1
Q
What are the muscles of the rotator cuff?
A
SITS
Supraspinatous, infraspinatous, teres minor, subscapularis
2
Q
Which tendon is most commonly involved in rotator cuff disease?
A
Supraspinatous
3
Q
How does rotator cuff tendinopathy present?
A
Subacute pain on abduction (e.g. painful arc test) and exacerbated with overhead activities
Reduced active ROM and mild weakness from pain (not passive)
4
Q
How does a rotator cuff tear present?
A
Severe pain, active weakness and reduced active range of motion on abduction from mechanical inability (not passive)
5
Q
How does a frozen shoulder present?
A
Pain, active weakness and active+passive reduced ROM
6
Q
What does a positive painful arc at 120-60 indicate?
A
- pain at 60-120 = rotator cuff tendinopathy aka subacromial impingement syndrome
7
Q
What does a positive painful arc at 180-120 indicate?
A
- pain at 180-120 = acromioclavicular impingement
8
Q
What does a positive empty can test indicate?
A
Rotator cuff pathology, specifically supraspinatous muscle - tendinopathy or tear
9
Q
What does a positive infraspinatous test indicate?
A
Rotator cuff pathology, specifically infraspinatous and teres minor tear/tendinopathy
10
Q
What does a positive lift-off (gerber’s) test indicate?
A
Rotator cuff pathology, specifically supscapularis tear/tendinopathy
11
Q
What 4 special shoulder exam tests indicate rotator cuff pathology?
A
Painful aarc, empty can, lift off, infraspinatous (there are others but these are the Geeky medic’s/med school ones)
12
Q
What does a positive Simmond’s test indicate?
A
Ruptured achilles tendon
13
Q
What is a Simmond’s test?
A
Lie patient with feet hanging off the bed, squeeze calf, foot should plantarflex
14
Q
What does a positive scarf test indicate?
A
Acromioclavicular pathology e.g. arthritis
15
Q
What are the screening tests in a shoulder exam? What movements do they test?
A
Shoulders behind head and push elbows back - external rotation and abduction
Hands in small of back and reach up - internal rotation and adduction
16
Q
What motion does an empty can test assess?
A
Resisted active abduction
17
Q
What motion does an infraspinatous test assess?
A
Resisted active external rotation
18
Q
What movement does a lift off test?
A
Resisted active internal rotation
19
Q
A
20
Q
Describe the golfer’s elbow test:
A
Patients elbow flexed and in a supine position
Palpate medial epicondyle
Extend wrist
Extends elbow
Illicits pain
21
Q
What are the special tests in an elbow exam?
A
Golfers elbow test
Tennis elbow test
22
Q
What is the golfer’s elbow test for?
A
Medial epicondylitis
23
Q
Describe the tennis elbow (Mill’s) test:
A
Patients elbow flexed and in a prone position
Palpate lateral epicondyle
Flex wrist
Extend elbow
Illicits pain
24
Q
What is the tennis elbow test for?
A
Lateral epicondylitis
25
During a hand exam, what are the special tests for the median nerve?
Palmar abduction - point thumb to sky against resistance
Provocation - tinel's and phalen's
26
During a hand exam, what are the special tests for the radial nerve?
Wrist and finger extension against resistance
27
During a hand exam, what are the special tests for the ulnar nerve?
Abduct fingers against resistance
Cross fingers
Pinch a piece of paper without bending thumb - Froment's sign
28
What are the special tests in a hip exam?
Trendelenberg's test (hip abductors)
Thomas's test (hip flexors)
29
Describe a Trendelenberg test:
Stand on one leg and observe for a drop int he hip
30
Describe a Thomas's test:
With the patient positioned flat on the bed, place a hand below their lumbar spine with your palm facing upwards (this helps to prevent the patient from masking a fixed flexion deformity by increasing lumbar lordosis).
2. Passively flex the hip of the unaffected leg as far as you are able to with the knee bent and observe the contralateral limb.
