Abdomen system examination

Examination of the abdomen Inspection Shape Flanks Full or not Venous prominence Umbilicus Position- central/ to side Inverted/ everted Midway between xiphistertnum and pubis symphisis Venous prominence Hernia Granuloma Bluish discoloration around umbilicus Skin Ulcers Striae Pigmentation Scars Localised swelling Movement with respiration Pulsations Peristalsis Hernia sites Inguinal Emoral Umbilical Epigastric Incisional hernia Ask patient […]

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Gastrointestinal system examination

Alway start by looking around the room for any clues that the patient has bought- like medications   General examination- Level of consciousness- Alert/ Oriented/ cooperative Decubitus (position in bed) Gait Built- Average/ small or large for age Nutrition- Average/ undernutrition Dysmorphism   Face Eye  – Kayser- Fleischer Ring Skin- Pallor/ scars/ Telangiectasia / Incontinentia […]

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Kidney examination

The two kidneys are palpated separately. It might be easier to palpate both the kidneys by standing on the right of the patient (in right-handed doctor) You can sit down if needed for your hands to be at the level with abdomen Now place your right hand over the exposed anterior abdomen at the right […]

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Spleen examination

Palpating the spleen There are many ways to palpate the spleen. Stand to the right side of the patient Expose the abdomen from the ribcage to the pubis symphysis Method Place the palm of the right hand on the right iliac fossa and move upward and laterally towards the left hypochondrium Palpate all the way […]

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Apical impulse types

Hyper dynamic apical impulse Seen in volume overload Seen as forceful and sustained beats in left ventricular diastolic overload Conditions associated Mitral regurgitation Aortic regurgitation VSD PDA Heaving apical impulse Seen as forceful and well sustained heave Generally seen in pressure overload of left ventricular Conditions associated Aortic stenosis Systemic hypertension Coarctation of aorta Obstructive cardiomyopathy Tapping […]

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Cardiovascular system history and examination

Look around the room to see if any accessories/ instruments like wheelchairs/ inhalers/ Sputum sample Once the child is seated, ask if you could expose the upper body. For lower body, you may need to ask permission from the examiner also General examination Level of consciousness- Alert/ Oriented/ cooperative Decubitus (position in bed) Gait Built- […]

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Cardiovascular system examination

General examination Level of consciousness- Alert/ Oriented/ cooperative Decubitus (position in bed) Gait Built- Average/ small or large for age Nutrition- Average/ undernutrition Any obvious dysmorphism Respiration effort- rate, rhythm, pattern, depth, laboured or not Face Dysmorphism Cyanosis/ Pallor Respiratory distress- nasal cannula/ nasal flaring Cardiovascular system examination involves 2 systems- peripheral and central cardiovascular […]

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Clubbing Examination

Clubbing This is the swelling go the terminal part of fingers and toes It happens due to hypertrophy of the soft tissue in nail bed causing an increase in the anterior-posterior and transverse diameter of the nail Measurement It is measured by measuring the angle between the nail and nail bed  – Its called the […]

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Conditions with audible S3, S4

S3 and S4 is not generally heard. Occasionally it can happen in the following conditions Causes of S3 Left of right ventricular failure Chronic Myocardial infarction Hyperkinetic circulation like severe anemia, thyrotoxicosis Dilated cardiomyopathy Causes of S4 Ischaemic heart disease Aortic stenosis Systemic hypertension Hypertrophic cardiomyopathy

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Cyanosis- Examination perspective

Cyanosis can be seen in most examination cases. It is a grave mistake to miss such a finding. The advice below will help you answer questions. There are 2 types of cyanosis Peripheral cyanosis and central cyanosis Causes of peripheral cyanosis Exposure to cold Raynaud’s phenomenon Congestive cardiac failure Hyper viscosity syndrome Shock Causes of […]

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Eisenmengers syndrome

It is the development of pulmonary hypertension due to reversal of blood flow from right side of heart to left The common causes are Ventricular septal defect Patent ductus arteriosus Atrial septal defect Signs and symptoms Cyanosis Clubbing Polycythemia Signs of right ventricular hypertrophy Loud P2 Ejection click and ejection systolic murmur due to pulmonary […]

