then ask patient to flex wrist against restistance
69
What is the test for lateral epicondylitis?
Feel lateral epicondyle with one hand and then ask patient to extend wrist against resistance
70
Look - wrist and hand
Swelling, bruising, erythema, bony prominences, muscle wasting, psoriatic changes, oncholysis and nail pitting Signs of rheumatoid arthritis - z thumb, boutinneres, swan neck deformites Signs of osteoarthritis - bouchards and heberdens
71
Feel - wrist and hands
Temperature Palpate each joint bimanually Feel for muscle wasting Sensation and thenar and hypothenar eminence MCP Squeeze Anatomical snuffbox
72
Move - wrist and hand
Active and passive flexion and extension Squeeze my fingers Pincer grip Pick up a small object
73
What is Tinels test?
Positive if patient feels tingling over thumb and medial section of index and middle finger = medial nerve compression
74
What is phalens test?
Push dorsal aspect of hands together = pain equals carpal tunnel
75
MSK shoulder - look
Look for any shoulder asymmetry Bruising Redness Swelling Rashes Muscle wasting Scars Scoliosis Winged Scapula
76
MSK shoulder - feel
Shoulder joint - AC joint - SC joint - Acromion - Clavicle - Coracoid process of scapula - Head of humerus - Greater tubercle of humerus - Spine of scapula
77
MSK Shoulder - Move
Active and passive - extension, flexion, adduction, abduction, external rotation, internal rotation, scapular rotation
78
MSK Spine - look
Deformities Cervical and lumbar lordosis Thoracic kyphosis Swelling Bruises Body habitus Gait
79
MSK Spine - Feel
Down spinous processes and paraspinal muscles
80
MSK Spine - Move
Cervical spine - flexion, extension, lateral flexion, rotation Thoracic spine - rotation Lumbar spine - flexion - extension - lateral flexion Sciatic nerve test

Final Osce (4 decks)

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