EMTL

Moulage
SoB - Asthma, COPD, Anaphylaxis

DKA

RTA/Unconscious
Raised ICP
AAA
TIA/Stroke
Pneumothorax/Tension penumothorax
Pneumonia
Sepsis
Haematesis
BLS
ALS
Choking
Skills
Cannulation
Suturing a wound

Rheum & Ortho

Examinations
Hip

Knee

Shoulder

Hands
Back

Elbow

Ankle and Foot

GALS

Spine
Explanations
Rheum - explain rheumatoid arthritis
Ortho - explain OA

Rheum Hx
Pre-op assessment

Anaesthetics

Pre-op assessment
Explain PCA
Explain epidural
Explain spinal

Explain post hepatic neuralgia

Explain trigeminal neuralgia

Wheeze - CXR, know when to call for senior help

Don't examine through clothes, ask about other
symptoms of diabetes, discuss diagnosis with
patient

Gown and gloved up. Still need to introduc.

Secondary survey - full neurological exam - focal
neurology and evidence of skull fracture eg battle's
sign or racoon's eyes in basal skull fracture, CSF
leak, depressions. Current medications anticoagulation eg clopidogrel or warfarin.
Neurological Sx: severe headache, persistent N&V,
seizure activity, amnesia, LoC. . Management ensure adequate cerebral perfusion and reduce ICP
when elevated - hyperventilation - causes decreaed
CO2 and lowering cerebral blood flow and blood
volume and ICP - causes cerebral vasoconstriction.
Hyperventilation to moderate levels 25-35 mmHg,
mannitol. Control bleeding and complete closure of
open wounds, avoid sedating drugs, refer to
neurosurgeons.Lumbar - check for local tenderness,
cauda edquinsyndeome -myotomes, dermatomes,
saddle anaesthesia, PR
RTA accident - brace and raised ICP
Bruising had bleeding on the abdomen. Permissive
hypotension
CXR for fractures, muffled heart sounds, clea area
prior to needle decompression
Ask for CXR
Talk to patient about diagnosis and management
Assess red flags for GI bleed
Remember 4H 4Ts. Mention to document in notes
and talk to family

ligament injuries - highly vascular so rapidly

dedveloping effusions; meniscal injurites - slower
developing effusion. All - rest and analgesia,
physiotherapy first, immuobolisation if needed. ACL
- ligament reconstruction/repair meniscal tear if
chronic instability, OA. PCL injury - unable to weight
bear, gives way. Meniscal injury - joint line pain,
tenderness, effusion, locked knee, swelling,
meniscal cyst - one way leak. Intiial treatment
RICE, analgesia and physio then surgical total or
partial meniscectomy. McMurray's/apley's +ve ;
Extensor mechanism injury?- transverse patellar
fracture/quadriceps tendon/patellar tendon rupture
- AP and lateral knee
AP and axillary or Y views - dislocation:
conservative: immediate reduction with analgesia
and sedation using Kochers - traction, external
rotation, adduction, internal rotation. Surgical:
arthroscopic exploration and stabilisation for young
professional athletes. Recurrent dislocation
-TRAUMA --> hill sachs, bankart, elderly with rotator
cuff disease. Atraumatic e.g. ehles-danlos
syndrome - positive apprehensive test

scaphoid view radiographs (AP, lateral and two

olique) - immobolisation, consider surgical if
instablity, displacement, angulation or concomitant
carpal dislocation; percutanous K-wire fixation.
Mallet finger- extensor tendon rupture +/- avulsion
from the base of distal phalanx. Clinical
presentation: flexed at DIPJ, no extension possible
(passive extension is possible) - hx of traume. Rx:
mallet splint (immobilisation) of the DIPJ in
hyperextension. Phalens for 2 mins. Dupuytren's hueston tabletop test. Painless fibrotic thickening,
ass, with liver disease AIDs etc FH, usually bilateral
and symmetrical, omkig. RA differential: psoriatic
arthropathy rheumatoid-like polyarthritis type.
Methotrexate - blood test weekly until therapy
stabilised, then monitored every 2-3 months. Folic
acid 5mg once weekly should be co-prescribed,
taken more than 24 hours after methotrexate dose.
Avoid prescribing trimethoprim or cotrimoxazole
concurrently - increases risk of marrow aplasia