The test is positive (abnormal) if the affected thigh raises off the bed, indicating a loss of hip joint extension.
31
If a Trendelenberg test is positive, where is the pathology?
Hip abductor muscles - gluteus medium, gluteus minimum, tensor fascia latae and sartorius
32
What does a Thomas's test assess?
Fixed flexion deformity of iliopsoas, rectus femoris, and tensor fascia latae
33
If a Thomas's test is positive, where is the pathology?
Hip flexors - iliopsoas, rectus femoris, and tensor fascia latae
34
What does Lachman's test assess?
ACL injury
35
What does McMurray's test assess?
Torn meniscus - a palpable or audible click = positive
36
What special tests can be done in a spine exam?
Straight leg raise
Bowstring test
Femoral stretch test
37
Describe a straight leg raise:
Patient lies flat on bed on back
Passively flex hip whilst keeping knee fully extended - pain = nerve root itrritation
38
Describe a femoral stretch test:
Patient lies on front
Anterior thigh is on couch
Knee is flexed passively
Thigh is lifted off the bed
Pain due to stretched nerve roots in L2-4
39
WHat does a winged scapula indicate?
Long thoracic nerve pathology
40
Where does the long thoracic nerve originate?
C567 - arms to heaven
41
What special tests are done in a hip exam?
Thomas's
Trendelenberg's
Leg length
Sciatic stretch
42
What does a positive Trendelenberg's test mean?
Hip abductor pathology (gluteus medius, gluteus minimus, tensor fasciae latae)
43
What does SWIFT stand for in a neurological exam?
Scars
Wasting
Involuntary movements
Fasciculations
Tremor
44
What are some upper motor neurone signs?
increased muscle tone (spasticity), hyperreflexia (brisk reflexes), weakness, clonus, and a positive Babinski sign (upgoing plantar reflex).
45
What are some upper motor neurone signs?
spasticity, hyperreflexia, Babinski sign (upgoing plantar), clonus, and muscle weakness
46
What are some lower motor neurone signs?
muscle atrophy (wasting), involuntary muscle twitching (fasciculations), reduced or absent reflexes (hyporeflexia/areflexia), reduced muscle tone (hypotonia), and downward-going plantar response (normal)
47
What are some examples of bulbar signs?
progressive muscle weakness, slurred or nasal speech (dysarthria), severe swallowing difficulties (dysphagia), muscle wasting/twitching in the tongue (fasciculations), drooling, and a reduced or absent gag reflex
48
What are the screening tests in a shoulder exam and what motions do they involve?
Hands behind head - assesses external rotation and abduction
Hands as far up back as possible - assesses internal rotation and adduction
49
What are the GALS questions?
Do you have any pain or stiffness in your joints, muscles, or back?
Can you walk up and down stairs without difficulty?
Do you have any difficulty dressing yourself?
50
How is the shoulder examined in GALS?
Shoulder abduction with hands pushed behind head (hands behind head)
51
How is hands examined in GALS?
Look - prone and supine
Feel - MCP squeeze
Move - fist
Function - squeeze my fingers, pincer grip, pick up a coin
52
How are hips and knees examined in GALS?
Look
Feel - patellar tap
Move - active hip and knee flexion, passive internal rotation
53
How are feet examined in GALS?
Look
Feel - MTP squeeze
54
How is the spine assessed in GALS?
Look
Lumbar - Schober's, touch your toes
Cervical - lateral
55
What are the general rules of GALS?
Upper limb = function
Lower limb = walking
56
What are the special tests in a spinal exam?
Schober's test
Straight leg raise
Femoral stretch test
57
What does a positive straight leg test show?
L5-S1 nerve root compression - sciatica, shooting down posterior part of leg
58
What does a positive femoral stretch test show?
L2-L4 nerve root compression - femoral nerve, shooting down anterior part of leg
59
Will thyroid gland masses move with swallowing?
Yes
60
Will thyroglossal cysts move with swallowing?
Yes
61
Will lymph nodes move with swallowing?