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Heart Failure causes

Causes of Left ventricular failure Acute myocardial infarction Systemic hypertension Aortic regurgitation Aortic stenosis Mitral regurgitation Cardiomyopathy Coarctation of aorta Myocarditis Severe anemia Ventricular septal defect Causes of Right ventricular failure Chronic lung diseases Pulmonary stenosis Pulmonary hypertension Pulmonary thromboembolism Cardiomyopathy Myocarditis Causes of Left atrial failure Mitral stenosis Left atrial myxoma Mitral atresia Causes […]

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Importance of general examination in CVS

Decubitus If sitting up could mean orthopnoea Built Short stature in cyanotic heart disease Tall in Marfan’s syndrome Stunted in – Turner’s syndrome Nutrition Failure to thrive in chronic heart conditions Anaemia May be present in subacute bacterial endocarditis Cyanosis- can be seen in Congenital heart disease Acute pulmonary oedema Clubbing- could mean Congenital heart […]

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Innocent murmurs

These murmurs are non-organic and are caused due to the flow rather than any anatomical damage to the heart These disappear with age Characteristics Usually systolic Never beyond grade 2 No thrill Best heard over pulmonary area No radiation Changes with opposition Otherwise normal heart sounds, normal chest X Ray and ECG Examples of innocent […]

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Localising the Apex beat

Ask the patient to lie supine on the bed Stand on the right side of patient Place your hand over the left side of chest over the lower sternum such that the fingers of your hand spread at the intercostal spaces. Feel for the maximal impulse If unable to feel, ask the patient to lean […]

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Murmurs classification

Systolic murmurs Ejection systolic Starts after S1 and ends before S2 Conditions Aortic stenosis Pulmonary stenosis Atrial septal defect Pan systolic Starts with S1 and continues through S2 Conditions Mitral regurgitation Tricuspid regurgitations Ventricular septal defect Late systolic Mitral valve prolapse Papillary muscle dysfunction Diastolic murmurs Early diastolic Aortic regurgitation Pulmonary regurgitation Mid diastolic Mitral […]

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Pulsations in different areas- causes

Pulsations can be felt at the following areas. Carotid pulsation Aortic regurgitation Aortic aneurysm Thyrotoxicosis Fever Anaemia Suprasternal notch pulsations Hyperkinetic states- anaemia Thyrotoxicosis, fever Aortic regurgitation Coarctation of aorta Aortic aneurysm Pulsation at pulmonary area Patent ductus arteriosus Atrial septal defect Ventricular septal defect Pulmonary hypertension Pulsation at Left parasternal area Ventricular septal defect […]

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S1(Heart sound) Variations

S1 consists of the simultaneous closure of Mitral and Tricuspid valve. It is a low frequency sound, occurring at the beginning of systole.  Its best heard over the apex The S1 can have many variations which could hint to the diagnosis. Types of S1 Loud S1 Mitral stenosis Sinus tachycardia Hyperkinetic circulation due to fever, anaemia, […]

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Thrill – differential diagnosis

Mitral area Systolic Myocardial infarction Ventricular septal defect Atrial septal defect Diastolic Mitral stenosis Left atrial myxoma Aortic area Aortic stenosis Diastolic thrill of Aortic regurgitation Pulmonary area Pulmonary stenosis Atrial septal defect High velocity Ventricular septal defect Tetralogy of Fallot Patent ductus arteriosus Tricuspid area Ventricular septal defect Tricuspid regurgitation Atrial septal defect Pulmonary […]

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What is precordium?

