Short cases made easy

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About Course

A bedside examination, also known as a clinical examination or physical examination, is a fundamental component of medical assessment that is conducted at the patient’s bedside. It involves the systematic evaluation of the patient’s body and organ systems using various techniques, including inspection, palpation, percussion, and auscultation.

The bedside examination serves several purposes:

  1. Diagnostic: It helps clinicians gather information about the patient’s symptoms, signs, and physical findings to establish a diagnosis or differential diagnosis.
  2. Monitoring: It allows clinicians to monitor the patient’s condition over time and assess the effectiveness of treatment interventions.
  3. Communication: It provides an opportunity for clinicians to communicate with patients, gather relevant medical history, and address any concerns or questions the patient may have.
  4. Education: Bedside examinations are also valuable for medical education, as they allow students, residents, and other healthcare professionals to learn and practice clinical skills under the guidance of experienced clinicians.

During a bedside examination, the clinician typically evaluates various aspects of the patient’s health, including:

  • Vital signs (such as blood pressure, heart rate, respiratory rate, and temperature)
  • General appearance and demeanor
  • Skin color, temperature, and texture
  • Head and neck examination (including inspection of the eyes, ears, nose, and throat)
  • Cardiovascular examination (including inspection, palpation, and auscultation of the heart and blood vessels)
  • Respiratory examination (including inspection, palpation, and auscultation of the lungs)
  • Abdominal examination (including inspection, palpation, and percussion of the abdomen)
  • Neurological examination (including assessment of mental status, cranial nerves, motor function, sensory function, and reflexes)
  • Musculoskeletal examination (including inspection and palpation of the bones, joints, and muscles)

The findings of the bedside examination, along with other diagnostic tests and investigations, help guide clinical decision-making and management strategies for the patient.

Overall, the bedside examination is a critical component of patient care, providing valuable information that contributes to the diagnosis, treatment, and ongoing management of medical conditions.

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What Will You Learn?

  • How to conduct a general physical examination
  • How to examine the abdomen
  • How to examine the respiratory system
  • How to examine the cardiovascular system
  • How to examine the nervous system
  • How to find out the severity of a valvular lesion
  • How to find out the dominance in case of mixed lesions
  • How to plan the examination of short case
  • How to interpret the clinical signs in chest and heart without using a stethoscope
  • How to interpret the clinical signs in chest and heart while using a stethoscope

Course Content

Examination of cardiovascular system
The examination of the cardiovascular system involves a systematic assessment of the heart, blood vessels, and peripheral circulation. It aims to evaluate the structure and function of the cardiovascular system and detect any abnormalities or signs of cardiovascular disease. Here's an overview of the steps involved in examining the cardiovascular system: General inspection: Begin by observing the patient's general appearance, demeanor, and vital signs. Look for signs of distress, cyanosis (bluish discoloration of the skin), pallor, or edema (swelling), which may indicate underlying cardiovascular problems. Palpation: Palpate the carotid arteries one at a time to assess their amplitude, contour, and presence of any bruits (abnormal sounds). Palpate the apex of the heart to locate the point of maximal impulse (PMI), which corresponds to the apex beat. Note its location, intensity, and duration. Auscultation: Use a stethoscope to auscultate the heart sounds, which are typically divided into four areas: aortic, pulmonic, tricuspid, and mitral (apex). Listen for the first heart sound (S1), which corresponds to the closure of the mitral and tricuspid valves, and the second heart sound (S2), which corresponds to the closure of the aortic and pulmonic valves. Check for any additional heart sounds, such as S3 (ventricular filling) or S4 (atrial contraction), as well as murmurs (abnormal heart sounds) that may indicate valvular abnormalities or other cardiac conditions. Assess for extra-cardiac sounds, including pericardial friction rubs (indicative of pericarditis) or venous hums (indicative of venous obstruction). Assessment of jugular venous pressure (JVP): Assess the JVP by positioning the patient at a 45-degree angle and observing the pulsations of the internal jugular vein. Measure the height of the JVP relative to the sternal angle (angle of Louis). Elevated JVP may indicate fluid overload or right-sided heart failure. Assessment of peripheral pulses: Palpate peripheral pulses, including the radial, brachial, femoral, popliteal, posterior tibial, and dorsalis pedis pulses, to assess their rate, rhythm, and amplitude. Absent or diminished pulses may indicate peripheral vascular disease. Assess for peripheral edema, which may be indicative of venous insufficiency or heart failure. Assessment of blood pressure: Measure blood pressure using a sphygmomanometer and stethoscope or automated blood pressure monitor. Measure both arms, and compare readings to assess for any discrepancies. Elevated blood pressure may indicate hypertension, while low blood pressure may indicate hypotension, shock, or other circulatory problems. Throughout the examination, it's essential to communicate with the patient, explain the procedures, and ensure their comfort and privacy. Document any relevant findings, including abnormalities, and consider the patient's medical history, risk factors, and symptoms when interpreting the results of the cardiovascular examination.

