Combine CardioRespGIT Exam

Introduction- Wash hands, obtain consent

General Inspection- Room Inspection, ABCDE, Vital Signs
Hands- Pallor, cyanosis, leukonychia, koilonychia clubbing, signs of
endocarditis,
Wrist- Radial pulse (rate, rhythm and power), asterixis/hepatic flap,
Skin- spider naevi, bruising, wasting, scratch marks, radio-radial
delay. Get blood pressure
Face- Eyes- xanthelasma, conjunctival pallor, jaundice, splinter
hemorrhages
Nose- polyps, enlarged turbinates, sinus tenderness
Mouth- central cyanosis, palate, teeth, gums, tonsils, cough
Neck-JVP, carotid pulse and bruits, lymph nodes, tracheal deviation,
Forced Expiratory Time for COPD
Back- Inspect for scars and deformities, measure chest expansion,
palpate for sacral oedema, percuss lung bases for effusion (with
arms crossed), auscultate lung bases, vocal resonance
Chest- Scars, deformities, apex beat, thrills, parasternal and LV
heaves
Percuss over clavicle, auscultate lung bases and heart sounds
Abdomen- Inspect for scars, striae, bruising, pigmentation,
distension, masses, veins, peristalsis, pulsation (bend down)
Palpate superficial and deep
McBurneys point (1/3rd from R ASIS to umbilicus), Rosvings sign
(pressure in left iliac fossa)
Liver palpation- start at right iliac fossa and advance hand whilst
patient is expiring
Gallbladder- curl hands under right costal margin, and ask patient to
take deep breath (Murphys sign- pain on inspiration)
Spleen- have left hand below left ribs and start right hand at
umbilicus and move up to left upper quadrant in expiration,
Percuss for ascites, Shifting Dullness (percuss from midline, and get
patient to roll over to percuss again)
Auscultate for bowel sounds, aortic and renal bruits (
Legs- varicose veins, pitting oedema,
Pulses-popliteal, posterior tibial and dorsalis pedis pulses

Brief Neuro Exam

Speech & comprehension, Facial asymmetry, PERLA (pupils equal
and reactive to light and accommodation), External ocular
movements, Gait, Power and reflexes in UL and LL.

Full Neuro Exam

Diagnostic Case
- Do nildocaafiat, then do relevant SR (also questions to rule
in/out your differential diagnoses) + red flags, and briefly
other SRs
History Taking
Nature (sharp, dull, burning, cramping, stabbing, throbbing)
Intensity
Location (radiate anywhere)
Duration
Onset (when did it start? What was the first thing you noticed? Has
anything changed since then)
Contributing (is there anything that might have caused this?)
Aggravating (does anything make it worse)
Alleviating (does anything make it better or help it improve)
Frequency for repeated episodes (Is it present continuously or
intermittently? how often does it occur?)
Impact- how is this affecting your life?
Attribute- what do you think is causing the problem?
Treatment- have you taken any medication for it?
Systems Review- ask general, CVS, RESP, GI, neuro, MSK,
haem, urinary, psych, genital
General- have you had any fevers lately? What about any nights
sweats? Change in weight? Rashes or any skin changes anywhere?
Cardiovascular History- Have you ever had any pain in your neck,
chest or arm? Do you get short of breath easily? Can you lie flat
without feeling breathless? Do you wake up at night being short of
breath? Do you ever feel like your hearts racing or skipping beats?
Do you have cold or blue hands or feet? Have you ever had
rheumatic fever? What about a heart attack or really high blood
pressure?
Respiratory- Have you had a cough lately? Do you cough up
anything? Have you ever coughed up blood? Do you snore loudly?
Have you had any wheezing? Have you ever had pneumonia? What
about TB? Have you recently had a chest x-ray?
GI- Have you had any stomach problems lately? Like nausea,
vomiting, diarrhea, pain or constipation? Have there been any
recent changes in bowel habits?
Neurological- Have you had fits before? Have you fainted? Do you
often get headaches? Have you noticed any changes in your vision?
Have you experienced weakness or numbness anywhere?
MSK- Do you get any muscle weakness or stiffness? What about
pain or stiffness in you joints?
Haematological- Do you bleed or bruise easily? Have you noticed
lumps anywhere over you body?
Psych- Are you sleeping well at night? Any mood changes recently?
Urinary- Do you have trouble with passing urine? Is it painful?

Menstrual- Please tell me about your usual menstrual cycle. When

was your last period? Was it a normal period? Any inter-menstrual or
post-coital bleeding? What do you use for contraception?
Sexual History- Are you sexually active? Do you have a regular
partner? How long have you been together? Any casual partners?
We often screen for STIs in young people. Would you consent to
having a STI screen?
Genital- vaginal discharge, itch, pelvic pain, pain with intercourse,
pattern of periods, last normal menstrual period, genital rash or
ulcers, penile discharge
Summarise, is there anything else youd like to talk to me
about today?
Past Medical History- Do you have any illness or medical
conditions? Have you ever been in hospital for anything? Have you
ever had any heart problems, high blood pressure? Lung problems?
Asthma? Diabetes? Kidney or liver disease? Thyroid Problems? Have
you had any mental health problems?
Past Surgical History- Have you ever had any operations? (if done
ask why and when?) Have you had a coronary bypass surgery?
Current MedicationsRecreational Drugs
Past Family History- Are your parents well? Do you have siblings?
Hows their health? Do you have any children? How are they? Do
you know of any diseases that run in the family?
Allergies- include reaction if any

Liver mets

Social History
Occupation- are they able to get leave for rest, will they go back to
work, flexibility? Occupational exposure to dusts, gases, carcinogens
Overseas travel- gastroenteritis, PE
Home life- ADLs, help at home, family, main carer, spouse and their
health
Smoking
Nutrition
Alcohol
Physical exercise
Problem biggest
Drugs recreation (esp. marijuana use in COPD)
Hobbies
Allergies
Social supports
DOg (pets) driving
GP- frequent visits
Monetary financial situation, do they have private health insurance
AHD and will
Insight into condition
Sleep apnoea- for OBESITY (snoring, refreshed in mornings, early
morning diuresis, daytime somnolence) , sleep pattern
Mood
Screening tests already completed
Always ask what investigations have been done so far, what doctors
say they have, what examiners commented on, did physical
examination for

INTRODUCTION (START OF THE PRESENTATION: SASPOP)

Sex
Age
Social statement (the most important, relevant social factoid)
Past history (of relevance only)
Onset
Presentation
eg- Mr Jones is a 48 year old heavy smoker with a past
history of myocardial infarction and hypertension who presents
with the diagnostic problem of the sudden onset of central
chest pain in the setting of nausea and dyspnea.
If on warfarin ask similar questions to insulin- who checks INR, how
often, how high

 Hello Mr/Mrs My name is.This is a very important exam for me. I will
need to ask you a lot of questions very quickly. From time to time I may
need to cut you off.
Please dont feel that Im being rude, its just that I need to get a lot of
information very quickly.
How old are you? Are you allergic to anything? What are your health
problems, I need to make a quick list (also quickly look at the drug chart).

What do you see as the main issue with your health

at the moment?

Before ending the interview, ask the patient

Is there anything else you want to tell me or you think I should
know?
Is there anything else that the examiners were interested in?