It’s the area on the anterior chest wall which lies over the heart Variations During inspection of the chest wall look for the following variations. Bulging precordium This could mean chronic cardiac condition The common causes are- Ventricular Septal Defect Rheumatic heart disease Pericardial effusion Scoliosis Mediastinal tumours Left pleural effusion Flattening  precordium The chest […]

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Development assessment of 6 week old

All development assessment are done in 4 fields Gross motor, Fine motor, hearing and social skills. Failure to do so with confidence could mean to fail in exams. GROSS MOTOR Head control Method Lie the baby supine and pull him to sitting position You can do this by gently holding on his hands or wrist […]

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Development in a child

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Hypotonia in Infancy approach

A hypotonic infant can be a typical case in neurology station. It is also likely to see one in your clinic The following points are mandatory Points to remember in Prenatal History: History of TORCH infections History of antenatal Drugs or alcohol Any Maternal illness Fetal movements- normal or hypoactive? Points in Neonatal History: Complications […]

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Assessment of hypotonia in muscles

Hypotonia Low muscle tone is a common finding. Remember the following points Causes of Hypotonia In new-borns Anterior Horn cell disorders like Hypoxic-ischaemic myelopathy, Spinal muscular atrophy Congenital myelopathy like Charcot Marie Tooth disease Neuromuscular junction disorders like Congenital myasthenia Congenital myopathy like Nemaline myopathy Muscular dystrophy Syndromes- like Downs syndrome, Prader Willi syndrome, Hypothyroidism, […]

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Developmental Dysplasia of Hip- management

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Differentiation between Neuropathy and myopathy

In cases of weakness, it is very important to differentiate between neuropathy and myopathy. This can be asked as a differential in weakness and confirming the below factors can help differentiate.

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Marfans syndrome – examination

Features of Marfans syndrome It is a very common condition that can be presented in the musculoskeletal station You may be given the patient and asked to examine Look for the following clinical features Examination Kyphoscoliosis Anterior chest wall deformity- pectus excavation/ carinatum High arched palate Long slender fingers (Arachnodactyly) Cardiac findings- Mitral valve prolapse, […]

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Muscle examination

Examining muscle is fundamental in musculoskeletal conditions and neurology Muscles is examined in following 3 domains Nutrition of muscles Tone of muscles Power of muscles Nutrition of muscle Inspection Look for wasting or atrophy of muscles like deltoid or calf muscle Prominent bony prominences Prominent tendon at foot and hand Palpation Soft and flabby muscle […]

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RICKETS

  FEATURES Symptoms Irritable child with flabby muscles Delayed gross motor development Delayed dentition REcurrent respiratory and digestive tract infections Excess sweating Severe deficiency may present with Fits( especially in babies) Signs Head signs Craniotabes- seen at 1 year old due to soft bones Frontal and parietal bone bossing Widening Of sutures Delayed closure to […]

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Variations in shape of the spine

There are 2 main variations that can be seen. Kyphosis and scoliosis Kyphosis is backward bending of the vertebral column Scoliosis is lateral bending of the vertebral column Common Causes Congenital Ankylosing spondylitis Rheumatoid arthritis Rickets Neurofibromatosis Friedrich’s ataxia Cerebral palsy Marfans syndrome Turners syndrome Method to diagnose scoliosis Request the child to remove their […]

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Differentiation between Neuropathy and myopathy

In cases of weakness, it is very important to differentiate between neuropathy and myopathy. This can be asked as a differential in weakness and confirming the below factors can help differentiate.

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Examination of Cerebellar function

Hypotonia Speech Dysarthria and slowing of speech with slurring and stuttering Knee jerk The knee jerk is pendular and on elicitation of the reflex, there are more than 3 pendular movements Tremor The child may have intentional tremor. Finger test can show this effect Dysmetria On finger nose finger test, the child may overestimate the […]

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Examination of Central nervous system

This is one of the few feared areas in medicine. It is easier to remember if you make sure you write this below format repeatedly and use it every time you examine a patient Below is a brief note of headings for easy revision in exams. For detailed examination, look into individual articles. Look around […]

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Hypotonia in Infancy approach

A hypotonic infant can be a typical case in neurology station. It is also likely to see one in your clinic The following points are mandatory Points to remember in Prenatal History: History of TORCH infections History of antenatal Drugs or alcohol Any Maternal illness Fetal movements- normal or hypoactive? Points in Neonatal History: Complications […]

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Quick assessment of level of lesion

