ROUND 1
In a GIT examination, what are you examining on the ABDOMEN?
Inspect - skin changes (scars, lesions, striae, veins), enlargements (distention, swelling, hernias), movements (peristalsis, pulsatations, abdominal wall movements)
Palpate - light, deep, liver edge, spleen edge, loin, aorta
Percuss - liver, spleen, ascites, bladder
Auscultate - general, abdominal aorta bruits, renal artery bruits, friction rubs, venous hums
In a RESP examination, what are you examining on the POSTERIOR CHEST?
(make sure you ask the patient to move their scapulae out of the way!)
Palpate for posterior chest expansion
Percuss lobes
Auscultate lobes (breathing + vocal resonance)
In a CARDIO examination, what are you examining on the HANDS?
Clubbing, cigarette stains, pallor, cyanosis, splinter haemorrhages, arachnydactyly, tendon xanthomata
Rate and rhythm of radial artery
In a GIT examination, what are you looking for on the HANDS?
Leuconychia, clubbing, palmar erythema, pallor, Dupytren's contracture, asterixis
In a GIT examination, what are you looking for on the FACE AND NECK?
Eyes - scleral jaundice, conjunctival pallor, xanthalesma, periorbital purpura
Tongue - geographic tongue, glossitis, macroglossia
Mouth - aphthous ulcers, angular stomatitis, thrush
Dentition, gingiva, breath/fetor, salivary glands
In a RESP examination, what are you examining on the HANDS?
Clubbing, cigarette stains, pallor, cyanosis, asterixis, small muscle wasting
Character of radial pulse
In a CARDIO examination, what are you examining on the LEGS?
(comparing left and right, proximal and distal) Inspect for colour, thinning of skin, ulcerations hair loss, varicose veins, cyanosis, clubbing of toes
Palpate temperature, pitting oedema and peripheral pulses (femoral, popliteal, dorsalis pedis, posterior tibial)
In a GIT examination, what are you examining on the ARMS?
Petechiae, purpura, ecchymoses, scratch marks, muscle wasting, spider naevi, axillary lymphadenopathy
In a RESP examination, what are you examining on the ANTERIOR CHEST?
Inspect for pectus excavatum, pectus carinatum, Harrison's sulci, Barrel chest, symmetry of chest wall movement, use of accessory muscles, scars, lesions
Palpate for anterior chest expansion
Percuss lobes
Auscultate lobes (breathing + vocal resonance)
How do you calculate pack years?
Pack year = (# of cigarettes smoked/20) x (number of years smoked)
In a CARDIO examination, what are you examining on the PRECORDIUM?
Inspect for scars, deformities, pacemaker, apex beat, visible pulsations
Palpate for thrills, heaves and apex beat
Auscultate mitral, tricuspid, aortic and pulmonary areas
In a CARDIO examination, what are you examining on the ABDOMEN?
Inspect for liver tenderness, enlargement and pulsatility
Percuss for ascites
Auscultate for aortic, renal and femoral bruits
In a RESP examination, what are you examining on the FACE AND NECK?
Inspect for central cyanosis, ptosis/miosis/anhidrosis, thick neck/receding chin, Pemberton's sign
Palpate trachea and cervical lymph nodes
In a CARDIO examination, what are you examining on the FACE AND NECK?
Malar flush, xanthelasma, conjunctival pallor, scleral jaundice, central cyanosis, high arched palate
JVP
Volume, character and presence of bruits in carotid arteries
In a CARDIO examination, what are you examining on the BACK?
Inspect for scars and deformities
Palpate for sacral oedema
Percuss for lung base dullness
Auscultate for bibasal crackles
Why do we look for ptosis, miosis and anhisdrosis in a respiratory examination?
Horner's syndrome, where sympathetic innervation to the chest, neck and eye areas is disrupted due to (1) central lesions (e.g. stroke), (2) preganglionic lesions (e.g. pancoast tumour) or (3) postganglionic lesions (e.g. severe migraine).
What is pink, frothy sputum a sign of?
Left ventricular failure.
What is asterixis? What can cause it?
Asterixis is a brief, involuntary loss of muscle tone that causes a sudden, flapping motion of the hand.
Causes include build up of ammonia, carbon dioxide or urea.
How would you describe the location of the mitral, tricuspid, pulmonary and aortic valvular areas?
Mitral = 5th intercostal space, LHS mid-clavicular line
Tricuspid = 5th intercostal space, left parasternal border
Pulmonary = 2nd intercostal space, left parasternal border
Aortic = 2nd intercostal space, right parasternal border
Indirect (unconjugated) bilirubin → before liver conjugation. It is water-insoluble, bound to albumin and increased in haemolysis.
Direct (conjugated) bilirubin → after liver conjugation. It is water-soluble, not bound to albumin and increased in hepatocellular disease and biliary obstruction
HR = 300 ÷ number of large squares between two R waves
OR
HR = QRS complexes in 6 sec × 10
Where do the limb and chest leads go on a 12 lead ECG?
RA → right arm, LA → left arm, RL → right leg, LL → left leg
V1 = 4th intercostal space, right sternal border
V2 = 4th intercostal space, left sternal border
V3= Midway between V2 and V4
V4 = 5th intercostal space, mid-clavicular line
V5 = Same horizontal level as V4, anterior axillary line
V6 = Same horizontal level as V4/V5, mid-axillary line
Respiratory history. You must ask about occupation because it is one of the biggest causes of respiratory disease (e.g. asbestos exposure causing mesothelioma, sand/concrete/brick exposure causing silicosis)
Why do you ask about recent dental work in a cardio history?
Invasive dental procedures can introduce harmful bacteria directly into the bloodstream, causing infective endocarditis!
What causes gynaecomastia?
Liver disease, such as cirrhosis, can cause an imbalance in estrogen and testosterone, driving male breast tissue development (i.e. gynaecomastia).