4 Contents 3 Introduction Page 1 Foreword 1 3 I Abbreviations 2 4 Meal 41 Cardiovascular System 3 4 2 — Heart Murmurs 5 3 Respiratory System 7 4 4 Gastrointestinal System 9 5 Chronic Renal Failure / Renal Transplant " 4 6 Cranial Nerves 1 13 7 Cranial Nerves 2 18 4 8 Upper Limb Neurological System 7 9 Lower Limb Neurological System 19 4 10 Nerves of the Hand a 41 Extrapyramidal System / Tremor 23 4 42 Cerebellar Function 25 13 Endocrine ar 4 «Examination for signs of Cushing's syndrome ‘+ Examination for signs of Acromegaly 4 , Surgery 3 14 Hands 2 15 Shoulder 3 3 16 Kn 3 17 Hip 35 18 Spine & Gait 31 4 19 Groin Hernia 29 20 Thyroid / Neck Lump & Thyroid Status 4 4 21 Lower Limb Arteriat System 43 22 Lower Limb Venous System 45 4 23 Inlimate Examinations 47 * Breast Examination =| + Examination of the Male Genitalia 24 Lumps & Skin Lesions 49 4 25 Anterior Abdominal Wall 5 + Examination of a Stoma 4 + Examination of a Ventral Hernia App 4 ‘A Lymph Nodes of the Head & Neck 53. 4 B Key Differential Diagnoses 54 = |Foreword Background Essential Examination began life as a set of notes | produced for my 3" year OSCE. At that time I was unable to purchase an examination skils book that laid out the full sequence for examination of one body system on one age. This format is the basis of the current publication, which has steadily expanded over the past 4 years. ‘Although the content has been refined, much of what is contained is presented in ways which help me to remember it you have other ways that you already use to remember the same information, stick to what works for you. Goneric Format Each examination scenario described has its own page (with the exception of cranial nerves, which needed two). On the front side is a clear, step-by-step guide to examining that particular patient, including useful things to say to the patient (or an examiner), detailed descriptions of special tests etc. Contained in the right hand column is a collection of key information: potential findings, differential diagnoses of clinical signs and examination tips. On the reverse side is a series of facts relating to that particular examination, selected because of the regularity with which they are asked about in bedside teaching and OSCEs. In some sections there are also tips on how to present your findings succinctly — we all know how easy itis to lose our way here! What's Not Included To use this book requires a good baseline understanding of the physiology and pathophysiology of the systems examined. Some detail has been omitted intentionally — for example nowhere is the exact method of examining for flapping tremor explained. It is assumed that core skills ike this become second nature as they are taught time and time again in clinical teaching. This makes space for other useful information, and detailed descriptions of less familiar elements of examination where the margins between looking slick and looking awkward are smaller. Often there are many ways of examining the same thing in medicine; in such cases | have either described the method preferred by specialists, or where no consensus exists the method which | find the easiest. How To Use This Book To get the most out of Essential Examination first familiarise yourself with the examinations and leam some of the associated facts. Then the key is practice. Spend as much time as you can with fellow students examining patients (and each other), and quizzing one another on the information in the right hand columns and on the reverse of each section. Remember that usually you should examine from the patient's right hand side, although some examinations (especially orthopaedic) require you to move around the bed. ANote On Exams Often in clinical exams you will not be asked to complete the full examination of a particular body system. Instead, you may be asked to complete part of that examination (rather than ‘examine the cardiovascular system’, simply ‘examine the precordium’ for example). However, in order to be able to do this requires the baseline knowledge of how to complete the examination in its entirety. Always listen to what the examiner asks. Itis also important to remember that many examinations follow a similar sequence, in particular: * Core medicine: