Basic Physician Training MCQs
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​
  1. Wash your hands
  2. Introduce yourself and thank the patient
Ensure patient is at 45 degree
  1. Inspect the room for devices, fluid infusions, oxygen therapy etc
  2. Inspect fingers
    1. Leukonychia - white nails, a sign of hypoalbuminaemia, seen in chronic liver disease, nephrotic syndrome
    2. clubbing - seen in IBD, CLD, congenital heart disease, CF
  3. Inspect hands
    1. palmar erythema - reflects vasodilated state of cirrhosis secondary to increased oestrodiol: free testosterone
    2. dupytren's contracture
    3. tendon xanthoma
  4. Check for hepatic flap
    1. Ask patient to dorsiflex wrist with fingers spread apart
    2. asterixis is found in all grades of hepatic encephalopathy, and is not specific (eg metabolic, uraemic encephalopathies)
  5. Whilst checking for hepatic flap determine orientation
    1. Which hospital they are at
    2. What day of the week is it
  6. Inspect arms
    1. brusing, ecchymoses, marks of excoriation from pruritis, track marks, tatoos, A-V fistula, cachexia, jaundiceK-F
  7. Ask for blood pressure and temperature and repeat it back to examiner
  8. Look into eyes
    1. Jaundice
    2. K-F rings
    3. Xantholesma
    4. Arcus-senilis
    5. scleritis, episcleritis, anterior uveitis
  9. Look into mouth
    1. appreciate fetor hepaticus
    2. Look for telangiectasia
    3. ulcers
    4. dentition
    5. gum hypertrophy (CsA use in liver/ renal Tx)
    6. glossitis
    7. angular chelitis
  10. Palpate the parotids
  11. Palpate supraclavicular lymphadenopathy
    1. look for virchow's node on the left
  12. Check JVP and feel for hepato-abdominal reflex 
    1. evidence of congestive hepatic cirrhosis
  13. Palpate for gynecomastia
  14. Lie patient flat
  15. Ask the patient to lift their head of the bed, looking for hernias
  16. Make a point of observing from top and from sides, trace out scars clearly for examiner
  17. Ask if there is any tenderness
  18. Palpate superficially
  19. Palpate deeply
  20. Palpate from RIF for liver and tract liver edge, noting whether it is firm/ irrergular etc
  21. Measure liver span by finding the superior surface through percussion
  22. Palpate for spleen from RIF
  23. Percuss for spleen and note its contour
  24. Percuss for shifting dullness towards you and make a note of position of dullness
  25. Turn pt to right hand side and palpate for spleen if not felt earlier, otherwise wait 30s and look at back whist waiting for shifting dullness
  26. Percuss for shifting dullness
  27. Ballot kidneys
  28. Auscultate for hepatic venous hum, bruit, renal artery bruit, bowel sounds
  29. Ask the patient to look at the groin for hernias and palpate for inguinal lymphadenopathy
  30. Thank the patient
  31. Turn to examiner and say that you would like to assess for testicular atrophy, perform a PR examination for malena and masses, and note the results of the urinalysis
  32. Request to present your findings
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  • About
  • Written
    • Respiratory Medicine
    • Medical Oncology >
      • Colorectal Cancer
      • Lung Cancer
      • Urogenital Cancers
      • Emergencies
      • Melanoma
      • Breast
    • Haematology >
      • Anaemia
      • Coagulation
      • Malignancy
    • Cardiology >
      • General Cardiology
      • Coronary Artery Disease
      • Heart Failure
      • Valvular Heart Disease
      • Arrhythmia
    • Endocrinology >
      • General Endocrinology
      • Reproduction
      • Pituitary
      • Diabetes
    • Clinical Immunology
    • Clinical Toxicology
    • Genetics
    • Geriatrics
    • General Medicine
    • Statistics
    • Gastroenterology >
      • Pancreas
      • Inflammatory Bowel Disease
      • Oesophageal Diseases
      • Stomach and Small Intestine
      • Liver
    • Infectious Diseases >
      • Viruses
      • Bacteria
      • Parasites
      • Fungus
    • Neurology >
      • Anatomy
      • Nystagmus
      • Myopathies
      • Stroke
      • Neurodegenerative Disorders
      • Neuropathy
    • Nephrology >
      • Glomerulonephritis
      • General Nephrology
      • Chronic Kidney Disease
    • Psychiatry
    • Palliative Care
    • Pharmacology
    • Rheumatology >
      • Rheumatoid Arthritis
      • Connective Tissue Diseases
      • Spondyloarthropathies
      • Crystal Arthropathy
  • Clinical
    • Short Cases >
      • Haematology
      • Endocrine
      • Neurology
      • Rheumatology
      • Renal
      • Gastroenterology
      • Cardiology
      • Respiratory
    • Long Cases >
      • Addiction & Psychiatry
      • Cardiology
      • Endocrinology
      • Geriatrics
      • Gastroenterology
      • Renal
      • Haematology
      • Infectious Diseases
      • Oncology
      • Rheumatology
      • Respiratory
      • Neurology
      • Set pieces
  • Medical Students
  • Respiratory
    • Asthma >
      • Acute Exacerbation
    • COPD >
      • Exacerbations
    • Lung Cancer >
      • Targeted therapy
    • Tobacco
    • Questionnaires