Clinical findings & guidelines 🩺

Aged Care


Anaesthetics


Cardioresp

APO CXR findings

Alveolar opacities (oedema)     

Batwinging (or Kerly B lines)                  

Cardiomegaly

Diffuse interstitial thickening (septal lines) & diversions (vasc. upper zone diversion) 

Effusion (pleural)


APO mx 

Lasix (frusemide/furosemide 😡) 

Morphine IV

Nitrate (GTN IV, C/I if SBP <100) 

O2 therapy

Position (30 degrees heads up) and PPV (positive pressure ventilation)


Cardiac auscultation 

All (aortic) Procedures (pulmonary)   ← (R)   (L) →   Take (tricuspid) Money (mitral) 


Cardiac murmurs by character


Cardiac murmurs - SYSTOLIC murmur grading (out of 6)

1 - very hard to hear (reg and consultant maybe) 

2 - interns can be taught to hear 

3 - med students can be taught to hear 

4 - easily audible, assoc. w thrills 

5 - easily audible w seth lightly touching chest, assoc. w thrills

6 - appreciable even w/o seth


CHADS-VASC score (calc. risk of stroke in pt w stroke) 


Wells score (PE risk) 



Derm

Skin cancer screening


Endo 

HbA1c targets for DM (2023)



Scyanthen Test 

TFT (thyroid function test) 


GI & Gen Surg

Appendicitis 

Clinical dx → Alvarado score (7-8/10 probable, 9-10/10 highly suggestive) 

use MANTRELS mnemonic to remember




Bowel distension 

> 3mm diameter for small intestine 
> 6mm diameter for colon 
> 9mm diameter for caecum 

Bowel cancer screening (FOBT - national program) 

- 50-74yo everyone
- yearly if -ve 
- if +ve → colonoscopy r/f

Child-Pugh Score (Liver cirrhosis mortality)


Courvoisier's law/principle/sign 

If  painless palpable enlarged gallbladder WITH mild jaundice, NOT likely caused by gallstones


H. pylori eradication 


Portosystemic anastamose sites 




Haem & Immuno


 ID

Vaccines 

- Childhood vax 
       - Hep B
       - diphtheria, pertussis (whooping cough), tetanus 
       - rotavirus
       - meningococcal (indigenous and other at-risk popln)
       - pneumococcal (pneumovax) (indigenous or children w specific med conds.) 
       - Hib (H. influenzae type b) 
       - mumps, measles, rubella, VZV (chickenpox)
       - COVID vax → ?how many doses; ?when was last dose; ?booster
       - yearly influenza/flu vax (at risk popln)

- Adolescent vax
       - HPV (Yr 7) 
       - diphtheria, tetanus, pertussis booster
       - pneumoccocal ACWY (Yr 10) 
       - yearly influenza/flu vax (at risk popln)

- Adult vax
       - yearly influenza/flu vax 
       - COVID vax → ?how many doses; ?when was last dose; ?booster
       - HPV vax 
       - pneumococcal (people w specific med conds) 
       - Hib (people w specific med conds)

- Travel vax
       - Malarial
       - Mumps/measles
       - yellow fever
       - Hep A
       - Hep B


Neuro

Cerebellar signs (DANISH)

Dysdiadochokenesia (hand coord test) 

Ataxia

Nystagmus

Intention tremor 

Scanning/staccato speech 

Heel-to-toe +ve

Cranial n.

I Oh → Olfactory n.                                                I Some                                 S = sensory

II Oh → Optic n.                                                     II Say                                   M = motor

III Oh → Occulomotor n.                                       III Money                              B = both

IV To → Trochlear n.                                             IV Matters

V Touch → Trigeminal n.                                       V But

VI And → Abducens n.                                          VI My

VII Feel → Facial n.                                              VII Brother

VIII Very → Vestibulocular n.                               VIII Says

IX Good → Glossophyrgneal n.                             IX Big

X Velvet → Vagus n.                                               X Boobs

XI Ah → Accessory n.                                            XI Matter

XII Heaven → Hypoglossal n.                                XII Most


UL peripheral nerve palsy





Visual field pathway + assoc. lesion defects 



Obs/Gynae

Cervical Screening (HPV/ PAP smear)

- 25-74yo females
- 5 yearly
- if experience any sx of cervical cancer, even if reg screened 
- exit screening between 70-74


Ortho 

NOF #

intracapsular and displaced → urgent THR (avascular head of femur necrosis)


For all ortho theatres → cefazolin 2g iv intraop (has good bone penetration) (adults)


Paeds

Pre-natal genetic testing (aminocentesis)


Post-natal genetic testing (Heel-prick) 


Psych

DSM-5 is the Holy Bible of Psych

Renal & Uro

Nephritic v nephrotic syndrome (issue w/ the glomeruli)



CKD



 

Rheum



Trauma, resus, and ICU


Vasc 

Critical limb ischaemia

6Ps clin ft (left 3 MOST COMMON initial ft) 

   Pain                               Paraesthesia

   Pallor                             Perishingly cold

   Pulselessness                 Paralysis 


Ruthford crit. limb isch. classification 





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