Peripheral signs —+ inspection — palpation -> percussion -> auscultation * Neurology: Inspection, -> tone —+ power ~» reflexes —> sensation — co-ordination © Orthopaedics: Look —» feel -» move —» special tests —> check distal neurovascular integrity If you get lost in an examination (which is easy to do under the pressure of assessment), default to these basic frameworks to get yourself back on track. Some examinations, of course, follow thelr own unique sequence; these are the most difficult to learn, and so you should become very familiar with them, Always have some concluding remarks up your sleeve too — i's a good way to finish off, and gives the impression that you really know your stuff. Finally, remember that in order to pass you do not need to recall every single piece of information contained in this ook ~ a slick, comprehensive clinical examination combined with some solid core knowledge is certainly enough. ‘The old saying that difficult questions mean you are doing well is very true — don’t forget it! Best of luck in all of your studies. Dr Alasdair K B Ruthven wecrs (Hons) 85 (Hons) Foundation Year 2 Doctor essential.examination@gmail.com © DrAKB Ruthven | 2008Short Hand an Ditferential agnosis # Fracture é Male g Female Alphabetical List Of Abbreviations AAA ARG ABPI AC ACEI ACL. AGTH AF AP ‘APKD AR as ASIS AV AVN BP CABG cor CDH CFA cHD cKD cL ML CN NS corp RP CRE SF cr OR DHS DP DM DMD DvT EAA EBV ECG ESR FAP ENA GCA GFR a GIN HB Hoo HocM HS. HTN 180 lep iE wo INO. Ibu ‘Abdominal aortic aneurysm ‘Attaral blood gas ‘Ankle brachial prossure index ‘Acromio-clavicular (joint) ‘Ace inhibitor Anterior cruciate ligament (of knee} ‘Adrenocerticotrephic hormone Axial ibrilation ‘Anterior-posterior (diameter) ult palyeystc kidney disease Aortic regurgitation onic stenosis, ‘Anterior superior iliac spine ‘Arterio-venous (matformation / fistula) ‘vascular necrosis Blood pressure Coronary artery bypass graft Congestive cardiac failure Congenital dislocation of the hip Cryptogenic fibrosing alveoltis Gongenital heart cisease Chronic kkiney disease Chronic iver disease Chronic myeloid leukaemia Cranial nerve Central nervaus system Chronie obstructive pulmonary disease C-reactive protein Chronic renal failure Cerebrospinal fluid ‘Computerised tomography (scan) Chest xray Dynamic hip screw Distal interphalangeal (joint) Diabetes melitus Duchenne muscular dystrophy Deep vain thrombosis Extrinsic allergic aiveoiitis Epstein-Barr virus Electracardiogram Erythrocyte sedimentation rate Femilial adenomatous polyposis, Fine needle aspiration Giant cell artentis Glomerular filtration rate Gastrointestinal Gilcory tintrate Heart block Hepatocellular carcinoma Hypertrophic obstructive cardiomyopathy Hoart sound Hypertension Inflammatory bowel disease Implantable carcioverter-defibillator Infective endocarditis Interstitial lang disease {intranuclear ophthalmoplegia Intravenous drug user 2 Ca Pt Re MN (LSE tsv. wv. LH MCL Mi MND MNG MR MRI MS NOF NSAID PCL. ‘SUFE svc TAH TFTs TIPSS Ts TSA Uses uc UMN Abbreviations Secondary \o Patient Treatment / meinayennnt Lower aft slemale Long saphenous vein Left ventricle Left ventricular hypertipy Madial collateral figamost (ol tee) Myocardial infarction Motor neurone disease: Maltinodular gottre Mitral regurgitation ‘Magnetic resonance angiograp iy Magnetic resonance imaging (0) Mitral stenoss / Multige sclers Neck of femur (fracture) Non-sieroidal ant-inflammnatory this Osteoarthritis Oral contraceptive pil Primary iary citshosis Posterior communicating artery Posterior cruciate ligament (of har) Pulmonary embolism Pulmonary function lasts Paroxysmal nocturnat dy Peripheral nervous sy Pulmonary regurgitation) Pex tr Lal ose Primary sclerosing chokana Pariphoral vascular use Rheumatoid arthit Renin-angiolensinairsinimie ster Relative afferont payallary een! Right heart fain Right ac foss Range of motion Road trafiie ace Subculaneou Subacute combine fespeenationy oft ‘Small 1 Sternocinidom Side effect Sapheno foment jn th Systomic pies vay these Shortness ol bres Saphenw-tonnral jae Saphieno. poplin Onygen salsnatios| Shar sparrows vob Sipe ty a9 tetera opi Toll yi ists Trotsjsgsbsaitlnpate pity ay Tava engi cart stones ty Aes aor Uppor tanto peepee eee eee PP PE PEED