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BIMA Clinical Refreshers Session Rohan Bhupal 5 Year Medical Student at Imperial College London BIMA Networking and Careers Officer rsb120@ic.ac.uk 7/11/24 6-7:15PM What we’ll coveClinical refreshers session aimed at preclinical students (Y2+ Y3) • Basic Examinations and how to do them, associated clinical signs Lung function tests • ECGsPointer on Examination for Y2/Y3 • Patients in CPA/OSCEs have no signs so focus on what signs you are looking for but not identifying them • Clear confident patient manner • Clear introduction and professionalismExam Introductions •Always WASH HANDS •‘I am ‘Rohan Bhupal a 5 medical student’ •Check name and date of birth of patient •Explain examination- ‘Today I am performing a cardiovascular examination. This involves me looking from the end of the bed, feeling a pulse in your wrist and neck, and listening to your heart’ •Check for pain and any questions •Help with undressing •Correct exposure •Gain CONSENTCardio Examination • General Inspection- tilt bed to 45 degree angle, expose patients chest/lower legs • Demographics • Look for signs AROUND THE BED - GTN Sprays - Obs - Cardiac Monitor - Inspect Patient looking for signs of: - Cyanosis - Shortness of Breath - Pallor - Malar Flush - Oedema•Hands •- Clubbing •Osler’s Nodes • Janeway Lesions • Splinter Haemorrhages •Temperature •Capillary Refill Time •Radial Pulse •Collapsing Pulse •Offer blood pressure, radio-radial delay• Auscultate and feel for carotid pulse • Assess JVP • Eyes • Mouth (Raise tongue to roof of mouth) • Chest Inspection- scars + chest wall deformities • Palpate apex beat Valve Location • Heaves + Thrills Mitral valve 5th intercostal space in the midclavicular line. Tricuspid valve 4th or 5th intercostal space at the lower left sternal edge. Pulmonary valve 2nd intercostal space at the left sternal edge. Aortic Valve 2nd intercostal space at the right sternal edge.• Auscultate Heart + Manuevers • Pulmonary, Pedal + Sacral Oedema Condition Murmur Accentuation Maneuver Aortic Stenosis Ejection Systolic Listen to carotids Aortic Regurgitation Early Diastolic Sit forward. Lower left sternal border during expiration Mitral Regurgitation Pan Systolic Roll to left. Mitral area using diaphragm during expiration (into axilla) Mitral Stenosis Mid DiastolicRespiratory Examination • General Inspection • Hands- Temperature, Clubbing • Fine Tremor • Asterixis • Pulse + Resp Rate • JVP • face• Trachea+ Cricosternal Distance • Chest Expansion • Apex Beat • Percussion • Areas to percuss: Supraclavicular, infraclavicular, Chest wall, axilla Types of Percussion Note Associated Conditions Resonant Normal Dullness Cardiac dullness, consolidation, tumour, lobar collapse). Stony Dullness pleural effusion. Hyper-Resonance Pneumothorax• Vocal fremitus (tactile) Vibration Level Pathology Increased Consolidation, Tumour, Lobar Collapse Decreased Pleural Effusion, Pneumothorax Added Sounds Associated Pathology • Auscultation Wheeze Obstructive lung disease (Asthma, COPD, Bronchiectasis) Stridor Upper Airway Obstruction Coarse Crackles Pneumonia, Pulmonary Oedema Fine end-inspiratory crackles Pulmonary Fibrosis (Restrictive Lung Disease)• Lymph nodes • Repeat POSTERIOR CHEST • Sacral +Pedal OedemaAbdominal Examination • Inspection- Scars, Jaundice, Masses • Hands: • Asterixis • Bruising • Clubbing • Dupretyen’s Contracture • Erythema (palmar) • Eyes- Anemia, Jaundice • Mouth • Lymph Nodes- Virchow’s- left supraclavicular fossa• Inspect • Palpate quadrants • Check for pain, masses, guarding • Palpate liver + spleen • Ballot kidneys • Palpate aorta • Percuss liver+ spleen • Shifting dullness • Auscultate (bowel sounds + bruits) • Pitting oedemaImaging • X-Rays • CT, • MRI • PET • US • Angiogram • When to use eachLung Function T ests • Spirometry • Peak flow • FEV/FVC 1ECGSpirometry • Differentiate between restrictive and obstructive disease • Measures: • FEV1 • FVC • FEV1/FVCReversibility