No
62
Will thyroid gland masses move with tongue protrusion?
No
63
Will thyroglossal cysts move with tongue protrusion?
Yes
64
Will lymph nodes move with tongue protrusion?
No
65
What hand signs might you see in thyroid disease?
Thyroid acropachy (looks like clubbing)
Onycholysis
Palmar erythema
66
How do you assess the olfactory nerve?
Ask the patient if they have noticed any recent changes to their sense of smell
67
How do you assess the optic nerve?
Inspect pupils, assess direct and consensual pupil reflexes, assess swinging light reflex, assess accommodation, assess for neglect, assess for visual fields, blind spot
68
What else do you offer for an examination of the optic nerve?
Visual acuity - Snellen
Colour vision - ishihara
Fundoscopy
69
How do you assess cranial nerves 3, 4 and 6?
Inspect eyelids for ptosis
Assess eye movements
70
What do you offer for an examination of cranial nerves 3, 4 and 6?
Assess for evidence of strabismus (light reflex test and cover test)
71
What does cranial nerve 4 innervate?
Superior oblique
72
What does cranial nerve 6 innervate?
Lateral rectus
73
How do you examine cranial nerve 5?
Assess sensation in the 3 regions
Assess muscles of masticcation
74
What do you offer in an examination of cranial nerve 5?
Jaw jerk reflex
Corneal reflex
75
What are the branches of cranial nerve 5?
Ophthalmic Nerve (V1): Sensory nerve supplying the forehead, scalp, upper eyelid, cornea, and frontal sinus.
Maxillary Nerve (V2): Sensory nerve supplying the lower eyelid, cheek, upper lip, upper teeth, and palate.
Mandibular Nerve (V3): Mixed nerve (sensory and motor) supplying the lower face, including the jaw, chin, lower teeth, and muscles of mastication.
76
How do you assess CN7?
Ask if they have any changes to taste
Ask if they have any changes to hearing
Inspect for asymmetry
Assess facial movement by asking the patient to perform various facial expressions
77
What part of the tongue does CN7 innervate?
Anterior 2/3s of the tongue
78
Why might CN7 cause hyperacousis?
Hyperacusis related to Cranial Nerve VII (CN VII, the facial nerve) occurs when damage to this nerve causes paralysis of the stapedius muscle in the middle ear. This muscle normally dampens vibrations of the ossicles to reduce sound volume; when paralyzed, everyday sounds can seem painfully loud.
79
How do you assess CNVIII?
Perform gross hearing assessment
Perform Rinne's
Perform Weber's
80
What do you offer for assessment of CNVIII?
Vestibular testing - turning test, vestibular-ocular reflex
81
What is the turning test?
Ask the patient to march on the spot with their arms outstretched and their eyes closed
82
What is a normal turning test?
the patient remains in the same position.
83
What is an abnormal turning test?
The patient will turn towards the side of the lesion
84
How do you assess CNIX and CNX?
Inspect the soft palate
Ask the patient to say aaah
Ask the patient to cough
Perform swallow reflex
85
What do you offer for an assessment of CNIX and CNX?
Gag reflex
86
How do you assess CNXI?
Assess trapezius muscle strength
Assess sternocleiodomastoid strength
87
How do you assess CNXII?
Inspect the tongue
Ask the patient to stick their tongue out?
Assess tongue strength
88
How is Rinne's performed?
Place a vibrating 512 Hz tuning fork firmly on the mastoid process (apply pressure to the opposite side of the head to make sure the contact is firm). This tests bone conduction.
2. Confirm the patient can hear the sound of the tuning fork and then ask them to tell you when they can no longer hear it.
3. When the patient can no longer hear the sound, move the tuning fork in front of the external auditory meatus to test air conduction.
4. Ask the patient if they can now hear the sound again. If they can hear the sound, it suggests air conduction is better than bone conduction, which is what would be expected in a healthy individual (this is often confusingly referred to as a “Rinne’s positive” result).
89
How is Weber's performed?
