🟪CVS examination

Initial approuch to the patient, introduce yourself, explain what are you going to do , take permission , ask about pain , hand hygiene

➡️Inspection
Inspect the chest for deformity, scars , visible pulsation, visible dilated veins , any skin lesions (bruises , cautery marks)

➡️Palpation
Palpate the apex beat and describe its character then localise its site
Palpate for Lt parasternal heave
Palpate for trill

➡️Auscultation
Auscultate mitral area by diaphragm of stethoscope for S1 + Murmer of MR
Auscultate axilla for radiation of MR
Auscultate mitral area by bell of stethoscope while you're turning the patient to his lt lateral side
Auscultate tricuspid area by diaphragm of stethoscope for murmur of TR / TS
Auscultate 1st aortic area for S2 + Murmer of AS
Auscultate the root of neck for radiation of AS
Auscultate pulmonary area for murmur of
PR/PS
Auscultate 2nd aortic area for murmur of AR then leaning the patient forward and ask him to hold breathing on expiration

Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

🟪Abdominal examination

Initial approuch to the patient, introduce yourself, explain what are you going to do , take permission , ask about pain , hand hygiene

➡️Inspection
Inspect for abdominal symmetry, abdominal distension , ask the
patient to take breath and Inspect for abdominal movement , Inspect the umbilicus and ask the patient to cough , Inspect for scars, superficial dilated veins , brucies, skin pigmentation,stia ,scratch marks

➡️Palpation
◾️Superficial palpation
Ask the patient if he has pain then palpate the whole 9 abdominal areas for Superficial masses, tenderness and hotness
◾️Deep palpation
Palpate the live and measure the liver span
Palpation the spleen
Do balotabale test

➡️Percusdion
Test for Stiffening dulness (if +ve then test for fluid trill)

➡️Auscultation
Ascultate over macbarny point for bowel sounds
Ascultate 1 cm above and lateral to the umbilicus for bruit
Ascultate Rt hypochondrial area for hump and bruit (if patient has signs of portal hypertension)
Auscultate Lt hypochondrial area for fraction rub (if patient has splenomegally)

Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

🟪Chest examination from the back

Initial approuch to the patient, introduce yourself, explain what are you going to do , take permission , ask about pain , hand hygiene

➡️Inspection
Inspec the chest for any deformity , scars (lateral thoracotomy scar , scar of plural tap) , any skin lesion (cautery marks)
Ask the patient to take a breath and look for his chest movement

➡️Palpation
chest expansion
TVF

➡️Percussion
➡️Auscultation
Auscultate the chest for air enty , type of breathing, added sounds
Auscultation the chest for vocal resonance

Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

🟪General examination

Initial approuch to the patient, introduce yourself, explain what are you going to do , take permission , ask about pain , hand hygiene

➡️General look
A / appearance
B / bulit
C / conscious level
S / skin (clour , rash , brucies , scar , pigmentation , fistula )
S / surroundings (cannula , O2 mask , medications )

➡️ head
1_Hair /for hair distribution
2_Eyes / for sings of anemia and jundice
3_Face / malar rash
4_Mouth / for sings of anemia (Angular stomatitis + pale mucous membrane , smooth tongue) , central cyanosis , mouth hygiene, artificial teeth.

➡️neck
1_Look for any Neck swelling
2_Palpate the Trachea/ centalized or deviated
3_Palpate Carotid artery and look for JVP
4_LN examination

➡️ hands
1_Inspect dorsal surface
2_Inspect palmer surface / for pale palmer creases , palmer erythema , atrophy of thenar and hypothenar ms
3_Inspect nails / for leukonykia, kolionykia , peripheral cyanosis , culbbing
طبعا لازم اديروا test for clubbing
inspect the nail angle
Fluctuation test
Window sing
4_Test for fine and flapping tremors
5_VS measurement

➡️ LL
1_Inspect for symmetry, sewlling and for any skin changes
2_Palpate for hotness and tenderness
3_Test for BLLE
4_Inspect between toes for fungal infection
5_Palpable dorsalis pedis artery and posterior tibilal artery


Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

🟪Rheumatoid hand examination

Initial approuch to the patient, introduce yourself, explain what are you going to do , take permission , ask about pain , hand hygiene

➡️Inspection
Inspection for joint swelling, deformity, redness, Ms atrophy, palmer erythema, scars , rash , nail changes (pitting nails / splinter hemorrhage/ peranular telagectasia)

➡️Palpation
Palpate all of hand joints for hotness and tenderness
Palpable for rheumatoid nodules
Assess the skin laxity

➡️Movement and Ms resistance
Tumb / flexion , extension, adduction , abduction , apposition
4 fingers /flexion , extension, adduction ,abduction

➡️Special test
Phalen test
Tinel test

Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

🟪 Thyroid examination

➡️Inspection
Inspent the swelling and comment on (5 S)
Site
Size
Shape
Skin over (scars , redness)

➡️Palpation
Palpable for hotness and tenderness
Palpable the mass and comment on
Site
Size
Shape
Surface
Consistency
Is it attached to skin ,ms and underlying structure
Special test/ ask the patient to swallow again

➡️Percussion
Percuss from the suprasternal notch toward the sternum

➡️Auscultation
Ascultate Rt and Lt lobe for bruit


Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

🟪Motor examination LL

Initial approuch to the patient, introduce yourself, explain what are you going to do , take permission , ask about pain , hand hygiene

➡️Inspection
Inspect for asymmetry ,ms wasting, deformity, abnormal posture, abnormal movement, any skin lesion

