Combine CardioRespGIT Exam

8/18/2019 Combine CardioRespGIT Exam

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Combine CardioRespGIT Exam

Introduction- Wash hands, obtain consent

General Inspection- Room Inspection, ABCDE, Vital i!ns

"ands- #allor, c$anosis, leu%on$chia, %oilon$chia clubbin!, si!ns o&endocarditis,

Wrist- Radial pulse 'rate, rh$thm and po(er), asterixis*hepatic +ap,%in- spider naei, bruisin!, (astin!, scratch mar%s, radio-radialdela$ Get blood pressure

.ace- E$es- xanthelasma, con/unctial pallor, /aundice, splinterhemorrha!es0ose- pol$ps, enlar!ed turbinates, sinus tenderness1outh- central c$anosis, palate, teeth, !ums, tonsils, cou!h

0ec%-2V#, carotid pulse and bruits, l$mph nodes, tracheal deiation,.orced Expirator$ Time &or C3#D

Bac%- Inspect &or scars and de&ormities, measure chest expansion,palpate &or sacral oedema, percuss lun! bases &or e4usion 'witharms crossed), auscultate lun! bases, ocal resonance

Chest- cars, de&ormities, apex beat, thrills, parasternal and 5V

heaes#ercuss oer claicle, auscultate lun! bases and heart sounds

Abdomen- Inspect &or scars, striae, bruisin!, pi!mentation,distension, masses, eins, peristalsis, pulsation 'bend do(n)#alpate super6cial and deep1cBurne$7s point '8*9rd &rom R AI to umbilicus), Rosin!7s si!n'pressure in le&t iliac &ossa)5ier palpation- start at ri!ht iliac &ossa and adance hand (hilstpatient is expirin!Gallbladder- curl hands under ri!ht costal mar!in, and as% patient to

ta%e deep breath '1urph$7s si!n- pain on inspiration)pleen- hae le&t hand belo( le&t ribs and start ri!ht hand atumbilicus and moe up to le&t upper :uadrant in expiration,#ercuss &or ascites, hi&tin! Dullness 'percuss &rom midline, and !etpatient to roll oer to percuss a!ain)

Auscultate &or bo(el sounds, aortic and renal bruits '

5e!s- aricose eins, pittin! oedema,#ulses-popliteal, posterior tibial and dorsalis pedis pulses


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Brie& 0euro Exampeech ; comprehension, .acial as$mmetr$, #ER5A 'pupils e:ualand reactie to li!ht and accommodation), External ocularmoements, Gait, #o(er and re+exes in


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.ull 0euro Exam


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Dia!nostic Case- Do nildocaa6at, then do releant R 'also :uestions to rule

in*out $our di4erential dia!noses) = red +a!s, and brie+$other Rs

History Taking

Nature 'sharp, dull, burnin!, crampin!, stabbin!, throbbin!)Intensit$ Location 'radiate an$(here)DurationOnset '(hen did it start> What (as the 6rst thin! $ou noticed> "asan$thin! chan!ed since then)Contributin! 'is there an$thin! that mi!ht hae caused this>)A!!raatin! 'does an$thin! ma%e it (orse)Alleiatin! 'does an$thin! ma%e it better or help it improe)Fre:uenc$ &or repeated episodes 'Is it present continuousl$ orintermittentl$> ho( o&ten does it occur>)Impact- ho( is this a4ectin! $our li&e>Attribute- (hat do $ou thin% is causin! the problem>Treatment- hae $ou ta%en an$ medication &or it>

Systems Review ask genera!" C#S" R$S%" &I" ne'ro" (S)"haem" 'rinary" *sych" genita!

&enera! hae $ou had an$ &eers latel$> What about an$ ni!htss(eats> Chan!e in (ei!ht> Rashes or an$ s%in chan!es an$(here>Cardiovasc'!ar History "ae $ou eer had an$ pain in $our nec%,

chest or arm> Do $ou !et short o& breath easil$> Can $ou lie +at(ithout &eelin! breathless> Do $ou (a%e up at ni!ht bein! short o&breath> Do $ou eer &eel li%e $our heart7s racin! or s%ippin! beats>Do $ou hae cold or blue hands or &eet> "ae $ou eer hadrheumatic &eer> What about a heart attac% or reall$ hi!h bloodpressure>Res*iratory- "ae $ou had a cou!h latel$> Do $ou cou!h upan$thin!> "ae $ou eer cou!hed up blood> Do $ou snore loudl$>"ae $ou had an$ (hee?in!> "ae $ou eer had pneumonia> Whatabout TB> "ae $ou recentl$ had a chest x-ra$>&I- "ae $ou had an$ stomach problems latel$> 5i%e nausea,

omitin!, diarrhea, pain or constipation> "ae there been an$recent chan!es in bo(el habits>Ne'ro!ogica! "ae $ou had 6ts be&ore> "ae $ou &ainted> Do $ouo&ten !et headaches> "ae $ou noticed an$ chan!es in $our ision>"ae $ou experienced (ea%ness or numbness an$(here>(S) - Do $ou !et an$ muscle (ea%ness or sti4ness> What aboutpain or sti4ness in $ou /oints>Haemato!ogica!- Do $ou bleed or bruise easil$> "ae $ou noticedlumps an$(here oer $ou bod$>%sych- Are $ou sleepin! (ell at ni!ht> An$ mood chan!es recentl$>

