Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
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VITAMINSABCDEK
V stands for vascular, where the disease can be caused by vessel (bleed or
blocked), or anything related to hematology.
N is for neoplasia.
S is for diseases caused by social reasons, such as child abuse and social
deprivation.
Cardio = BLUE KXGTP = BNP, lipids, USS/echo, ECG, kidney (lytes, BUN, Cr), XR-
chest, glucose/HbA1c, troponins, pancreas
Neuro = 14-AA-BBB-CCCC-TT-S = BBACC-ATACT = 14-3-3 CJD, B12/folate (PBS) + BSL ,
ANCA/ANA-vasc, CSF + pressure, CT-B, alcohol levels, Thiamnine levels,
AST/ALT(LFTs), CAG repeat, TSH, syphilis, ESR, Temporal artery biopsy, CBC, carotid
doppler
CARDIAC
__________
45 degree, chest exposed
inspection
-dysp
-cyanosis
-marfan, turner, downs
-anky spond / rheumatological - AR
-acromegaly
-cachexia (anorexia/liver congestion, reduced intestinal abs/congested intestinal
veins, TNFa/inflamm)
hands
-clubbing (cyanotic HD, IE, Lung Ca, Bronchiectasis, Lung abscess/empyema, IPF, CF,
Asbestosis, mesothelioma, Biliary cirrhosis, IBD, Ceoliac)
-IE - splinter hemorrhages, osler nodes, janeway lesion
-splinter hemorrhages (IE, RA, PAN, antiphospholipid syndrome)
-cyanosis
-tendon xanthomata (type 2 hyperlipidemia)
-allens test = clench fist - occlude by thumbs over radial and ulnar arteries -
open/relax their hands - colour should be pale - releae ulnar - if patent should go
pink - repeat with radial
-brachial pulse at ante-cubital crease medial to biceps tendon
-feel epitrochlear node above medial epicondyle
pulse
-rate
-rhtym
.brady
-irreg irreg = AF + BB or blocks
-reg irreg = block 2.1
-reg = BB, hypoTHYR, hypoT, ICP/cushings, block 3, MI, vasovagal
.tachy
-irreg = AF, MAT, flutter
-fever, preg, hyperTHYR, anaemia, AV fistula, beriberi/thiamine, CHF,
pericarditis, B+, hypoVOL, SVT, VT, PE
-symmetry
-radio-radio
.dissection
.subclavian artery stenosis
-radio-femoral
.coarctation
BP
-grade 1 = 140/60, 2 = 160/80, 3/severe >180
-pulsus paradoxus = drop in BP on inspiration > 10 mmHg = constriction
pericarditis, pericardial effusion, asthma
-postural drop = decr >15 SBP on standing (HANDI = hypoVOL + hypoPITUIT, Addisons,
Neuropathy/DM, Drugs[ A(-), anti-hypertensives], Idiopathic
Face
-scleral icertus (liver congestons, prosthetic hemolysis)
-arcus senilis
-conjunctival pallor
-xanthelasma
-malar flush = MS, PS, pulmonary hypertension
Mouth
-cynaosis
-palate - hi arch - marfans (AR, Aortic root dilation, MR, MVP
-dentition - IE
-mucosal petechiae - IE
Neck
-palpate carotid artery - right carotid artery infront of SCM - lower neck to
avoid carotid sinus - AMPLITUDE AND CONTOUR vs beat/beat and respiration - compare
left side
.collapsing/bounding = AR
.pulsus alternans = LVF
.jerky/bifid = hypertrophic cardiomyopathy
-ausculate for bruit - arterial narrowing
-JVD - right internal jugular (between 2 attachments of SCM) - highest point of
pulsation - vertical height from sternal angle - also document angle of bed
elevation eg 1cm above sternal angle with head of bed to 30 degrees
.RA lies 5 cm below sternal angle
.normal decrease on inspiration
.ABnormal increase on inspiration = kussmauls = assoc with JVD causes
.>3cm above zero = elevated =
-volume overload or
-hyperdynamic/pregnancy/hyperTHYR or
-SVC obstruction or
-TS/TR
-or limited RV filling (RVF/RV infarction/constrictive pericarditis/tamponade
.A-wave = atrial systole
-cannon = block 3 (RA systole against closed tricuspid)
-large = atrial outflow obstruction (TS, PS, pulm htn)
.X-descent = atrial relax
-large = tamponade, constrictive pericarditis
-absent = AF
.V-wave = ventricular systole (tricuspid closed, atrial filling)
-large = TR
.Y-descent = ventricular filling (tricuspid open)
-large = TR, constrictive pericarditis
-decr = TS, right atrial myxoma
-wave form
-abdominal-jugular reflux text - sustained rise = RHF
-carotids-pulse character
Chest
-inspect, scars, pace makers, chest deformity, heaves, retractions
-Palpate - apex 5th ICS 1cm medial to MCS - IF FAINT MAKE LOUDER BY DECUBITUS
.forceful and sustained = AS, htn
.displaced, diffused, non-sustained = MR, HFrEF, dilated cardio, volume loaded
.larger area than normal = anterior MI, LVF
.double = hypertrophic cardiomyopathy
.tapping = MS
.absent = obesity, emphysema, pericardial effusion, shock, dextrocardia
-Palpate sternum = parasternal heave
.RVH
-Palpate pulmonic = palpable P2
.pulmonary htn
-Palpate base of heart = thrill (palpable murmur) - LOUDER SITTING LEANING FORWARD
IN EXPIRATION
-roll to left side and try again to feel apex impulse
-percuss from left side - pulmonary resonance laterally, cardiac dullness medially
LEGS
-peripheral pulses - dorsalis pedis + posterior tibial
-cyanosis
-temperature of legs, feet
-femoral pulse
-trophic changes, ulceration
-edema - pitting edema
-xanthomata
-calf tenderness
-clubbing
-popliteal pulse
-raise legs to 60degrees, wait for 60 seconds, then ask them to dangle legs over -
check how long for skin to return to usual color 10sec, and veins to fill 15 sec
-examine for varicosities and palpate for tenderness
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ENDO
______
GA:
-------------------
-hypoTHY
.slow cognition
.lethargy
.jumper /cold
-hyperTHY
.weight loss
.anxious
.thyroid stare
.singlet
.sweating
-cushing
.hirsute
.moon
.buffalo
.bruising
.pregnant
HANDS:
-hypoTHY
. yellow palm - carotinemia
. palmar crease pallor - anemia (menorrhagia, AOCD)
. carpal tunnel
-hyperTHY
. oncholysis (graves)
. clubbing = acropachy (graves)
. tremor (paper test)
. palmar erythema (hyperdynamic circ)
.
