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General Principles > Physical Examination > Flashcards

Physical Examination Flashcards

1
Q

Central vs Peripheral Cyanosis

A
  • Cyanosis is seen when >4g/dL of reduced Hb in BVs of skin/mucous membranes

Central

  • Decreased SaO2 [Pulmonary diseases, Cyanotic heart disease]
  • Abnormal Hb [metHb, CO poisoning]

Peripheral – ↓Blood flow [arterial/venous obstruction]

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2
Q

Clubbing Grading & Causes

A
  • Grade 1 – Floating sensation; 2 – Loss of normal angle; 3 – Increased convexity of nail bed; 4 – Drumsticks

Causes

  • C = Cardiac [IE, Cyanotic HD] or Congenital
  • L = Lungs [A = Abscess; B = Bronchiectasis; C = Cancer; D = Don’t say COPD; E = Empyema; F = Fibrosis]
  • U = Ulcerative colitis and Crohn’s disease
  • B = Biliary cirrhosis
    • Other forms of cirrhosis can also -> clubbing
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3
Q

Causes of Bilateral Pitting Ankle Oedema

A
  • Fluid Overload – CHF, Renal Failure
  • Hypoalbuminemia – Nephrotic Syndrome, Cirrhosis
  • Drugs – Nifedipine
  • Others – Immobility; Local obstruction
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4
Q

What to do if the apex beat cannot be felt?

A

Turn the patient to the left lateral position

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5
Q

What to mention at the end of the CVS Exam?

A

BP measurement and Pulses [in AF, DM & HTN]

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6
Q

Signs of Heart Failure

A
  • Right HF – Bilateral pitting ankle oedema/fluid overload; Raised JVP; Hepatomegaly
  • Left HF – Basal Crepitation; Displaced apex; S3 +/- S4
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7
Q

How to distinguish JVP from Carotid Pulse

[e.g. Giant v wave vs. Corrigan’s Sign]

A

JVP

  1. has 2 peaks;
  2. is posture dependent
  3. seen but not palpable
  4. can be obliterated
  5. shows hepatojugular reflux
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8
Q

What are the JVP Waveforms?

A
  • A wave – Right ATRIAL contraction
  • X descent – RA relaxation until TV closure
  • V wave – VENTRICULAR systole when there is RA filling
  • Y descent – TV opening
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9
Q

Causes of elevated JVP

A
  • JVP is an estimate of CVP; elevated when >4.5cm from sternal angle
  • Causes – RHF, Constrictive Pericarditis, SVCO, TR/TS
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10
Q

DDx for irregularly irregular pulse (4)

A

[PE = Try catching the rhythm when you next anticipate it]

  1. AF
  2. Atrial Flutter with variable block
  3. Multi-focal Atrial Tachycardia
  4. Frequent Ectopics
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11
Q

DDx for Collapsing Pulse (3)

A

[Detect reappearance of pulse by releasing so light that you cannot feel the pulse; OR can detect rapid upstroke + rapid downstroke instead of gradual]

  • AR
  • PDA
  • AVM
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12
Q

DDx for Radio-femoral Delay (3)

A
  • Coarctation of Aorta
  • AD
  • Severe PVD
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13
Q

What is the Kussmaul Sign?

A
  • JVP normally decreases on inspiration
  • Kussmaul Sign = Paradoxical rise in JVP on inspiration/failure to fall seen in Constrictive Pericarditis and Tamponade due to limited RV filling
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14
Q

Causes of Parasternal Heave (3)

A
  • LAE – Left Atrial Enlargement [e.g. severe MR]
  • PAH – Pulmonary Hypertension
  • RVH – Right Ventricular Hypertrophy – PR, TR, PS
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15
Q

Physiology & Causes of S3 & S4

A

S3 = Diastolic ventricular filling

  • Physiological [Young, Athlete, Pregnant] or Pathological [CHF, CMPs, MR, AR]

S4 = Forceful atrial contraction [hence never in AF]

  • Always pathological [decreased ventricular compliance]
  • In AS, HTN, MI, Acute severe MR
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16
Q

Grading and Description of Murmurs

A
  • Grading – 1&2 = Never say; 3 = Audible; 4 = Thrill; 5 = Very loud; 6 = Stetho not required
  • Describe in terms of Character, Systolic/Diastolic, Best Heard, Radiation, Exaggeration
  • E.g. AS = Ejection (Crescendo-Decrescendo) Systolic Murmur best heard over Aortic area with radiation to Carotids
17
Q

What are the main purposes of Rheumatological PE?

A
  1. Come up with a Diagnosis
  2. Determine if arthritis is active
  3. Joint dysfunction
18
Q

Outline how to perform Rheumatological PE

A

[Inspect -> Palpate -> ROM -> Joint Function]

  • Inspect (up to elbow) - No. of joints, Which joints, What problem [redness, swelling, deformity], muscle wasting
  • Palpate - Temperature, Tenderness, Redness, Swelling [soft tissue or bony], Deformity
    • Light palpation - with back of hand for temp
    • Move wrist joints lightly - tenderness
    • Palpate all joints inc. wrist - 4 fingers
  • Function
    • _​_Hand grip pull
    • Pincer grip (index and pinky)
19
Q

What feature indicates the chronicity of a patient’s arthritis?

A

Marked disuse muscle atrophy

  • Small hand muscle for upper limb
  • Quadriceps for lower limb
20
Q

How do you present findings on Rheumat?

A
  • Which side - Left/Right, Bilateral
  • Chronicity
  • How many joints - Mono or Polyarthritis
  • Symmetry
  • Problems - Swelling/Deformity
  • Provisional Diagnosis

General Principles (4 decks)

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