+rinary- Do $ou hae trouble (ith passin! urine> Is it pain&ul>


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1enstrual- #lease tell me about $our usual menstrual c$cle When(as $our last period> Was it a normal period> An$ inter-menstrual orpost-coital bleedin!> What do $ou use &or contraception>Sex'a! History- Are $ou sexuall$ actie> Do $ou hae a re!ularpartner> "o( lon! hae $ou been to!ether> An$ casual partners>

We o&ten screen &or TIs in $oun! people Would $ou consent tohain! a TI screen>

@ &enita!- a!inal dischar!e, itch, pelic pain, pain (ith intercourse,pattern o& periods, last normal menstrual period, !enital rash orulcers, penile dischar!e

S'mmarise" is there anything e!se yo',d !ike to ta!k to mea-o't today.

%ast (edica! History Do $ou hae an$ illness or medicalconditions> "ae $ou eer been in hospital &or an$thin!> "ae $ou

eer had an$ heart problems, hi!h blood pressure> 5un! problems>Asthma> Diabetes> idne$ or lier disease> Th$roid #roblems> "ae$ou had an$ mental health problems>

%ast S'rgica! History- "ae $ou eer had an$ operations> 'i& doneas% (h$ and (hen>) "ae $ou had a coronar$ b$pass sur!er$>

C'rrent (edications-Recreational Dru!s

%ast Fami!y History- Are $our parents (ell> Do $ou hae siblin!s>"o(7s their health> Do $ou hae an$ children> "o( are the$> Do$ou %no( o& an$ diseases that run in the &amil$>

A!!ergies- include reaction i& an$

Liver mets


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Socia! History

Occupation- are the$ able to !et leae &or rest, (ill the$ !o bac% to(or%, +exibilit$> 3ccupational exposure to dusts, !ases, carcino!ensOerseas trael- !astroenteritis, #EHome li&e- AD5s, help at home, &amil$, main carer, spouse and theirhealth

Smo%in!NutritionAlcohol%h$sical exercise%roblem bi!!estDru!s recreation 'esp mari/uana use in C3#D)

HobbiesAller!iesSocial supports

DO! 'pets) driin!

- &re:uent isits(onetar$ 6nancial situation, do the$ hae priate health insuranceA"D and (illInsi!ht into conditionSleep apnoea- &or 3BEIT 'snorin!, re&reshed in mornin!s, earl$mornin! diuresis, da$time somnolence) , sleep pattern(oodScreenin! tests alread$ completed

Al(a$s as% (hat inesti!ations hae been done so &ar, (hat doctorssa$ the$ hae, (hat examiners commented on, did ph$sical

examination &or


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INTROD+CTION /START OF TH$ %R$S$NTATION0 SAS%O%1

SexA!eSocial statement 'the most important, releant social &actoid)%ast histor$ 'o& releance onl$)Onset%resentation

e!- (r 2ones is a 23 year old heavy smoker (ith a *asthistory o& m$ocardial in&arction and h$pertension (ho presents(ith the diagnostic *ro-!em o& the s'dden onset o& centra!chest *ain in the setting o4 na'sea and dys*nea5

I& on (ar&arin as% similar :uestions to insulin- (ho chec%7s I0R, ho(o&ten, ho( hi!h


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"ello 1r*1rs 1$ name isThis is a er$ important exam &or me I (illneed to as% $ou a lot o& :uestions er$ :uic%l$ .rom time to time I ma$need to cut $ou o4

#lease don7t &eel that I7m bein! rude, it7s /ust that I need to !et a lot o&in&ormation er$ :uic%l$

"o( old are $ou> Are $ou aller!ic to an$thin!> What are $our healthproblems, I need to ma%e a :uic% list 'also :uic%l$ loo% at the dru! chart)

6hat do yo' see as the main iss'e with yo'r hea!that the moment.


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Be&ore endin! the interie(, as% the patient

Is there anything e!se yo' want to te!! me or yo' think I sho'!dknow.

Is there anything e!se that the examiners were interested in.

Combine CardioRespGIT Exam

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