Abdominal Assessment

Distension: liver problems, bowel obstruction Rigidity (board like): bleeding Guarding: muscular tension when touched Eviseration/ Ecchymosis Rebound tenderness: infection Masses

Altered Level of Consciousness: Reasons

Alcohol Epilepsy, Electrolytes, and Encephalopathy Insulin Overdose, Oxygen Underdose, Uremia Trauma, Temperature

Breast history checklist

Lump Mammary changes Nipple changes Other symptoms Patient risk factors

Cause of symptoms

Onset of the event Provocation or palliation Quality of the pain Region and radiation Severity Time

Clinical examination: initial Inspection of patient from end of bed

Appearance (SOB, pain, etc.) Behaviour Connections (drips, inhalers, etc. connected to patient) ABC

Differential diagnosis checklist

A and C stand for Acquired and Congenital VITAMIN stands for: Vascular Inflammatory (Infectious and non-Infectious) Trauma/ Toxins Autoimmune

Family history (FH)

Blood pressure (high) Arthritis Lung disease Diabetes Cancer Heart disease

Fetal Monitoring

FHR Pattern: Variable Early Deceleration Acceleration Late Deceleration

Four point physical assessment of a disease

Inspection Auscultation Percussion Palpation "I'm A People Person"

Glasgow coma scale: components and numbers

Visual response Verbal response Vibratory (motor) response Scale scores are 4,5,6: Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawal)

Head Trauma: rapid neuro exam

- 12 P's: Psychological (mental) status Pupils: size, symmetry, reaction Paired ocular movements Papilloedema

Heart valve auscultation sites

Reading from top left: Aortic Pulmonary Tricuspid Mitral

History

Signs and Symptoms Allergies Medications Past medical history, injuries, illnesses Last meal/intake Events leading up to the injury and/or illness

Medical history: disease checklist

Myocardial infarction Jaundice Tuberculosis Hypertension Rheumatic fever/ Rheumatoid arthritis Epilepsy

Mental state examination: stages in order

Appearance and behaviour observe state, clothing... Mood recent spirit Speech rate, form, content Thinking thoughts, perceptions Behavioural abnormalities Perception abnormalities

Neurovascular Assessment

- 5 P's: Pain Pallor Paresthesia Pulse

Ocular bobbing vs. dipping

Bobbing is fast Dipping is slow In both, the initial movement is down. "Breakfast is fast, Dinner is slow, both go down"

Orthopaedic Assessment

Character: sharp or dull pain Location: region (joint) of origin Onset: sudden vs. gradual Radiation: Intensity: how severe (scale 1-10), impact on ADLs (activities of daily living), is it getting better, worse or staying the same? Duration: acute vs. chronic

Pain history checklist

Site Onset Character Radiation Alleviating factors/ Associated symptoms Timing (duration, frequency)

Past medical history (PMH)

Vices (tobacco, alcohol, other drugs, sexual risks) Allergies Medications Preexisting medical conditions Trauma Hospitalizations

Patient examination organization

Subjective: what the patient says. Objective: what the examiner observes. Assessment: what the examiner thinks is going on. Plan: what they intend to do about it SOAP

Patient profile (PP)

Living situation/ Lifestyle Anxiety Depression Daily activities (describe a typical day) Environmental risks/ Exposure Relationships

Physical exam for 'lumps and bumps'

Site, Size, Shape, Surface, Skin, Scar Tenderness, Temperature, Transillumination Consistency Attachment Mobility Pulsation

Physical examination - correct order

Inspection Palpation Percussion Auscultation "I Palpate People's Abdomens"

Pupillary dilation (persistent): causes

3rd nerve palsy Anti-muscarinic eye drops (e.g. to facilitate fundoscopy) Myotonic pupil 3AM

Short stature causes

Rickets Endocrine (cretinism, hypopituitarism, Cushing's) Turner syndrome Achondroplasia Respiratory(suppurative lung disease) Down syndrome

Sign vs. symptom

- sIgn: something I can detect even if patient is unconscious. sYMptom is something only hYM knows about.

Surgical sieve for diagnostic categories

Iatrogenic Neoplastic Vascular Endocrine Structural/ Mechanical Traumatic

Surgical sieve for diagnostic categories (alternate)

Psychological Autoimmune Spontaneous/idiopathic Toxic Metabolic Inflammatory

Toxicological seizures: Causes

Organophosphates Tricyclic antidepressants Isoniazid, Insulin Sympathomimetics Camphor, Cocaine Amphetamines

Trauma assessment

Deformities & Discolorations Contusions Abrasions & Avulsion Penetrations & Punctures Burns Tenderness

Vomiting: non-GIT differential

Acute renal failure Brain increased ICP Cardiac inferior MI DKA Ears labyrinthitis Foreign substances paracetamol, theo, etc.