1. Tap a 512Hz tuning fork and place in the midline of the forehead. The tuning fork should be set in motion by striking it on your knee (not the patient’s knee or a table).
2. Ask the patient “Where do you hear the sound?”
90
What is a normal Rinne's?
air conduction > bone conduction (Rinne’s positive)
91
What is a conductive hearing loss on Rinne's?
bone conduction > air conduction (Rinne’s negative)
92
What is a sensorineural hearing loss on Rinne's
air conduction > bone conduction (Rinne’s positive) – due to both air and bone conduction being reduced equally
93
What is a normal Weber's?
Sound is heard equally in both ears.
94
What is a conductive hearing loss on Weber's?
Sound is heard louder on the side of the affected ear.
95
What is a sensorineural hearing loss on Weber's?
Sound is heard louder on the side of the intact ear
96
Which way does the tongue deviate for a vagus nerve palsy?
Away from the lesion (like going away on holiday to Vegas)
97
Which way does the tongue deviate for a hypoglossal nerve palsy?
Deviation towards the lesion (like a car)
Hypoglossal nerve palsy causes atrophy of the ipsilateral tongue and deviation of the tongue when protruded towards the side of the lesion. This occurs due to the overaction of the functioning genioglossus muscle on the unaffected side of the tongue.
98
What tuning fork is used for Rinne's and Weber's?
512Hz
99
What does a relative afferent pupillary defect indicate?
Unilateral disease of the retina or optic nerve such such as optic neuritis or CRAO, glaucoma
Tested with the swinging light reflex
100
What does RADP look like?
Pupils paradoxically dilate when a light moves from the unaffected eye to the diseased eye due to decreased sensation of light.
101
Where can you find the biceps reflex?
Tapping the biceps tendon in the antecubital fossa causes elbow flexion.
102
What nerve root is involved in the biceps reflex?
C5-C6
Mostly C5
103
Where can you find the brachioradialis reflex?
Tapping the radius 2-4 inches above the wrist causes forearm flexion and supination.
104
What nerve root is involved in the brachioradialis reflex?
C6
105
Where can you find the triceps reflex?
Tapping the triceps tendon just above the elbow causes elbow extension.
106
What nerve root is involved in the triceps reflex?
C7
| Tri-seven-tops idk
107
What nerve roots are involved in the patellar reflex?
L3/L4
108
What nerve roots are involved in the achilles reflex?
S1
109
What does the trochlear nerve innervate?
Superior oblique
110
What does the abducens nerve innervate?
Lateral rectus
111
What is 0 on the MRC power scale?
No contraction
112
What is 1 on the MRC power scale?
Flicker of contraction
113
What is 2 on the MRC power scale?
Active movement with gravity removed
114
What is 3 on the MRC power scale?
Active movement against gravity
115
What is 4 on the MRC power scale?
Active movement against gravity and resistance
116
What is 5 on the MRC power scale?
Normal power
117
How is jaw jerk performed?
It is performed by having the patient relax their jaw and allow their mouth to hang slightly open. The examiner places one finger (usually the index finger) on the patient’s chin or lower lip and strikes it gently with a tendon hammer in a downward direction. A normal response is absent or very slight; a brisk upward jerk indicates an upper motor neuron lesion
118
How is the corneal reflex assessed?
Ask the patient to look up --> touch the cornea with some cotton wool and observe for the blink reflex
119
What is the vestibulo-ocular reflex?
The vestibulo-ocular reflex (VOR) is a rapid, involuntary brainstem reflex that stabilizes images on the retina during head movement by producing eye movements in the opposite direction of the head's rotation.
Aka, your eyes remain stable as you move your head
120
How is the vestibulo-ocular reflex assessed?
Head impulse test - The patient fixes their gaze on the examiner's nose. The examiner places both hands on either side of the patient's head and moves it side to side slowly. Then, briskly rotates the patient's head to one side
121
What is a normal vestibulo-ocular reflex?
Eyes remain fixed on the examiner
122
What is an abnormal vestibulo-ocular reflex?
