Tip
Don’t forget general inspection and legs!
Respiratory
Exam
- Fine tremor & flapping tremor
- Respiratory rate
- Trachea position
- Lymph nodes
- Apex beat
- Chest expansion
History
- Travel history
- Vaccine history?
- Smoking use/history
- Pets/allergies
Cardio
Exam
- Cap refill
- Different pulses
- Blood pressure - ask examiner
- Carotid pulse palpation and auscultation
- JVP
- Accentuation manoeuvres
History
- Systems enquiry
- Smoking and alcohol use
- Recreational drug use
- Family history
Gastro
Exam
- Temperature of hands
- Arms and axillae
- Lymph nodes - Virchow’s node
- Palpate first and then percuss everywhere - don’t forget kidneys and aorta
- Ascultate bowel and renal arteries
History
- Red flag symptoms - change in bowel habit, change in stool, unexplained weight loss, new anaemia
- Diet and exercise
- Systems screen
Cranial Nerve Exam
- 40% of the exam is cranial nerves 2 and 3 effectively - once done everything with those on home straight
- CNII: Snellen test, visual fields, offer to do fundoscopy, check pupil size, alignment and reflexes, offer colour test with Ishihara charts
- CNV: assess muscles of mastication - assess atrophy. Say you would test jaw jerk and corneal reflex
Upper Limb Neuro
- Pronator drift
- Biceps C5/6
- Supinator C5/6
- Triceps C7
- Finger nose test
- Dysdiadochokinesia
Lower Limb Neuro
- Gait - stance, stability, arm swing, steps, turning
- Romberg’s test
- Ankle clonus
- Knee jerk L3/4
- Ankle-jerk S1/2
- Plantar reflex L5-S1
- Heel shin
Urological Examination
- Inspection
- HR, BP, RR
- Inspect abdo
- Front - 4
- Inspect
- Bimanual ballottment kidneys
- Percussion - general renal angles
- Auscultation - epigastrium, flank and costovertebral angle for bruit
- Bladder - 3
- Inspect - for distension
- Palpate bladder for distension
- Percuss - dull in distension
- Back - 2
- Inspect
- Palpate renal angle on the back
- End pieces
Thyroid
Thyroid Exam
- Weight, behaviour, clothing, voice
- Trachea central?
- Percussion for retrosternal projection
- Reflexes
History
- Appetite and weight loss
- Diahorrea
- Palpitations
- Temperature intolerance
- Menstrual cycle changes
- Amiodarone or recent contrast material use
- Recent viral infection
Lower Limb Vascular Exam
Warning
Read the station to see if they only want lower limb or complete peripheral vascular exam.
This is for all peripheral
- Don’t forget temperature and cap refill in hands and feet
- Inspect everywhere too
- Pulses: radial, brachial, carotid (auscultate first), aorta (auscultate), renal arteries (auscultate only), femoral (offer), popliteal, posterior tibial (medial malleolus), dorsalis pedis
- Gross peripheral (feet) movement and sensation
- Buerger’s test ± Trendelenburg
Knee Joint Exam
- Gross inspection in all planes
- Assess gait
- Closer inspection on bed
- Patella tap + effusion tests?
