-
Respiratory Exam
- Introduction, Consent & Explain procedure
- 1. Inspection
- Note: Relaxed/distressed
- Resp Rate: norm= 8-12/min
- Hands: Peripheral Cyanosis
- Clubbing
- Palmar creases/Erythemma
- Radial pulse
- Flapping tremor (?)
- Face: Central Cyanosis - lips & tongue
- Pallor of conjunctiva (anaemia)
- Chest: shape (kyphosis, scoliosis, barrel)
- Symmetry
- Scars
- 2. Palpation
- Position of Trachea - Central
- Apex beat - 5th intercost, mid clavicular
- Chest Expansion (2 @ front, 3 @ back) Thumbs @ midline
- Vocal Fremitus (111, diminished vibration on pathology)
- 3. Percussion
- Tap Clavicles intercostals & axillae
- Dull over liver & heart
- 4.Auscultation
- Deap Breaths THRU THE MOUTH
- Listen for crackles, wheeze, bronchial breathsnormal = vesicular
- Vocal Resonance (111, louder on pathology)
- Continue onto back and do same
- Examine lymph nodes (cervical and supraclavicular)for malignancy
-
Cardiovascular Exam
- 1. Inspection
- General: unwell/breathless/uncofortable
- Hands: Tar stains
- Cyanosis
- Clubbing
- Anaemia (pale creases)
- Splinter Haemorrhages (Infect. Endocarditis)
- Face: Mallor flush (red cheeks)
- Conjuctiva - pale, anaemia
- Eyelids - Xanthalasma (hyperlipidaemia)
- Corneal Arcus
- Tongue for Central Cyanosis
- Pulse & B.P
- JVP: Right internal jugular vein, indicates RH fail
- estimate height from sternum
- Antagonise w. hepatojugular reflux
- Chest: Scars
- Visible
- Pulsations
- 2. Palpation
- Apex Beat - norm 5th midclavicular
- RV Heave - @ L. sternal edge, during expiration
- Thrills - Palpable murmur (aortic stenosis)
- 3. Auscultation
- Over 4 valve areas, use diaphragm then bell
- Apex - Mitral Area
- L. Lower Sternal edge - Tricuspid
- 2nd Int on L. Side - Pulmonary
- 2nd Int on R. Side - Aortic
- S1 = Mitral & Tricuspid closing (APEX)
- S2 = Aortic & Pulmonary closing (A & P)
- Carotid (Bruits)
- Amplify by turning patient on left side/leaning forward
-
REMs Spinal Exam
- Look
- Normal shape, cervical lordosis, thoracic kyphosis, scoliosis
- Feel
- Spinal processes
- sacroiliac joints
- paraspinal muscles -> Spasm/Tenderness
- Move
- Flexion -tough toes
- Extension
- Fingers adjacent to spinal process to show movement
- Lat. Flexion-> Hands down thighs
- Rotation -> seated, arms @ sides
- C-spine-flex/ext/rotation/lat flex
- Temporo-mandibular joint
- Additional
- Peripheral pulses
- Reflexes
- Straight leg raise
-
REMs Hip Exam
- Look
- Scars
- swelling
- deformity
- gluteal muscle wasting
- assymetry
- length discrepancy (True/Apparent)
- Feel
- G. Trochanter
- trochanteric bursa -> inflamm/heat
- Warmth @ Hip, Knee & Ankle
- Move
- (N.B. Active & Passive)
- Flexion; stabilise iliac crest, move @ knee
- Rotation; bend knee, int/ext rotation
- Abduction; stabilise opposite hip, leg away
- Adduction; Stablise same hip, leg move medial
- Extension; Assist hamstring curls
- Function
- Gait;
- trendelenburg
- Antalgic (Limping)
- Short Limb
- Additional Tests
- Thomas' Test
- Flex knee, w. hand under back @ Lumbar region
- For fixed flexion deformity
- Trendelenburg Sign