➡️Palpation
◾️Tone
Do rolling manover then assess the tone of each joint
◾️Power (0_5 scale )
Ask the patient to elevate his limb
Assess Ms resistant
◾️Reflexes
Ankle reflex
Knee reflex
Plantar reflex
Clonus
( If absent/Don't forget reinforcement )

Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

🟪 Coordination

Initial approuch to the patient, introduce yourself, explain what are you going to do , take permission , ask about pain , hand hygiene

Ask the patient to say a short sentence to assess if patient has dysarteria or not
Test for eye nystagmus
Finger to nose test
Alternating hand movement
Rebound
Heel to shin test
Assess the patient gait (Before this step ask the patient if he can stand and walk or not)
Heel to toe test
Romberg's test

Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

🟪Cranial nerve examination

CN 1 (Olfactory)
تجيبوا معاكم قهوة و لا ليمون و لا نعناع ، تقولوا للمريض يغمض عيونه و مرة يسكر Rt nostril و تقربله الحاجة و تسأله يشم فيها او لا ، و بعدين العكس يسكر ال Lt

CN 2 (Optic)
ما ينداش🎊

CN 3 , 4 , 6
Test for light reflex
Test for eye movement

CN 5
◽️Sensory
تفحصوا التلاتة أماكن اللي يغدي فيها بقطن و حاجة مدببة
◽️Motor
تقول للمريض يعض على سنونه و ايديك مرة عال
maseter و مرة على temporalis ms
Ms resistant of jaw
في أربعة اتجاهات
◽️Reflex
Jaw reflex
Glabbellar reflex
Corneal reflex (Just mension)

CN 7
Inspect for ➡️ forehead wrinkles, nasolabial fold , moth angle (depression+ deviation)
بعدين تلاتة حركات فوق
1 قيم حواجبك
2 اقرن حواجبك
3 سكر عيونك و ما تخلينيش نفتحهم

تلاتة تحت
1عبي فمك هواء
2 انفخ قدام صبعي
3 وريني سنونك

CN 8
ما يندارش🎊

CN 9 + 10
Ask pt to open his mouth and Inspect the uvula (Centralized or deviated)
بعدين خود زوز tounge depressor في ايدك و تلفت للممتحن و قوله
I would like to do gag reflex

CN 12
Ask pt to protrude his tongue and Inspect for➡️ atrophy, tremor , deviation
Do tongue ms resistant

CN 11
Ask pt to turn his neck once to the LT side and resist his movement
و العكس
Ask pt to elevate his shoulders and resist his movement .

دكاترة هادو كل خطوات ال examination ملخصتهم لكل system 📝

و هذا شيت لل most common findings اللي تجي في إمتحان ال Examination

بال DD و ال Investigations 📝

لازم تقروا حيفيدكم بعون الله

موفقين ان شاء الله 🤍

السلام عليكم دكاترة🩺

موفقين غداً في أول أيام إمتحان الكلينك و الديرما ، بعون الله حيكون اسهل و ابسط مما متخيلين ، كلنا مرينا بيها اللحظات هذه خوف و توتر و امشينا و امتحنا و نجحنا الحمد لله و العقبة ليكم توا💪


خليكم واتقين من نفسكم و توكلوا على ربي 🤍

حظ مُوفق للجميع.🙏

📝شوية نصائح لامتحان الكلينك🩺

جهزوا البالطو و السماعة و كل ال instruments اللي
محتاجينها

و انتو داخلين لللجنة ركزوا عالورقة شن مطلوب منكم أديروا ، تلقوها معلقة نهاية ال bed متع البيشنت

طبقوا الخطوات كاملة بداية ب introduce yourself ل عند ما تغطي البيشنت و تشكره
و ديما خليكم مبتسمين و اسألوا المريض لو عنده مكان يوجع فيه او لا من البداية

خليهم صادقين سواء عرفتوا findings او لا ، هما في النهاية 3 لجان ، حتى ما زبطتش في وحدة تزبط في الباقي ، و بعون الله تجيبوهم التلاتة

اعطوا presentation مرتبة

لما تنسالوا في ال DD حطوا في بالكم عمر البيشنت و اعطوا ال most likely DX هيا الأولى
متلا بيشنت عنده signs of UMNL
لقيتها حويجة كبيرة هادي عالاغلب ischemic CVA ، و لو كانت صغيرة في العمر عشرينات تلاتينات هادي عالاغلب MS


و ال Investigations تبدوا بتحاليل ال most likely DX و تكملوا على حسب ال DD

موفقين مسددين بعون الله تعالى 🤍🩺

ربي يفرحكم كلكم بنجاحكم و تفوقكم❤️

الحمد لله الذى سخر لنا هذا🤍

قداش ما تفرح فيا مسجاتكم اللطيفة🌸

نبي المسجات هادي تكون دافع إيجابي للكل🤍
نبيكم كلكم تمشوا للإمتحان و انتو متطمنين و واثقين انكم بتجاوبوا كويس💪

كل التوفيق لقروب الأربعاء و الخميس 🩺

السلام عليكم دكاترة ✨️

مُبارك عليكم نهاية امتحانات الباطنة🎊
و ان شاء الله ربي يفرحكم بالنتيجة اللي ترضيكم🤍

ان شاء الله تكونوا استفدتوا من القناة، و كل من خدي معاي كورس ان شاء الله تكونوا استفدتوا و ان شاء الله ما نكونش قصرت معاكم .🙏

عطلة سعيدة للجميع زملاء المستقبل.🎊