Corrective saccades - the eyes move with the head and then make a corrective saccade (jerk) back to the target.
https://www.youtube.com/watch?v=B09sz3prKBI
123
Is a abnormal vestibulo-ocular reflex concerning?
No - it indicates peripheral vertigo and a problem with CNVIII on the ipsilateral side, and therefore not a stroke
124
What does the HINTS exam test?
Whether vertigo is of peripheral or central
125
What does HINTS stand for?
head impulse test, evaluation of nystagmus, and a test of skew.
126
How is nystagmus assessed in a HINTS exam?
Ask the patient to look side to side without fixing on any object (as this can reduce nystagmus)
127
What is a non-concerning results for nystagmus in a HINTS exam?
Unidirectional nystagmus, horizontal (peripheral)
128
What is a concerning results for nystagmus in a HINTS exam?
Changing direction, bidirectional, vertical (central, specifically stroke)
129
What is a test of skew in a HINTS exam?
Ask the patient to look at your nose and subsequently cover one of their eyes.
2. Then, quickly move your hand to cover the patient’s other eye. During this process, observe the uncovered eye for any vertical and/or diagonal corrective movement.
3. Repeat this manoeuvre on the other eye.
130
What is an abnormal test of skew?
Any abnormal movement - indicates central vertigo
131
https://www.youtube.com/watch?v=1q-VTKPweuk
132
What is a reassuring HINTS exam?
All of:
Unidirectional nystagmus
No vertical skew
Abnormal head impulse test
133
What is a concerning HINTS exam?
Any of:
Bidirectional nystagmus
Abnormal test of skew
Normal head impulse test
134
Before confirming a patient's death, what should you confirm?
The patient meets the criteria for not attempting cardiopulmonary resuscitation (e.g. the patient has a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form)
Attempts at CPR have failed
Treatment aimed at sustaining life has been withdrawn as it has been decided that it would be to no further benefit to the patient
135
What are the stages of a cardiovascular death confirmation?
1. Check the identity of the patient, ensure this matches the identity of the patient by checking their wristband.
2. Assess the patient’s response to verbal stimuli e.g. “Hello, Mr Smith, can you hear me?” (response to verbal stimuli is not part of the formal process but is good practice as a first approach to the patient)
3. For a minimum of five minutes, confirm the absence of:
Central pulse on palpation (carotid artery)
Heart sounds on auscultation
Respiratory sounds on auscultation
Signs of life (e.g. movement and respiratory effort)
4. Confirm absence of pupillary reflexes, corneal reflexes, motor response to supraorbital pressure
136
What branch of the trigeminal nerve is involved in the corenal reflex?
V1 (ophthalmic)
137
What does HEADSSS stand for in a consultation with a teenager?
Home
Education/employment
Eating/drinking
Activity
Drugs and alcohol
Sexual activity, sexuality and gender
Suicide/self harm
Safety
138
What are the 3 key questions for depression?
Mood
Energy
Lack of pleasure
139
What are some cognitive symtpoms associated with depression?
Poor concentration
Guilt
Hopelessness
Low self esteem
140
What are some physical symptoms of depression?
Poor sleep
Poor appetite
Low libido
Agitation or psychomotor retardation
141
What areas of life should you ask a manic patient about?
Work/education
Friends/relationships
Sleep
Eating/drinking
Money
Risk taking
142
What are the physical symptoms of anxiety?
Palpitations
CHest tightness
Breathelssness
Sweating
Dizzy
Dry mouth
Poor sleep
143
What are the first rank symptoms of psychosis?
Passivity
Auditory hallucinations
Delusions
Thought disorders qas
144
What are some physical symptoms of an eating disorder?
Amenorrhoea, fatigue, constipation, dizziness, haematemesis, seizures
145
What are the 3 core symptoms of PTSD?
Hyperarousal
Re-experiencing the event
Avoidance of triggers
146
What are the benefits of a blood transfusion?