-addison
. pigment
-acro
. spade
. sweaty
. OA
. carpal tunnel
ARMS:
-hyperTHY
. prox myopathy - ar raise + strength
. brachial reflex ++++
. pulse AF
-cushing
. prox myopathy
. pigment
. bruising
-acro
. acanthosis
. axilla skin tag
EYES
-hyperTHY
. exopthalmos
. chemosis
. conjunctivitis
. EOM - LR(CN6, abducens)
. acuity
. lid lag
-pituitary + acro
. visual fields - bitemporal hemianopsia
. papilloedema
FACE:
-hypoTHY
. yellow - carotinemia
. periorbital edema
. eyebrow hairloss
. glossitis / tongue swelling
-acro
. macroglossia
. prognathism
-cushing
. hirsute
. acne
. telangiectasia
NECK:
-hyperTHY
. inspect - front sides neck scar dilated veins
. drink water - view from side - goitre/thyroglossal cysts rises with drinking
. tongue poke out - thyroglossal cyst moves
. palpate from behind - size, soft (normal), rubber (hashi), hard (carcinoma),
tender (thyroiditis), mobile, thrill auscultated
. palpate from front - tracheal deviation
. auscultate bruit
CHEST:
-hyperTHY
. systolic murmur
-cushing
. striae
-acro
. gynecomastia
LEGS:
-hypoTHY or PAN-hypopituitary
. non pitting edema
. hung up achilles reflexes
-hyperTHY
. pre-tibial myoedema - pink/brown nodules (graves)
. motor power (prox myopathy)
. patellar reflex +++++
-acro
. foot drop
. hip OA
TESTS
-acro
. UA - glucose
. BP - hi
-addisons
. postural BP
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ANKLES/FEET - talley
Neck ROM:
-active flexion
-active rotation, left, right
-active lateral flexion
-active extension
Hands and Wrists (look, feel, move, compare sides, assess function)
-expose to above elbow
- edge of bed + hands on pillow
-inspection - redness, rashes, atrophy, nail pitting/oncholysis/hyperkeratosis,
deformity, rash
.RA = ulnar deviation, Z-thumb deformity, boutonnierre, swan neck, volar
subluxation, swelling, warmth
.OA = heberdens, bouchards
-ask about pain before palpating
-make fist
-extend spread fingers
-flex wrists
-extend wrisits
-move hands laterally and medially
-turn hands over and examine palmar surfaces - palmar erythmea, palmar creases,
wasting
-palpate for palmar tendon crepitus
-carpal tunnel syndrome
.phalens (wrists flexed for 30 sec causes tingling)
Shoulders
-watch removal of shirt - limitation
-inspect FRONT + SIDES + BACL - for symmetry, acromioclavicular joints, deltoid
muscle wasting, scars, swelling
-passive + palpate at Acromioclav J - limitation, crepitus
.abduction to 90o
-active elevation
-active aduction
-active flexion and extension (palpate)
-active external rotation (hands behind head)
-active internal rotation (hands behind back)
-repeat flexion/ext/int rotation whilst palpating for crepitus
-palpate for pain - sternoclaviular J, acromial claviular, subacromial area, long
head of biceps tendon
-apley test (scratch opposite shoulder, scratch same side, scratch from below)
-apprehension test ()anterior stability) - stand behind, abduct 90o, flex forearm
90o, hold shoulder, push head of humerus forward with thumb
HIPS
-active flex (bend knee to chest)
-passive flex 90o, stabilize thigh, then internally and externally rotate
-passive abduction and feel contralteral ASIS move
-palpate - below inguinal for hip joint
-on side - palpate trochanteric tuberosity for trochanteric bursa
-on side - palpate ischial tuberosity for ischial bursa
-stand - observe front and behind
SPINE
-inspect curves, scholioss
-touch toes - scoliosis, lumbar curve should flatten
-standing - support hips from behind - lateral flexion + extension + rotation
-palpate spinous processes for tenderness
-palpate paravertebral muscles for tenderness and spasm
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