- Active and passive movement of the knee
- Fixed flexion deformities and hyperextension
- Special tests: Posterior sag (PCL), Anterior draw test (ACL), posterior draw, medial and lateral collateral ligament assessment, medial and lateral meniscus test
Thoracic and Lumbar Spine Exam
- Look - inspect from all planes DWASS
- Feel - para-vertebral muscles + joints + sacroiliac joint
- Move - flexion, extension, lateral movement, thoracic rotation
- Special tests - straight leg raise, reflexes, dorsiflexion of big toe
Breast
Breast exam
- Chaperone and consented for everything - maintain dignity
- Exaggerating manoeuvres
- Don’t forget infraclavicular and parasternal lymph nodes after axillary and cervical
- Describe the lesion with its size, shape, surface, tenderness, mobility, vector from the nipple
History
- Skin changes
- Discharge
- Constitutional symptoms - weight loss, fatigue,
- Brief OBGYN history - menarche and menopause, OCP use
- Family history of breast bowel or ovarian cancer
Dermatological Exam
- General inspection - Fitzpatrick skin type, hands, scalp, face, arms, legs
- Describe
- S2CAM2 - size, shape, colour, associated changes, morphology, margin
- ABCDE (melanoma) - Asymmetry, Borders, Colour, Diameter, Evolution
- Palpate - surface, consistency, mobility, tenderness, temperature
Other intimate
PR exam
- Need for a chaperone
- Don’t forget to position and inspect the perianal region
- In males palpate the prostate gland anteriorly
- Then 360 sweep
- Test anal tone? - ask to cough
Testicular exam
- Need for a chaperone
- Inspect the surrounding region and penis and testicles
- Box technique for testicular palpation
- Site, size shape, consistency tenderness, fluctuance, translummination, cough impulse, ability to get above the lump
- Epididymis and spermatic cord
- Special tests: Prehn’s test (elevating testes with pain reduction indicates epididymitis), Cremasteric reflex (inner thigh stimulation causes ipsilateral testicle to inguinal canal)
- Assess while standing
Psych
Mental State Exam
ASEPTIC
-
Appearance/Behaviour - open question observe throughout
-
Speech - observe throughout
-
Emotion - Mood & affect - SOCRATES, impact on life
-
Perception - can you see things other people can’t
-
Thoughts - intrusive, broadcast, routines, rituals, persecutions, possession, controlling
-
Insight - what do family and friends think. Do you think the thoughts are reasonable
-
Cognition - 4AT
-
Social history - other people in your situations may turn to drugs and alcohol - is that something
-
Risk & safe guarding - harming yourself and others
Mental Health History
- Presenting complaint - SOCRATES + disability
- Biological - sleep, eat, mood, libdo
- Cognitive - concentration, delirium?
- Perception - hallucinations, thoughts
- Insight - into mental health
- Risk assessment - harm to self and others
- ICE - how would you like us to help you?
- PMH - previous episodes, PMH, psychotic history, allergies drug history
- FH - psychiatric and medical
- SH - smoke, drunk, drugs, gambling, lifestyle, living situation, exercise, occupation, family and support network
Cognitive Assessment
Only Amy Loves Mcdonalds Clearly - rule of three
- Oritentation - three domains, three questions per domain.
- Time - time, month, year
- Place - location, city, county
- Person - age, date of birth, home address
- Attention - months backwards then 20-1
- Language - comment on and ask name of 3 common objects
- Memory - ask to remember 3 words
- Construction - ask to draw a clockface with the time 10 to 2
- Recall the words
AMTS
May be asked instead of a cognitive assessment - similar stuff
- How old are you
- Date of birth
- Current year
- Current time
- Ask them to remember an address
- Where are we
- Who’s the current monarch
- When did WW1 start
- Count backwards from 20
- What are the roles of 2 people
- What is the address that I gave you before
RRAPID Conditions and Management
Old ones the medical school thought was a good idea to tell us wasn’t in the exam 2 weeks before the exam (despite the fact they’ve been in every year before us)
GALS Exam
- Ask specific screening questions
- Close inspection in all planes
- Hands behind head, hands out palms down, palms up, make a fist, grip strength, precision grip, MCP squeeze
- Knee passive movements only, patella tap, MTP joint squeeze
- Spine movements
- TMJ function
Shoulder Exam
- Inspection in all planes
- Compound movements: hands on head, hands behind their back and reach up as far as they are able
- Active and passive movements
- Only internal and external rotation against resistance
- Special tests: Empty can test, painful arc, scarf test
Wrist Exam
- Loads of strange shit - basically a neuro exam
- Inspect the hand well - esp thenar/hypothenar
- Feel pulses, palmar thickening eminence bulk etc
- Joint squeeze
- Active, passive and functional movements
- Special tests: Tinel’s tests, Phalen’s test
Ankle and Foot Exam
- Gait
- Achilles tendon palpation
- Active and passive movements
- Special tests: Simmond’s for Achilles tendon rupture
Hip Exam
- Gait
- Apparent and true leg length
- Active and passive movement
- Special tests - Thomas’s test, Trendelenburg’s test
Elbow Exam
- Carrying angle
- Biceps tendon palpation
- Medial epicondylitis (golfer’s elbow)
- Lateral epicondylitis (tennis elbow)