AP and lateral elbow radiograph. Terrible triad =

posterior elbow dislocaiton, radial head fracture,
coronoid fracture - wrist - AP and lateral. Tennis
elbow - lateral epicondilitis - chronic inflammation,
degeneration and rupture of aponeurotic fibres of
the common extensor tendon where it originates
from the lateral supracondyar ridge of humerus
Weber A B C for ankle fractures. Hallux valgus severe lateral angulation and rotation of the hallux,
with medial deviation of the metatarsal. Tight
shoes, RA = RF. Treatment: shoe changes, orthotic
moudled insoles. Sruvery - first metartarsal
osteotomy (e.g. Chevron osteotomy), soft tissue
realigment, bunion excision or even joint
arthrodesis. Compliations - OA, exotosis and 2nd
MTPJ dislocation. Achilles tendon rupture: Thomson
test

Scoliosis: Postural, structural - does not change

with posture. Asolescent idiopathic scoliosis
commonly seen before puberty, and ceases when
growth comes to an end. Characterised by lateral
curvature of the vertebrae and ribs (convex to
right) causing a prominent hump on spinal flexion,
more common in girls, usually tall for age. One
shoulder elevated, decreased chest expansion [physio, bracing, surgery if severely progressing
curves. Rule out leg length discrepancy, hip
deformity. If old - degenerative, usually of lumbar
speine in elderly

Screen for more symptoms like bruising etc SLE SLE

SLE! Photosensitive rash - could be brought on by
the sun - has this happened before where you have
a rash in the sun
parathyroid

Smoking, no need to ask about muscle stiffness in

FHx, deal with concerns early - eg pain relief. Here
to work out what's the best anaesthetic for you
would be

most people see improvements quite quickly,

within a matter of month. For some people it could
take a bit longer and for some it goes away in a
year, and some maybe a bit longer than that.

UTI

Urine dip, MC&S,

Wound healing - stop smoking

Hip dislocation - hip, femur and knee radiographs
(AP and lateral)- immediate rduction after GA

OA knee - varus deformity

hip fracture - gardens. Shenton's line

Plantar fasciitis - self-limmiting inflammation of

plantar fascia, often seen in middle-aged obese
women - association with Retier's disease (reacitve
arthritis). Presentation: heel pain, worse in morning,
after rest. Tenderness over insertion of plantar fascia
on calcaneus. Rx: analgesia, insoles, physiotherapy,
night immobilisation, local corticosteroid, anaestetic
injections

Pseudogout: joint
aspiration: weaklypositively birefringent
rhomboid shaped crystals
x-ray: chondrocalcinosis

AS: loss of lumbar lordosis, stooped posture,

hyperextension of neck, flexion at hips and knees.
Mention - diminisehd chest expanision, plantar
fasciitis, achilles tendonitis, anterior uveitis, aortic
incompetence, restrictive ventilatory defect,
imaging - MRI more sensitive in early disease.
Treatment: NSAIDs and analgesics. Non-pharm physio. DMARDS sulfazalazine for bad ones.
Differential: Psoriatic spondilitis, undifferentiated
spondyloarthritis, enteropathic arthritis, reactive
arthritis

Colles - dinner fork, due to low-energy fall on palmar aspect (FOOSH) - seen in elderly osteop

ens. Shenton's line

een in elderly osteoporotic postmenopausal women

CHDA

PAEDIATRICS
Examinations

Cardiovascular
Respiratory
Abdomen
Developmental

Gait and neruological

Neonatal

Histories
Failure to thrive
Headache history

Infections - Resp, UTI, viral,

Safeguarding - Carpol overdose, unexplained bruises
Collateral history
Lactose intolerance
Explanations
Breastfeeding

Immunisations/MMR
Neonatal Jaundice
Asthma

Autism

Down's
Cerebral palsy

Febrile convulsions
Taking inhalers
CHILD PSYCH

ADHD
Autism
Conduct disorders

Suicide risk

Left thoracotomy scar, xanthelasma (not tendon xanethelasma), collapsing

pulse, "CXR, ECG, Echo"

Age. Ascites etc

Vomitting baby - pyloric stenosis, GORD, gastroenteritis/infection - billious

vomitting - what colour is the vomit - grass green? Infection - fever? Infectious
contact? Where does the vomit land? Fly across the room? (projectile) Hungry
afterwards - pyloric stenosis, +ve FH (not present in GORD)

