TALLEY EXAMINATIONS

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VITAMINSABCDEK
V stands for vascular, where the disease can be caused by vessel (bleed or
blocked), or anything related to hematology.

I is for infective or post infective causes.

T is for trauma or anything caused by mechanical factors such as obstructions

or pressure.

A is for causes of autoimmune-related illnesses or allergy.

M is for metabolic causes affecting lipids, proteins, carbohydrates, or

micronutrients, enzyme deficiencies

I is for idiopathic or iatrogenic causes.

N is for neoplasia.

S is for diseases caused by social reasons, such as child abuse and social
deprivation.

A is for diseases caused by alcohol-related issues.

B is for diseases caused by behavioral or psychosomatic disorders.

C is for diseases caused by congenital problems (the entire VITAMINSABCDEK

could be applied
again in the congenital causes).

D is for diseases caused by degenerative disorders or drug-related problems,

defciency

E is for diseases caused by endocrine or exocrine problems.

K would serve a reminder to diseases caused by karyotype or genetic disorders

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BIER BLLED
bloods (cbc)
infection (ESR, CRP)
endo (tsh, glu, fsh/lh)
renal (ua, lytes, cr, bun)

liver (ast, alt, alp, gall uss, hida, bili)

lipids (fasting chol, hdl, ldl, tag, amylase, lipase)
endoscopy, ct
drugs (valproate, digitoxin, alcohol, b12/folate)
---

[Diarrhoea = CHEST-FB = colonoscopy, hydration/kidney, ESR + ECG, STOOL

(O+P+rotavirus/crypto-antigen+ cdiff-TOXIN),transglutaminase, faecal leukocytes,
Biopsy]

[Resp = SCOAPS = spiro, CT-chest/CRP/CXR, oximetry, ABG, PPD, swabs + CULTURES,

esophago-gastro-duodenoscopy]

Cardio = BLUE KXGTP = BNP, lipids, USS/echo, ECG, kidney (lytes, BUN, Cr), XR-
chest, glucose/HbA1c, troponins, pancreas
Neuro = 14-AA-BBB-CCCC-TT-S = BBACC-ATACT = 14-3-3 CJD, B12/folate (PBS) + BSL ,
ANCA/ANA-vasc, CSF + pressure, CT-B, alcohol levels, Thiamnine levels,
AST/ALT(LFTs), CAG repeat, TSH, syphilis, ESR, Temporal artery biopsy, CBC, carotid
doppler

CARDIAC
__________
45 degree, chest exposed

inspection
-dysp
-cyanosis
-marfan, turner, downs
-anky spond / rheumatological - AR
-acromegaly
-cachexia (anorexia/liver congestion, reduced intestinal abs/congested intestinal
veins, TNFa/inflamm)

hands
-clubbing (cyanotic HD, IE, Lung Ca, Bronchiectasis, Lung abscess/empyema, IPF, CF,
Asbestosis, mesothelioma, Biliary cirrhosis, IBD, Ceoliac)
-IE - splinter hemorrhages, osler nodes, janeway lesion
-splinter hemorrhages (IE, RA, PAN, antiphospholipid syndrome)
-cyanosis
-tendon xanthomata (type 2 hyperlipidemia)
-allens test = clench fist - occlude by thumbs over radial and ulnar arteries -
open/relax their hands - colour should be pale - releae ulnar - if patent should go
pink - repeat with radial
-brachial pulse at ante-cubital crease medial to biceps tendon
-feel epitrochlear node above medial epicondyle

pulse
-rate
-rhtym
.brady
-irreg irreg = AF + BB or blocks
-reg irreg = block 2.1
-reg = BB, hypoTHYR, hypoT, ICP/cushings, block 3, MI, vasovagal
.tachy
-irreg = AF, MAT, flutter
-fever, preg, hyperTHYR, anaemia, AV fistula, beriberi/thiamine, CHF,
pericarditis, B+, hypoVOL, SVT, VT, PE
-symmetry
-radio-radio
.dissection
.subclavian artery stenosis
-radio-femoral
.coarctation

BP
-grade 1 = 140/60, 2 = 160/80, 3/severe >180
-pulsus paradoxus = drop in BP on inspiration > 10 mmHg = constriction
pericarditis, pericardial effusion, asthma
-postural drop = decr >15 SBP on standing (HANDI = hypoVOL + hypoPITUIT, Addisons,
Neuropathy/DM, Drugs[ A(-), anti-hypertensives], Idiopathic