When you are presented with a CNS case, a quick look at the movements of the patient can guide you to the site of lesion. Look below for the nerve supply for different areas of the body Upper body C1 to C6- Neck flexion C1 to T1- Neck extension C3 to C5- Supply to diaphragm […]

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Types of weakness

Monoplegia This is weakness of one limb when compared to the other. Always check the normal limb and then immediately check corresponding other limb Upper limb monoplegia Multiple sclerosis Encephalitis Poliomyelitis Mononeuropathy Brachial plexus lesion Lower limb monoplegia Multiple sclerosis Cauda equina syndrome Sciatic nerve palsy Prolapsed vertebral disc Hemiplegia This is the weakness of […]

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Clubbing Examination

Clubbing This is the swelling go the terminal part of fingers and toes It happens due to hypertrophy of the soft tissue in nail bed causing an increase in the anterior-posterior and transverse diameter of the nail Measurement It is measured by measuring the angle between the nail and nail bed  – Its called the […]

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Cyanosis- Examination perspective

Cyanosis can be seen in most examination cases. It is a grave mistake to miss such a finding. The advice below will help you answer questions. There are 2 types of cyanosis Peripheral cyanosis and central cyanosis Causes of peripheral cyanosis Exposure to cold Raynaud’s phenomenon Congestive cardiac failure Hyper viscosity syndrome Shock Causes of […]

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Lung percussion sounds

Tympanic note Pneumothorax Emphysematous bulla Subpleural lung cyst Left sided hiatus hernia Hyperresonant note Emphysema Lung cysts Impaired (Diminished) note Thick pleura Lung fibrosis Lung collapse Lung tumors Consolidation of lung Early pleural effusion Dull note Consolidation Pleural effusion Empyema

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PARA-NASAL SINUS Development

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Respiratory system examination

  Look around the room to see if any accessories/ instruments like crutches/ wheelchairs/ glasses/ inhalers/ Sputum sample Once the child is seated, ask if you could expose the upper body. For lower body, you may need to ask permission from the examiner also General examination Level of consciousness- Alert/ Oriented/ cooperative Decubitus (position in […]

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Respiratory system examination

Look around the room to see if any accessories/ instruments like crutches/ wheelchairs/ glasses/ inhalers/ Sputum sample Once the child is seated, ask if you could expose the upper body. For lower body, you may need to ask permission from the examiner also General examination Level of consciousness- Alert/ Oriented/ cooperative Decubitus (position in bed) […]

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Restricted chest movement causes

Unilateral restriction Pleural effusion Chest trauma Pleurisy Pneumothorax Collapse of lung Fibrosis to lung Thickened pleura Lung consolidation Bilateral restriction Emphysema Interstitial fibrosis Weak respiratory muscles Ankylosing spondylitis

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Tracheal position

The tracheal position also indicates the apex beat position. The normal position of trachea is slight deviation towards the right Methods to examine tracheal position. Method 1 Stand in front of the patient. Make sure the patient is sitting or standing and never lying down Gently palpate the cricoid cartilage with your finger and run […]

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Types of breathing

Dyspnoea Uncomfortable awareness of breathing Tachypnoea Rapid breathing Seen in anxiety, fever, heart failure, acidosis Hyperventilation Increased depth of ventilation Seen in anxiety, Metabolic acidosis, infections Bradypnea Slow breathing rate Orthopnoea Breathless on lying down Seen in heart failure, asthma, pleural effusion Cheyne Stokes respiration Periods of rapid breathing and periods of pause Each phase […]

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Types of cough

There are various types of cough, based on the type one can suspect the underlying conditions. These can be discussed in exams as well Dry cough Acute pleurisy Croup Wet cough Bronchiectasis Lung abscess Lobar pneumonia Brassy cough Laryngeal carcinoma Spluttering cough Tracheoesophageal fistula Barking cough Epiglottitis Foul smelling cough Bronchiectasis Lung abscess

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What is ‘Vocal resonance’

It is auscultating the patient’s chest in different field when the child speaks Method Ask the patient to repeat words like ‘Ninety Nine’ continuously in the same tone and voice depth Now auscultate the lung in different area like upper lobe, middle lobe and lower lobe. Auscultate the same areas simultaneously, i.e. once on the […]