  • GPE relevant to CVS
    10:48
  • Examination of neck veins
    06:42
  • Precordial examination
    16:57
  • Inspection of precordium
    02:11
  • Palpation of precordium
    06:35
  • Auscultation of precordium
    08:09

General physical examination
The general physical examination (GPE) is a systematic assessment of a patient's overall health and well-being. It typically includes several components aimed at evaluating various body systems and identifying any abnormalities or signs of disease. Here's a general outline of the components of a GPE: Vital Signs: Measurement of vital signs, including: Blood pressure Heart rate (pulse) Respiratory rate Temperature Oxygen saturation (pulse oximetry) General Inspection: Observation of the patient's general appearance, demeanor, and level of distress. Comprehensive examination of the skin for lesions, rashes, discoloration, texture changes, or signs of trauma. Assessment of skin turgor, temperature, and moisture. Evaluation for signs of nutritional status, hydration and fluid status (dependent edema), and overall hygiene. Head and Neck Examination: Inspection of the head and face for any abnormalities, such as asymmetry, lesions, or swelling. Assessment of the eyes, including examination of the pupils, sclera, conjunctiva, and extraocular movements. Examination of the ears, including inspection of the external ear canal and tympanic membrane. Assessment of the nose and sinuses for signs of congestion, discharge, or deformity. Examination of the oral cavity, including inspection of the lips, gums, teeth, tongue, and mucous membranes. Neck Examination: Palpation of the neck for lymph nodes, masses, or tenderness. Assessment of the thyroid gland for size, consistency, and tenderness. Inspection and palpation of the carotid arteries for pulsations and bruits. Chest Examination: Inspection and palpation of the chest for symmetry, shape, and any visible abnormalities, tenderness, masses, or abnormalities. Cardiovascular Examination: Assessment of the precordium for pulsations, heaves, or thrills. Palpation of peripheral pulses and assessment of their rate, rhythm, and amplitude. Assessment of jugular venous pressure (JVP) and assessment for jugular venous distension. Abdominal Examination: Inspection of the abdomen for symmetry, distension, scars, or visible masses. Extremities Examination: Assessment of the upper and lower extremities for edema, color changes, temperature, and pulses. Inspection and palpation of joints for swelling, tenderness, or deformity. Assessment of muscle strength, tone, and range of motion. Neurological Examination: Assessment of mental status, including orientation, cognition, and behavior.

Examination of abdomen
In this video, we shall see the examination of the abdomen proper and the general physical examination relevant to the abdominal examination.

Examination of respiratory system
In this lesson, we shall see the examination of the respiratory system and the relevant general physical examination.