Face
-scleral icertus (liver congestons, prosthetic hemolysis)
-arcus senilis
-conjunctival pallor
-xanthelasma
-malar flush = MS, PS, pulmonary hypertension

Mouth
-cynaosis
-palate - hi arch - marfans (AR, Aortic root dilation, MR, MVP
-dentition - IE
-mucosal petechiae - IE

Neck
-palpate carotid artery - right carotid artery infront of SCM - lower neck to
avoid carotid sinus - AMPLITUDE AND CONTOUR vs beat/beat and respiration - compare
left side
.collapsing/bounding = AR
.pulsus alternans = LVF
.jerky/bifid = hypertrophic cardiomyopathy
-ausculate for bruit - arterial narrowing
-JVD - right internal jugular (between 2 attachments of SCM) - highest point of
pulsation - vertical height from sternal angle - also document angle of bed
elevation eg 1cm above sternal angle with head of bed to 30 degrees
.RA lies 5 cm below sternal angle
.normal decrease on inspiration
.ABnormal increase on inspiration = kussmauls = assoc with JVD causes
.>3cm above zero = elevated =
-volume overload or
-hyperdynamic/pregnancy/hyperTHYR or
-SVC obstruction or
-TS/TR
-or limited RV filling (RVF/RV infarction/constrictive pericarditis/tamponade
.A-wave = atrial systole
-cannon = block 3 (RA systole against closed tricuspid)
-large = atrial outflow obstruction (TS, PS, pulm htn)
.X-descent = atrial relax
-large = tamponade, constrictive pericarditis
-absent = AF
.V-wave = ventricular systole (tricuspid closed, atrial filling)
-large = TR
.Y-descent = ventricular filling (tricuspid open)
-large = TR, constrictive pericarditis
-decr = TS, right atrial myxoma
-wave form
-abdominal-jugular reflux text - sustained rise = RHF
-carotids-pulse character

Chest
-inspect, scars, pace makers, chest deformity, heaves, retractions
-Palpate - apex 5th ICS 1cm medial to MCS - IF FAINT MAKE LOUDER BY DECUBITUS
.forceful and sustained = AS, htn
.displaced, diffused, non-sustained = MR, HFrEF, dilated cardio, volume loaded
.larger area than normal = anterior MI, LVF
.double = hypertrophic cardiomyopathy
.tapping = MS
.absent = obesity, emphysema, pericardial effusion, shock, dextrocardia
-Palpate sternum = parasternal heave
.RVH
-Palpate pulmonic = palpable P2
 .pulmonary htn
-Palpate base of heart = thrill (palpable murmur) - LOUDER SITTING LEANING FORWARD
IN EXPIRATION
-roll to left side and try again to feel apex impulse
-percuss from left side - pulmonary resonance laterally, cardiac dullness medially

-Auscultate - S1 (mitral close, systole), S2 (aortic close, diastole)

.apex = mitral - S1 louder than S2
-bell LIGHTLY PLACED - mitral = low pitched sounds = S3 and MS (can also use
bell in tri, pulm, mitral areas)
.S3 + apex + expiration = HFrEF = KENTUCKY
.S4 = HFpEF = TENNESSEE
-diaphragm = high pitched sounds = MR, S4 pericardial friction rubs
.tricuspid - left sternal 5 ICS - splitting of S2
.pulmonic - left 2 ICS, sternum - splitting of S2 (breath deeper than normal) =
A2 then P2
.aortic - right 2 ICS, sternum = S2 louder than S1
-S2 split normal with inspiration
-fixed = asd
-wide = PS
-reversed (P2 first then splitting in expiration)= AS, HCOM, LBBB, PDA

.carotid radiation if systolic murmur OR carotid bruit

.left decubitus = LV close to chest wall (MS, S3, S4) - lightly place bell at
apex - S3 = tennessee
.sitting forward
-feel base of heart - thrill
-expiration and hold breath = AR (pulmonic area and down left sternal border
to the apex)
-HOCM - valsalva
-inpsect back for scars, deformity, sacral edema, percuss for pleural
effusion
-percuss for effusion
-auscultate for crackles/heart failure
.HOCM - respiratory phase, valsalva, isometric hand grip, standing, squatting

LIE FLAT + 1 pillow

-palpate liver - pulsatile = tricuspid regurgitation
-palpate spleen = if endocarditis suspected
-palpate descending aorta
-percuss for ascites RHF