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Wheeze and Stridor

Differentiating different respiratory sounds can be asked in clinical exams Wheeze is the high pitch musical sound heard Characters Mostly heard in expiratory phase of respiration Indicates small airway obstruction Conditions Asthma Bronchitis Tropical eosinophilia Stridor This is a harsh hoarse sound which is low pitched Features Better heard in Inspiratory phase Indicates large airways […]

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History taking

History taking is an art and has to be practiced each time you see a patient. Below is the format The History 1) Chief complaints Should be in descending order of time of symptoms 2) History of presenting illness Mode of onset- Acute/ sub acute/ chronic Progress Duration Appetite Loss of weight/ fatigue Bladder/ bowel […]

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History taking scheme

Most history taking follows the below format Details of the patient History Physical examination Summary Diagnosis Differential diagnosis Investigations Management History of presenting complaints 1) Details of the patient Name Sex Age Occupation Address Accompanying person and the relation 2) History Chief presenting complaints Past medical history Family history Treatment history Psychological history Obstetric history […]

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The History Taking skill

1) Chief complaints All the complaints by the patient or family should be noted. It should be in descending order of time of symptoms 2) History of presenting illness- Ask about the following in brief Mode of onset- Acute/ sub acute/ chronic Progress Duration Appetite Loss of weight/ fatigue Bladder/ bowel 3) Past history   Rheumatic fever Tuberculosis Malaria Jaundice Systemic […]

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Common variations to look out for in the head and face

Causes of Delayed closure of Anterior Fontanelle Rickets Congenital hypothyroidism Achondroplasia Hydrocephalus Downs syndrome Causes of bulging anterior fontanelle Increase intracranial pressure Hydrocephalus Crying infant Galactosemia Causes of high arched palate Downs syndrome Marfan syndrome Crouzon syndrome Apert syndrome Turners syndrome Causes of Frontal bone bossing Thalassemia major Rickets Congenital syphilis Hydrocephalus Acromegaly Causes of […]

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Differences in milk types

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Differential diagnosis of hypoglycemia

Ketotic process Fasting Malabsorption Gastroenteritis Galactosemia Hereditary fructose intolerance Glycogen storage disease type 1 Idiopathic ketotic hypoglycemia Nonketotic process Hyperinsulinemia Infants of diabetic mothers Congenital panhypopituitarism Adrenal insufficiency Fatty acid oxidation defects Beckwith Wiedemann syndrome Others Sepsis Poisoning Overdoses Liver failure HYPOGLYCEMIA WITH ACIDOSIS METABOLIC ACIDOSIS WITH HYPOGLYCEMIA IN INFANTS

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Examination of tongue

The tongue has both motor and sensory functions. You can always ask the child about taste sensations. For the motor function, ask the child to open the mouth and protrude the tongue. You can also ask the child to move the tongue from side to side to see the motor component If you are looking […]

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Inborn errors of metabolism made simple

INBORN ERRORS OF METABOLISM The errors of IEM can be divided as a defect in the metabolism of Carbohydrates Amino acids Lipids Lysosomal storage disorders ~There are many more types of IEM with various classifications. The above mentioned are common and more focused in exams The IEM of lipids is further divided as ENZYME DEFECTS […]

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Marfans syndrome – examination

Features of Marfans syndrome It is a very common condition that can be presented in the musculoskeletal station You may be given the patient and asked to examine Look for the following clinical features Examination Kyphoscoliosis Anterior chest wall deformity- pectus excavation/ carinatum High arched palate Long slender fingers (Arachnodactyly) Cardiac findings- Mitral valve prolapse, […]

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Nail changes asked in exams

Common changes in nails are Clubbing Koilonychia Onycholysis Abnormal colour like yellow, blue Nail bed changes Splinter haemorrhages Lines or bands- Beaus, Mees lines Clubbing It is the increase in the angle between the nail and the nail bed. Place the two index fingers of the patient against each other, look for the diamond shaped […]

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