Flashcards
Examination skills
Cards in this deck (16)
- 1What are the cardiac causes of clubbing?Infective endocarditis
Congenital heart disease
Atrial myxoma - 2Describe the korotkov sounds1. Snapping heart sound at systolic BP
2. Murmurs heard for most of time between systolic and diastolic
3. Loud crisp tapping sound
4. Thumping and muting
5. Silent as the cuff pressure drops below diastolic pressure - 3Describe assessment of the JVPIn direct communication with the SVC and R atrium
Found between the sternal and clavicular heads of SCM, usually just above the clavicle
Procedure:
1.Ask patient to turn their head to the left, make sure neck muscles are relaxed
2. Differentiate carotid artery from JVP
3. To exaggerate the presence of the JVP, conduct the hepato-jugular reflux
4. Measure vertical height from manubrosternal angle to the top of the pulse (add 5cm) A pressure above 9 is elevated
5. Assess character and waveform - 4Describe the wave form of the JVPA = Right atrial systole occurs
C= Tramsission of rapid increasing RVP during tricuspid valve closure
X = Start of atrial relaxation during V systole
V = Atrial diastole whilst tricuspid valve remains closed during ventricular systole
Y= Tricuspid valves open and rapid ventricular filling occurs - 5What is Kussmaul's sign?Parodoxical rise in JVP on inspiration due to impaired right ventriuclar filling and back log of blood in to the R atrium. Seen in Constrictive pericarditis and cardiac tamponade.
Usually JVP goes down on inspiration due to the reduced pressure in the expanding chest - 6What is Beck's triad?Seen in cardiac tamponade:
Rise in JVP
Descreased arterial blood pressure
Muffled heart sounds - 7What are heaves and thrillsA thrill is a palpable murmur
A heave is a sign of LVH. - 8In what positions are the mitral murmurs best heard?Mitral STENOSIS - On LHS in held expiration with BELL
Mitral REGURGITATION - Apex, Radiates to axilla - 9What are the signs of retinal hypertension on fundoscopy?Arteriolar changes (arteriolar narrowing, AV nicking, changes in the wall)
Advanced retinopathy lesions - microaneurysms, blot haemorrhages, flame haemorrhages, ischaemic changes (cotton wool spots), hard exudates - 10Describe the difference between an upper and lower motor neurone lesion of the facial nerveUMN - Forehead spared.
Due to bilateral cortical representation of the upper part of the face (2 corticobulbar inputs) - 11Outline assessment of the facial nerve (VII)OBSERVE
Eyelid angles, upper facial wrinkling, nasolabial foldsm angles of mouth, facial expression and movment when smiling.
Make a frown, raise your eyebrows (frontalis)
Screw up your eyes (orbicularis oculi)
Blow out your cheeks (buccinator)
Show me your gums (risorius)
Whistle, purse your lips (orbicularis oris) - 12What are the causes of a lower motor neurone CN VII lesion?Acoustic neuroma
Trauma - skull fracture affecting petrous temporal bone
Ramsay-Hunt Syndrome (Herpes Zoster affecting geniculate ganglion - can get hyperacusis and loss of taste to ant 2/3 of tongue)
Bell's palsy
Pagets disease - 13What are the causes of Romberg's signA person requires requires 2/3 of:
Proprioception
Vestibular function
Vision
The patient is asked to close their eyes. Therefore those with a positive Romberg's test have SENSORY ataxia.
If a patient is ataxic but Romberg's is negative, the ataxia is sensory in nature.
CAUSES: B12 deficiency, tabes dorsalis (affects dorsal columns), CIPD, Friedrich's ataxia, Merniere's disease - 14List the 18 fibromyalgia tender point sitesOcciput
Lower cervical
Costochondral
Trapezius roll
Mid point of suprespinatus
Lateral elbow
Gluteal (lower lumbar)
Greater trochanter
Medial fat pad of knee - 15List the components of the 9 point Beighton score for hypermobilityTouch thumb to wrist
Little finger 90degrees
Elbow bending
Knee bending
Touch toes
4 or more is strongly predictive of hypermobility syndrome (major criteria)
1,2,3 is minor criteria - 16List the current screening programmes available in the UKPregnancy (infectious disease, Down's, Sickle cell, physical abnormalities)
Newborn (physical, haring, blood spot)
Diabetic eye (over 12 yearly)
Cervical screening (25-64)
Breast screening (47-73)
Bowel cancer (home test 60-74)
AAA (65th decade)
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- Flashcards on Examination skills, created by tamsin.clayton on 19/01/2016.
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