- Lift leg, bum drop on opposite side
-
REMs Knee Exam
- Look
- Assymetry
- Errythema/rash
- Scarring
- Quad wasting
- Deformity; Fix flex/valgus/varrus
- Feel
- Warmth (mid thigh to calf)
- Effusion; Patellar tap/bulge test
- Popliteal Swelling
- Pain; Patelar/Joint Line/Tibial Tuberosity
- Move
- Flex & Extend (0-140 degrees) Feel for crepitus
- Hyperetension -> Pull up @ ankles
- Additional:
- Cruciates -> Ant. Drawer test (ACL)
- Collaterals (Med/Lat bending of knee)
- McMurrays(Menisci)
- Hold @ foot & Flex knee, outward = m, inward = l feel for clicks
-
REMs Feet & Ankles
- Look
- symmetry
- joint swelling
- Clawed Toes
- Hallux Valgus
- Calluses
- Footwear -> insoles/abnormal wearing
- Feel
- temperature
- Pulses -> Dorsalis Pedis &Post. Tibial
- Metatarsal Squeeze
- Tarsal J's
- Ankle Joint line
- Sub-talar joints
- Move
- Dorsi & Plantar flex;
- Hallux
- Ankle Joint
- Inversion/Eversion;
- Subtalar J
- Function
- Gait
- Weight bearing -> Alignement/Arches-Achilles Calcaneal Tendon Align of hindfoot (Varrus/Valgus)
-
Neuro Exam Upper Limbs
- Inspection
- wasting
- tremor
- posture
- fasciculation
- Tone
- Rotate & Ext. Wrist -> Cogwheeling
- quick suppination; Spastic catch
- Power
- Shoulder;
- Elbows out, push against (above & below)
- ElbowBoxing gloves, pull = biceps, push = triceps
- Wrist
- Flex/Ext against resistance
- Fingers
- Grip 2 finger (C5&6)
- Abduction w. resistance
- Thumb Ab/ADduction
- OK sign
- Reflexes
- biceps/triceps/suppinator jerk
- Reinforce w. clenched teeth
Sensation Not Req'd
- Co-ordination
- Finger -> Hand -> Nose
- Hand Clapping; Dysdiodokinesis
-
Neuro Exam Lower Limbs
- Inspection
- Wasting
- Posture
- Fasciculation
- Tone
- Hip & Knee
- Log rolling, hand under & lift knee
- (Inc tone, heel off)
- Ankle
- 90deg flex knee
- Sharp move of ankle -> Clonus
- Power
- straight leg lift w. resist
- Knee
- Ext w. resist
- Pull against flexed knee
- Foot
- Dorsi/Plantar Flex w. resist
- Inversion w. resist
- Reflex
- Knee/Ankle/Plantar Flex
- Reinforce w. Hand Clasp
- Co-ordination
- Rub shin w. heel
- Heel to toe walking
-
GI EXAM
Introduce self, explain, consent, wash hands
- 1. Inspection
- Stand @ foot of bed, central/lateral distension
- Hands: spooning/white fleks on nails, palmar creases/erythema, dupytrons contracture (fibrosis of aponeurosis)
- Face: look @ eyes, conjunctiva (anaemia) sclera (jaundice)
- Mouth: hydrated, central cyanosis, sores (vit defficient)
- Abdomen: Previous surgery, caput medusae/spider nevae
- 2. Palpation
- light palpation from left iliac fossa round to right. Tenderness/GuardingDeep palpation for for lumps/growths
- Palpate for liver (breathe in, from RIF)
- Palpate for spleen (Breathe in, RIF to LHpC)
- Palpate for Kidneys (Hand on front & Back)
- 3. Percussion
- Percuss for liver & spleen
- Percuss from midline to flanks, check for shifting dullness
- 4. Auscultation
- Listen to ileocaecal valve (RIF)
- Thank patient, Wash hands
- "I would finish me exam with an examination of the hernial orifices, a PR and a urine dipstick"
|
|