1. CNS
a. Upper motor neurone lesion - test Motor (facial nerve)
i. Examination of face
ii. Tone of lower limb
iii. Babinski reflex
1. Describe the normal and pathological findings.
2. MSK
a. Length, palpation and inspection
(no feedback -no lecturer)
3. Respi - posterior back, consolidation
a. Palpation
i. Chest expansion -
1. *the whole hand should be touching the chest.*
2. Do not ask patient to cross hands yet.
ii. Tactile vocal phremitus
b. Percussion
i. Percuss over between the medial border of scapula.
c. Auscultation
i. Over between the medial border of scapula
d. Reporting
i. It will be dull on the site of consolidation, which is the right lower lobe. (NOT dull on affected side)
4. Endocrine - Hypothyroidism - plus some ECG component
a. Inspection
b. do not put your hand too far back - no Thyroid behind SCM
c. no need to do lymph node
d. make sure that you palpate as you indicate location of Thyroid - gentle rolling
If I were to add on, in the history taking…
1. Haematology
a. Probably CML / Aplastic Anemia / lung Ca??
2. GI
a. Upper GI bleed - due to NSAIDs
Day 2
1. Renal
a. Inspection of Abdomen
b. Palpation
i. Light palpation do not raise your hands.
c. Palpation of bladder
i. Same way as fundal height - check the height
ii. Check the lateral borders as well
iii. Press onto the bladder to check if is the bladder - like a balloon -may have tendeness.
d. Purcussion of abdomen
e. VIVA
2. I.M. Injection
a. GIEP
i. You need explain there will be a pain.
b. Hand-washing
i. Wash from tip of finger down
ii. Wipe hand from tip to finger down
c. How to handle sharps
d. Prescription slip
i. Check patient, mode of transmission, themedicine, the area of admission.
e. Vaccine -
i. Make sure it is the correct vaccine - LOOK AT IT
f. Extracting the vaccine
i. Pull air into syringe - the amount you’re going to pull
ii. Push needle into vial
iii. The vaccine should naturally flow into syringe
g. Injection
i. Make sure you’re gloved up.
h. After injection
i. You can recap using ONE HAND -
i. Disposal of waste
i. Sharps
1. No need to separate syringe with needle
ii. Biological waste
1. Glove and swab
iii. The rest goes into normal dustbin
j. It is a good practice to distract the patient while procedure - to prevent the patient to become anxious.
3. Abdomen
a. Inspection of abdomen
i. do it when you say it - e.g. if you say you’re going to pull down the trousers till pubic symphysis - do it rather than just saying it
ii. don’t just say the word “lesion”, “discolouration”, etc. be very specific.
b. Fluid thrill
i. Common mistake - you need to put palm fully onto the side of abdomen.
ii. Make sure when you ask patient to put the hand in the middle, press it down so as to make sure that all the palm is touching the abdomen. - to make sure that the fat does not transmit the impulse
c. Shifting dullness
i. Step 1 of shifting dullness -
1. percuss starting from umbilicus - to the lateral abdomen, FURTHER from you. You will notice a resonant percussive note going to dullness shall there be an ascites.
2. Turn the patient towards you, and wait for 15-30 seconds
3. Percuss the same area and comment that the dull percussion note has now become resonant - therefore implying the fluid level has moved.
ii. Step 2 of shifting dullness -
1. percuss down till the dullness moves down, while the patient is still lying on the side. (recomfirmation)
4. Opthalmoscope
a. Inspection of eye
b. opthalmoscopy
History taking component
· Think when you take history.
· Look at the time at which the PC started - is it chronic? Acute?
o If the PC is acute, you can pretty much rule out the chronic conditions
· HPC
o Be very complete
· Medical history
o Ask drug type, dosage, how many they drink, how many times a day
o Any problems upon taking the medication?
· Diagnosis
o Contains these components
§ Acute/chronic?
§ What is it?
§ Is it primary / secondary to something?
o E.g.
§ Acute perforated Peptic ulcer secondary to NSAIDs
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