Basic Physician Training MCQs
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  1. Wash hands
  2. Greet examiner
  3. Place briefcase in safe place and take stethoscope out, hang around neck
  4. Introduce and thank the patient
    1. Hello Mr/ Mrs ..., my name is Dr ... Thank you for letting me examine you today
  5. Position the patient sitting over the bed
  6. Expose the patient to the waist 
  7. Modestly ask female patient to remove bra
  8. Step back from patient and make a show to the examiners that your examining the patient
    1. Look for obvious features (RA, SLE, pectus excavatum, ank spond, heliotrope rash, shawl sign, work of breathing)
    2. Look for lines
    3. Look for oxygen tank
    4. Look for sputum cup and examine contents
  9. Re-cover female patient until you get back to thorax
  10. Hands
    1. Do not focus on RA/ SLE/ Scleroderma  - make movements to let the examiner know that you acknowledge the presence of peripheral signs and be happy that you are aware of what you are going to find on the clinical examination
    2. Start at nails
      1. yellow nail syndrome " primary lymphedema associated with yellow nails and pleural effusion, 40% develop bronchiectesis"
      2. leukonychia
      3. splinter haemorrhages
    3. Inspect for clubbing (remember multiple causes not just resp)
      1. look at nails from top
      2. Look from side
      3. Shammroth sign
    4. Inspect for cyanosis
    5. Inspect palms
      1. palmar erythema of hypercarbia
      2. anaemia
  11. Look for T1 lesion by testing finger abduction. Also tests integrity of small hand muscles
    1. Pancoast tumour
  12. Look for evidence of acute CO2 retention
  13. Squeeze the wrists gently to look for evidence of hypertrophic pulmonary osteoarthropathy
  14. Palpate pulse and measure RR
  15. Check for pembertons sign
    1. Can you please raise you arms above your head
    2. This should take 60s to elicit, during this time, proceed with the rest of the examination of the face
    3. Looking for distended neck veins, facial flushing, inspiratory stridor
  16. Inspect the face - look for peripheral signs of connective tissue disease
  17. Examine for horners syndrome
    1. Palpate each side of the brow with the index finger
    2. Look in the eye for miosis and ptosis
  18. Examine the mouth
    1. Look for central cyanosis
    2. Peripheral signs eg ulcers
    3. Tonsilitis/ tonsilar adenopathy
    4. Pharyngeal crowding, retnognathia, large tongue (signs of risk of OSA)
    5. Oral hairy leukoplakia
    6. Oral candidiasis associated with long term steroid use
  19. Ask patient to drop their arms
  20. Inspect neck and check for scars
  21. Check patients lymph nodes from the back
  22. Inform patient that you will feel their windpipe and they may experience some discomfort
  23. Examine for tracheal tug and deviation (volume loss eg tuberculosis scarring)
  24. Examine the patient from the back 
    1. Inspect for scars under both arms
    2. Visually inspect chest expansion
  25. Check for chest expansion, noting normal is >5cm
  26. Percuss lung fields
    1. include the axillae 
      1. RML is only heard near the axilla
    2. include the lateral lung fields
  27. Auscultate the lung fields
    1. Ask the patient to take big deep breaths in and out with their mouth
    2. Listen for noises, time them
      1. early, mid, late, pan --> inspiratory or expiratory
  28. Assess for vocal resonance
    1. Ask the patient to say '99' each time the stethescope touches their chest
  29. Now move to the front of the patient
  30. Inspect patient for radiation tattoos, scars etc
  31. Check for chest expansion from the front
  32. Percuss the clavicles
  33. Percuss the anterior chest
  34. Auscultate the anterior chest
  35. Assess for vocal resonance
  36. Ask the patient to lie flat on the bed positioned at 45 degrees
  37. Assess for signs of pulmonary hypertension
    1. JVP + hepato-abdominal reflex + pulsatile liver
    2. palpate for left parasternal heave, parasternal thrill, palpable P2
    3. Auscultate for functional TR, loud P2
  38. Ask to complete the examination by performing bedside spirometry and a formal cardiovascular examination
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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