Measles paeds haven't vaccinated. Good thing that we've caught it now.
'Croup - DON'T LOOK STRESSED BE AWARE OF BODY LANGUAGE. B ytalking to
me it will help us find out what's going on and will ensure that we'll get him
the best treatment. Woman - ask son's name. Were their any problems (rather
than complications)? Stridor - type of noise - wheezy, rattling? TRAVEL
HISTORY. Meningitis. Rash - meningitis, measles, vaccinations? Fever - highest
temp? anything to bring it down? DIFFERENTIALS for GORD = esophagitis,
cow's milk protein allergy. Pyloric stenosis - say want U&E for hypocholaemic
hypokalemi metabolic alkalosis, test feed with milk for visible gastric
peristalsisis --> IV fluids, pyloromyotomy. Crying - ask about nature of it,
drawing up of the knees - colic. Appendicitis DDx - mesenteric adenitis but
usually follows resp infection and lymphadenopathy. Intussception -colicky
pain, pallor, during episodes of pain, pale around mouth. Increasingly
lethalgic, inconsolable crying, refuse feeds, susage-shaped mass, redcurrent
jelly stool
Hone down on signs, replace development with social
Signs for lactose intolerance: dehydration, growth failure, perianal excoriations
due to acidic stools

MMR: Remember measles outbreak - 1/200 will get seizures and 1/5000 will
die. NHS choices. Green book provided by NHS England. ICE ICE ICE!

Over-medicalising. Can improve someone's life significantly if we know that

he's finding some activities difficult.Strength of autism: almost obsessed with
certain activities - becoming a mini expert and has actually mastered the
topic. Creator of pokemon has autism. In some ways there are strengths to it
that other people don't have. Yes brian is diffierent but doesn't mean that it's
better or worse. If we're aware of the differences then understanding it could
be really empowering for parents

family therapy, behavioural, school THEN MEDs. Teaching assistant. Work

together as a team. Do you have any questions for me? LISTEN TO PATIENT
Remember developmental delay, genetic component - highly
genetic/polygenic

Ask more about paracetamol overdose - any drugs/alcohol? Have we tested

you for anything? DEPRESSION SCREEN!! Intro - where's mum, medical things.
BEFORE, DURING, AFTER. Going to ask the pyschiatrist to come and see you. If
depressed, counselling or medication. "Did you want to kill yourself.
Physical/sexual abuse? I won't do anything without telling you
Who's at home? Mum/ WHERE'S DAD? SAFEGUARDING TEAM as she's
uncomfortable about the home situation

GERIATRICS
Geriatric hx

Depression hx
Faills hx
ADL

Discharge - MI
Discharge - COPD
Discharge - Epilepsy

Discharge - wound infection

Discharge - Falls
Discharge - TIA/Stroke

Collateral Hx - Dementia
Collateral Hx - Delirium
Explaining Alzheimer's

PALLIATIVE CARE

Pain Mx

N&V Mx
Dyspnoea Mx
Constipation Mx

OLD AGE PSYCH

Assessing suicide risk
Depression screen

Alzheimers Hx
Explaining alzheimers
Capacity assessment
Schizophrenia/ Paraphrenia

ask if seeing/hearing me properly - need

to put glasses/hearing aids on? Do you
have any fears?

Ask about suicidal risk/alcohol/substance m

Who what when etc, see geeky medics.
Epleys test and tilt table if vertigo

Are you aware that we're thinking of

sending you home quite swiftly. Important
for us on our medical side to make sure
that you're safe to go home - rattle Qs

Ask about visual defect

DEMENTIA!!!!! - MEMORY DUH! Assess

mood, substance misuse is a cause of
confusion? Screen for other potential
causes
Explore past psych Hx or substance misuse

Agitation?

Is there something that you're worried

about? Clarify medications
When was the last time you opened your
bowels? Constipation? Pain? + Vomitting ask if billous - BOWEL
OBSTRUCTION!!??!?!?!?! Ask for signs of
dehydration - dizziness etc.

DERMATOLOGY
Derm Hx - malignancy, psoriasis, eczema etc

Derm Ex
Advice on sun protection

ce misuse

Medical, Emotional, Legal - will and finances, Religious?

ICE ICE ICE!!!!!! LISTEN TO HINTS. Use what

she said to interject her with questions

Contact dermatitis - examine hairline, mucous membranes,

nails DON'T SAY STOP SCRATCHING. PAINFUL? DISCHARGE?
BLEEDING? LYMPHADENOPATHY? WEIGHT LOSS NIGHT
SWEATS? SPEND A LOT OF TIME IN THE SUN - HAVE YOU EVEN
SPEND EXCESSIVE AMOUNT OF TIME IN THE SUN.
OCCUPATION!!!!! What exactly does this involve? (if designer
etc)

ances, Religious?