Receiving a blood transfusion can relieve symptoms caused by anaemia
It can prevent damage caused to organs associated with anaemia
It can allow earlier mobilisation and quicker recovery after an operation, acute illness or injury
147
What are the possible risks of a blood transfusion?
Small risk of patient receiving the wrong blood and having a severe reaction (acute haemolytic reaction)
Acute reactions such as fever (non-haemolytic febrile reaction) or rash (minor allergic reaction)
Build up of fluid
Infection with blood borne viruses
Formation of antibodies which might make it harder to match blood if patients need another one in future
Iron overload
Damage to lungs (transfusion related lung injury)
148
How is a febrile reaction managed?
Paracetamol and monitor
Stop transfusion
149
How is aminor allergic reaction managed?
Antihistamines and monitor
Stop transfusion
150
How is anaphylaxis managed?
Adrenaline
Stop transfusion
151
How is an acute haemolytic reaction (mismatched blood) managed?
Bloods are taken twice, checked, strict procedure for checking identity before giving
152
How is TACO managed?
IV furosemide
Stop transfusion
153
How is a TRALI managed?
Stop transfusion, oxygen
154
How is blood borne virus infection managed?
Donated blood is carefully tested and processed, so the risk of infection due to bacteria or viruses like hepatitis or HIV is tiny – less than 1 in a million
155
How are patients monitored during the transfusion?
Patients should tell staff if they feel unwell
Monitor temp, HR, BP before, during and after
156
What is it important to mention to a patient after receiving a blood transfusion?
They can no longer donate blood
157
What are some alternatives to blood transfusions?
Iron replacement therapy (IV or tablet)
EPO injections
Doing nothing
158
What are some alternatives to blood transfusions during surgery?
the blood lost during or just after the operation is collected, filtered and given back to the patient - might be good for Jehovas Witnesses
159
How long do blood transfusions take?
2-3 hours normally
160
What should you offer at the end of a counselling station?
A LEAFLETTTTTTTTTT
161
What is done in a falls examination?
A-E (heart sounds, lung sounds, feel abdomen, feel calves)
Neuro (look in eyes, eye movements, facial nerve, power in upper and lower limbs)
Head: lateral neck, c spine tenderness
Hips: greater trochanter
162
163
What is the actual leg length?
ASIS to MM
164
Describe good inhaler technique:
1. Remove cap and shake
2. Breathe out gently
3. Put mouthpiece in mouth and as you begin to breathe in, which should be slow and deep, press canister down and continue to inhale steadily and deeply
4. Hold breath for 10 seconds, or as long as is comfortable
5. For a second dose wait for approximately 30 seconds before repeating steps 1-4.
165
How many breaths should a patient using a spacer take?
5 normal breaths
166
What part of inhaler technique is important to remind a patient using an inhaler/spacer?
Make a tight seal with your lips, sit up straight, lengthen your neck
167
How can you examine someone after a fall?
1. Airway, breathing, circulation, abdomen
2. Palpate their cervical spine and head
2. Palpate their hips and greater trochanter
3. Gross cranial nerves - eye movements and facial movements
4. Upper and lower limb power
168
How many people survive a cardiac arrest in and out of hospital?
Out - <10%
In - 20% or so
169
170
What are the 4 components of capacity?
Understand the info, retain, it, weigh it up and communicate it back
171
What should you ask someone after consenting (or lack of consent)?
Can you repeat back to me what I've said just so I can check you've understood (after a BRAN)
Phase 4
flashcards
Decks in class (19)
# Cards
-
Cardiolovascular272
-
Respiratory18
-
Gastroenterology63
-
Endocrinology12
-
Neurology12
-
Hepatobiliary25
-
Nephrology32
-
Haematology26
-
Dermatology379
-
Bloods and Electrolytes14
-
Obstetrics and Gynaecology2
-
Urology4
-
ENT183
-
Ophthalmology126
-
Rheumatology56
-
Infectious Disease30
-
Psychiatry41
-
OSCE171
-
Things I got Wrong201