LEGS
-peripheral pulses - dorsalis pedis + posterior tibial
-cyanosis
-temperature of legs, feet
-femoral pulse
-trophic changes, ulceration
-edema - pitting edema
-xanthomata
-calf tenderness
-clubbing
-popliteal pulse
-raise legs to 60degrees, wait for 60 seconds, then ask them to dangle legs over -
check how long for skin to return to usual color 10sec, and veins to fill 15 sec
-examine for varicosities and palpate for tenderness

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ENDO
______

GA:
-------------------
-hypoTHY
.slow cognition
.lethargy
.jumper /cold

-hyperTHY
.weight loss
.anxious
.thyroid stare
.singlet
.sweating

-cushing
.hirsute
.moon
.buffalo
.bruising
.pregnant

HANDS:
-hypoTHY
. yellow palm - carotinemia
. palmar crease pallor - anemia (menorrhagia, AOCD)
. carpal tunnel

-hyperTHY
. oncholysis (graves)
. clubbing = acropachy (graves)
. tremor (paper test)
. palmar erythema (hyperdynamic circ)
.
-addison
. pigment

-acro
. spade
. sweaty
. OA
. carpal tunnel

ARMS:
-hyperTHY
. prox myopathy - ar raise + strength
. brachial reflex ++++
. pulse AF
-cushing
. prox myopathy
. pigment
. bruising
-acro
. acanthosis
. axilla skin tag

EYES
-hyperTHY
. exopthalmos
. chemosis
. conjunctivitis
. EOM - LR(CN6, abducens)
. acuity
. lid lag
-pituitary + acro
. visual fields - bitemporal hemianopsia
. papilloedema

FACE:
-hypoTHY
. yellow - carotinemia
. periorbital edema
. eyebrow hairloss
. glossitis / tongue swelling
-acro
. macroglossia
. prognathism
-cushing
. hirsute
. acne
. telangiectasia

NECK:
-hyperTHY
. inspect - front sides neck scar dilated veins
. drink water - view from side - goitre/thyroglossal cysts rises with drinking
. tongue poke out - thyroglossal cyst moves
. palpate from behind - size, soft (normal), rubber (hashi), hard (carcinoma),
tender (thyroiditis), mobile, thrill auscultated
. palpate from front - tracheal deviation
. auscultate bruit

CHEST:
-hyperTHY
. systolic murmur
-cushing
. striae
-acro
. gynecomastia

LEGS:
-hypoTHY or PAN-hypopituitary
. non pitting edema
. hung up achilles reflexes
-hyperTHY
. pre-tibial myoedema - pink/brown nodules (graves)
. motor power (prox myopathy)
. patellar reflex +++++
-acro
. foot drop
. hip OA

TESTS
-acro
. UA - glucose
. BP - hi
-addisons
. postural BP

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ANKLES/FEET - talley

On bed, legs/feet exposed

Look + compare normal to abn side: swelling, scars, deform (hallux valgus =
rheumatoid arth, sausage toes = ank spond/reiters/psoriatic arthropathy ),
nails/psoriasi, muscle wasting, transverse arch, longitudinal (flattening),
calluses over metatarsal heads on plantar surface occurs with subluxation of these
joints
Palpate
-temperature:
-lat + medial malleoli
passive mvmnt:
-talar ankle joint (plantar + dorsiflex)
-subtalar joint = inversion + eversion
-midtarsal rotation = fix hind foot/ankle with hand and try to inv/ev the rest of
the foot - tenderness ?
-MTP joints squeeze 1st and 5th joints together - tenderness ?
-IP joints - tender on movement ?
-mortons - press upward at base of MTP joints 3/4
-achilles
-heel - plantar fascitis

-pulses - dorsalis pedis/ posterior tibial

-reflexes
-sensation
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MSK

Head and Neck:

-TMJ - fingers front of tragus, open close mouth, tenderness, crepitus
-inspect neck, SCM, assymetry, abn posture
-palpate certical spine
-palpate trapezius
-palpate inter-scapular muscles and paraspinal mm

Neck ROM:
-active flexion
-active rotation, left, right
-active lateral flexion
-active extension

Hands and Wrists (look, feel, move, compare sides, assess function)
-expose to above elbow
- edge of bed + hands on pillow
-inspection - redness, rashes, atrophy, nail pitting/oncholysis/hyperkeratosis,
deformity, rash
.RA = ulnar deviation, Z-thumb deformity, boutonnierre, swan neck, volar
subluxation, swelling, warmth
.OA = heberdens, bouchards
-ask about pain before palpating
-make fist
-extend spread fingers
-flex wrists
-extend wrisits
-move hands laterally and medially

