YEAR 3 EXAMINATIONS

1. YEAR 3 EXAMINATIONS

2. What can come up? • Abdominal • Respiratory • Cardio • Neurological • Vascular • Lymph node • Thyroid • Diabetic foot • DRE • Focused examinations

3. Top tips • Practice practicepractice → be confident and polite • Mention max 3 things in each component of the examination • Talk through what you are doing throughout • What you are doing • Why you are doing it • What are you findings - say whether you can or cannot see something (not what you are looking for) • Learn common surgical scars • For larger systems examinations start at the hand and work around the body so you don’t miss anything

4. Top tips • Repeat patients name throughout – so you don’t forget it! • When presenting • Hands behind back • Use patient’s name and age • Don’t list everything off – group components together • Say the diagnosis – can be a healthy actor! • To complete the examination • Full history • Other examinations to perform • Investigations you would like

5. Abdominal examination

6. Respiratory examination • Examine for: • Pleural effusion • Pneumothorax • Consolidation • Lobe collapse • COPD

7. Cardio examination • Examine for • Murmurs • Mnemonic: AS(K)MR ARMS (From systolic to diastolic of heart cycle) • Aortic Stenosis: Ejection systolic • Mitral Regurgitation: Pan-systolic • Aortic Regurgitation: End-diastolic murmur • Mitral Stenosis: Rumbling mid-diastolic murmur • Heart failure • AF – calculate CHADSVASC

8. Neurological examination • Upper limb examination • Lower limb examination • Cranial nerve examination • Learn your dermatomes and myotomes

9. Vascular examination • 6 Ps of limb ischaemia • Painful, pulseless, pallor, paralysis, paraesthesia, perishingly cold • Signs of peripheral vascular disease • Sores or ulcers on foot • Feet pale, red or blue • Atrophic skin • Absent hair • Absent femoral pulse • Absent foot pulses • Limb bruit present • One foot cooler • Capillary refill time • Intermittent claudication

10. Lymph node examination • Examine neck lump • Site, Size, Shape and symmetry, Surface, Consistency, Edge, Pulsation • Midline – goitre, thyroglossal cyst • Anterior triangle – brachial cyst, carotid body tumour, lymph node • Posterior triangle – cystic hygroma, lymph node • Anywhere – sebaceous cyst, lipoma

11. Thyroid examination • Examine neck or neck lump • Examine lymph nodes • Other aspects • Hands and wrists – Ps → Palms, Palmar erythema, Paper (fine tremor), Pulse • Face – appearance, hair, eyes, eye movements, lid lag • Limbs – reflexes, carpal tunnel (previous scar), proximal myopathy, oedema

12. Digital rectal examination • Inspect for • Skin integrity, rash, skin tags, pilonidal sinus, fissures, fistulae, swelling from anus • Palpation • In 360 degree • Assess anal tone • Note size and location of abnormality • Prostate • Size • Sulcus between left and right lobes • Consistency

13. Explanations

14. 4 broad categories • Conditions – TCD cases • Procedures – e.g. - scopes • Test results – e.g. HbA1c + glucose • Medications – e.g. inhalers, antihypertensives

15. Explaining conditions • To prepare – read patient leaflets (patient.co.uk, NHS website, specific websites) • NO JARGON • What to cover: • What is it (normal + abnormal) • Why – causes, risk factors, triggers • Course – prognosis, any complications • Management – lifestyle, medications, support, follow-up, monitoring

16. Make a list and practise • Note: NOT exhaustive

18. Drug Counseling – ‘ATHLETICS’ • [A] Action • [T] Timeline • [H] How to take • [L] Length of treatment • [E] Effects (what benefits + when benefits will start) • [T] Tests – before and during • [I] Important Side Effects • [C] Complications • [S] Summary

19. Explaining procedures • SPIKES + ICE again • Things to cover: • Why – purpose of the procedure • Before – eating and drinking, stopping medications • During – what happens + pain/discomfort + consciousness + length of procedure • After – going home, driving, hospital admission, possible side effects, safety net, results

20. General points • COMM SKILLS • Think what patient can do + what you can do for them • Balance structure with patient’s agenda • Summarise + leaflet at the end