This is a lesion located on the lebow

bilaterally, aprox 3 cm in dimeter, a
symmetrical, circular, well-demarcated lesion.
Its surface consists of silvery scales sitting on
an erythematous base. The immediate
surrounding is a downward sloping
erythematous border and there are no
satellite lesions. No bleeding nor any pus.
bowen's disease, lichen
Touch, temperature, mobile. In conclusion this simplex, psoriasis. Guttate
is consistent with a psoriatic plaque
psoriasis

RSH

Exainations

Breast

Speculum and bimanual

Obs palpation
Female catheterisation
Histories
Obs

Gynae

Sexual health
Explanations
Regular contraception - condoms, pills, patches, coils
Emergency contraception

Termination of pregnancy
Ectopic pregnancy
Miscarriage - threatened
HIV risk assessment

Chlamydia
Gonorrhoea
Cervical smear
Antenatal tests
Down Syndrome Screening

Pre-eclampsia (bad news)

Know triple assessment, remember axilla, remember supraclavicular

nodes. Pregancy esp in old lady'm thankful to have met all these
amazing people in my life - they have shown me what success
means and how, past results don't dictate your lives - your
determination does. I'm proud of these doctors - they'll be the most
loving, most compassionate doctors out there., smoking, COCP, early
menarche

let patient know she could ask to stop. Explain bimanual too.
Meantion lubrication. ASK if patient would like the door to be locked.
Ask to undress. Cancer not only cause of PC bleeding
Pre-eclampsia - discuss implications of high BP, suggest to recheck
BP. Enquire about family history, feel maternal pulse when palpating,
measure BP first if pre-exlampsia??? Reassure when things are
normal

Mucus plug?!?! PPROM but no fluids. SHx - smoking. Conception?

Been trying for baby for 5 years
What's your cycle like? Secondary amenorrhea - ask about nipple
dicharge - galactorrhea, eye problems - rule of pituitary,
hyperandrogenism
Urinary symptoms, Paid for sex? Testicular pain? GONORRHOEA AND
CHLAMYDIA GO TOGETHER. LAST TIME HAD SEX - WHO?
PENETRATIVE, RECEPTIVE? BEFORE THAT BEFORE THAT? Lumps clarify where? Molloscum contagiosum (itchy, wart-like, dot in
middle?) - what does it look like? STI screen, offer HIV screen

Identify day of cycle, discuss side effects, potential STI risk

Talk about risks as you're going mentioning them. Mifepristone in

clinic then 2 days later misoprostol AT HOME. Safety net - fever,chills,
discharge, bleeding, vomitting, pain --> come back!

Allergy? Medications? Contraception - don't get drunk. Contact

tracing - ANYYYYYYONE ELSE? Cheating? "These STIs can be in body
for a long time without symptoms so it's possible that he might not
even know that he has it" Ask allergies. Partner notification - who to
contact, how to do it, whether partners need treatment, how long to
avoid sex. CONTACT TRACING. Chlamydia - what does she know
about it PRECISE QUESTIONS. What do you stop from yourself getting
pregnant

34 weeks, get baby out and safe for you and baby. Give medications
making sure baby's lung okay. Safe thing, not uncommon. We'll keep
a close eye in you

Vertical strand

Post-natal depression partner cheating

Mum worried about URTI

Communication
Miscarriage
VBAC

Derm Hx and examination

Baby okay, are you okay? How was the birth? Baby checks - everything okay? Grandparents
do you mean? Baby waking up a lot for milk - option to express milk? Breastfeeding - good
contraceptive, if you're getting periods again chance you could get pregnant. Vaginal episiotomy.Cut when you were giving birth? Is that healing well? Blood loss? Pain/bleeding fro
down below? Complications during pregnancy? Gestational diabetes, pre-eclampsia? BABY - b
didn't have to go into special care unit? Feeding okay? Putting on weight? How's everything i
book? Nothing you're worried about? How's home? Who else is at home? Is everything okay?
sounds a lot of people, how's everyone managing?

As about rashes, wheeze. Take feeding history - how long between feeds, baby's ability to fee
Nasal drops

Feeding - latching on probably? Suckling - pain? How long for? When does he stop? Stops ear
why does he stop early? Does he go blue? Does he seem short of breath? WET nappies - how
a day? It seems everything is going well, what we tend to find when people are having
breastfeeding problems, may like to talk to other people. Do you feel like you have enough su
Have you tried anything to mke this better? Suction in nose????

Give stats

When you are out in the sun, do you often go red and blister? Pink before you tan or tan
sraightaway? Sunbeds
Light therapy for psoriasis
Do you spend a lot of time under the sun?
If you do go on holidays, where do you usually go?
We'd always like to rule out cancer with someone that comes in with a mole or a lump

Breastfeeding cafes, leaflets, advisors. Direct

towards community services, support groups or
family support. Rule out post-natal depression. Ask
about husaband and wife's relationship. Don't
suggest expressing breast milk when feeding
hourly! Antenatal, delivery and postnatal history.