-palpate elbow for nodes

-palpate wrist - ulnar styloid tenderness
-palpate DIP and PIP between your index/thumb - tenderness, swelling, bogginess
-compress hand across knuckles - pain in MCP joints
-palpate each MCP between thumbs - tenderness, swelling, bogginess
-palpate each wrist between thumbs

-turn hands over and examine palmar surfaces - palmar erythmea, palmar creases,
wasting
-palpate for palmar tendon crepitus
-carpal tunnel syndrome
.phalens (wrists flexed for 30 sec causes tingling)

-active ROM - prayer sign

-passive ROM
.wrist flexion and extension, MCPs, fingers
.thumbs (palms up)
- extension against resistance (push out against me)
- abduction (push toward ceiling) against resistance
- adduction (push toward palm) against resistance
-opposition against resistance
-MCP + IPJ
.make fist over my fingers
-fingers - if flexion of any seems limited
.(palms down) hold finger, at DIP, ask them to wiggle the end of finger (flexor
profundus)
.(palms up) hold other fingers, extended, ask them to flex the problem finger
(flexor superficialis)
-function
.grip strength
.key grip
.oppositional strength
.undo button, write with pen
-neurological nerve assessment

Elbows - do both sides

-active flexion, extension
-active supination, pronation (these are at 90o flexion)
-flex to 70o, palpate elbow for pain lat/med epicondyle, thickening

Shoulders
-watch removal of shirt - limitation
-inspect FRONT + SIDES + BACL - for symmetry, acromioclavicular joints, deltoid
muscle wasting, scars, swelling
-passive + palpate at Acromioclav J - limitation, crepitus
.abduction to 90o
-active elevation
-active aduction
-active flexion and extension (palpate)
-active external rotation (hands behind head)
-active internal rotation (hands behind back)
-repeat flexion/ext/int rotation whilst palpating for crepitus
-palpate for pain - sternoclaviular J, acromial claviular, subacromial area, long
head of biceps tendon
-apley test (scratch opposite shoulder, scratch same side, scratch from below)
-apprehension test ()anterior stability) - stand behind, abduct 90o, flex forearm
90o, hold shoulder, push head of humerus forward with thumb

Feet and Ankles - compare sides

-supine
-inspect - redness, swelling, calluses, ulcers
-palpate anterial ankle joints between thumbs - swelling, bogginess, pain
-palpate achilles - nodules, tenderness
-MTP pain but compression
-palpate each MTP between thumb and finger
- ROM - dorsi + plantar flex ankles
- ROM - stabilise ankle with one hand and invert, evert
- ROM - invert, evert forfoot
- ROM - flex toes

KNEES (look, feel, move, compare sides, assess function)

-expose knees and thihs - valgus, varus
-observe walking, sit and stand from chair (folded arms)
-then bed at 45o
-inspect - alignment, deformity, quads atrophy, loss of patellar hollows
-active flexion, extension
-palpate quadricepts
-palpate knees for warmth and synovial swelling
-palpate suprapatellar pouch on each side of quads - thickening, swelling,
tenderness
-palpate each side of patellar - swelling, warmth
-bulge sign
.milk medial up displace fluid
.tap lateral patellar to see fluid flow back down
-balloon sign / patellar tap
.thumb and index on each side of patellar
.with other hand compress suprapatellar poounch back against femur - feel for
fluid rushing under your thumb and index finger = positive
.ballot patellar against femur to feel for fluid
-move patellar side/side
-push patellar distal and ask them to tense quads
-flex knee 90o - press with thumbs into tibial-femoral joint margin - tenderness
from damaged meniscus
-passive flexion, extension
-lateral and medial ligaments
.knee slightly flexed and foreleg taken under your arm pit as you push the knee
medially and laterally
-cruciate
.flexed to 90o, sit on their feet
.anterior and posterior draw tests
-meniscal
.external and internal rotation from flexion to extension
-prone
.bakers cyst (extended)
.

HIPS
-active flex (bend knee to chest)
-passive flex 90o, stabilize thigh, then internally and externally rotate
-passive abduction and feel contralteral ASIS move
-palpate - below inguinal for hip joint
-on side - palpate trochanteric tuberosity for trochanteric bursa
-on side - palpate ischial tuberosity for ischial bursa
-stand - observe front and behind
SPINE
-inspect curves, scholioss
-touch toes - scoliosis, lumbar curve should flatten
-standing - support hips from behind - lateral flexion + extension + rotation
-palpate spinous processes for tenderness
-palpate paravertebral muscles for tenderness and spasm
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