Examination of cranial nerves
The examination of cranial nerves involves assessing the function of the 12 pairs of cranial nerves that originate from the brain and control various sensory, motor, and autonomic functions of the head and neck. Here's a structured approach to conducting a cranial nerve examination: Preparation and Introduction: Explain the procedure to the patient, ensuring their understanding and cooperation. Provide clear instructions and reassure the patient throughout the examination process. Ensure adequate lighting and privacy for the examination. Visual Inspection: Begin by observing the patient's face and head for any asymmetry, abnormalities, or involuntary movements. Note the position of the head, facial expression, and any signs of facial weakness or drooping. Olfactory Nerve (CN I): Test the sense of smell by asking the patient to close their eyes and identify familiar odors presented to each nostril separately. Commonly used substances for olfactory testing include coffee, mint, or vanilla. Optic Nerve (CN II): Test visual acuity using a Snellen chart or handheld visual acuity card. Assess visual fields by confrontation, asking the patient to identify the number of fingers presented in each quadrant of their visual field while the examiner does the same in the opposite eye. Perform fundoscopic examination using an ophthalmoscope to assess the optic disc, retina, and blood vessels. Oculomotor (CN III), Trochlear (CN IV), and Abducens (CN VI) Nerves: Assess extraocular movements by asking the patient to follow your finger or a pen in various directions of gaze (up, down, medial, lateral, and diagonal). Note any limitations, nystagmus (involuntary eye movements), or diplopia (double vision) during eye movements. Trigeminal Nerve (CN V): Test sensation in the three divisions of the trigeminal nerve (ophthalmic, maxillary, and mandibular) by using a cotton swab or soft brush to lightly touch the patient's forehead, cheeks, and jaw. Test motor function by asking the patient to clench their teeth while palpating the masseter and temporalis muscles for strength and symmetry. Facial Nerve (CN VII): Assess facial symmetry and muscle strength by asking the patient to perform various facial movements, including smiling, frowning, raising eyebrows, puffing out cheeks, and closing eyes tightly. Observe for any asymmetry or weakness of facial muscles. Vestibulocochlear Nerve (CN VIII): Test auditory acuity by asking the patient to identify sounds presented through a tuning fork or audiometer in each ear separately. Assess vestibular function by performing the Romberg test, observing for balance and coordination with eyes open and closed. Glossopharyngeal (CN IX) and Vagus (CN X) Nerves: Evaluate the gag reflex by touching the back of the patient's throat with a tongue depressor and observing for a gag response. Assess voice quality and speech articulation by asking the patient to speak and swallow. Accessory Nerve (CN XI): Test motor function of the sternocleidomastoid and trapezius muscles by asking the patient to shrug their shoulders against resistance and turn their head against resistance. Hypoglossal Nerve (CN XII): Assess tongue movement and strength by asking the patient to protrude their tongue and move it from side to side. Observe for any deviation, asymmetry, or weakness of tongue movement. The examination will be divided into two components. In one video you will see the examination of all 12 cranial nerves. In subsequent videos the nerves will be examined in groups, for example, the 3,4,6 will be examined in one video, and so on.

Examination of motor system
In this lesson, we shall see the examination of the motor system in a single video. This will be further divided into three portions in separate videos. In the first video, we shall see the examination of bulk and tone, in the second video, power, and coordination and the third video, we shall see deep tendon reflexes

Examination of sensory system
In this lesson, we shall how to examine the sensory system. The first video is a complete sensory system examination. In the second video, we shall see the dorsal column sensations and in the third video, we shall see lateral column sensations.

Signs of meningeal irritation
In this brief lesson, we shall see how to elicit signs of meningeal irritation

Plans for short case examination
This lesson is about the schemes of examination. This will explain how to proceed for short cases if given a specific command. What could be the underlying pathologies/diseases? For example, how should you proceed if you are asked to examine the chest? You not only have to make a diagnosis, but to find the effect of disease on the body as well.

Severity of a valvular lesion and assessment of mixed valvular lesions
In this lesson, we shall see how to assess the severity of a valvular lesion and how to find which one is the dominant lesion in case of mixed lesions.

Interpretation of clinical signs in chest and heart
In this lesson, we shall see how to interpret signs during a clinical examination of the chest and heart. At times the examiner interrupts you before you can auscultate. In this case, you should be able to interpret the findings of palpation and percussion. This video will help you interpret the findings with or without a stethoscope.

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