High-Yield Clinical Exam Notes: Cranial OmpathStudy

MBIM 3100 — Clinical Techniques: Past Paper Notes Source: MKU past papers (CATs + Main Exams, 2016–2022) Compiled topics: Cranial nerves, Respiratory, Cardiovascular, Abdominal, CNS/Cerebellar, Neurology --- CRANIAL NERVES — HIGH-YIELD FACTS Nerve Key Function Clinical Clue --- --- --- CN V — Trigeminal Sensation: forehead, cheeks, lower jaw; Motor: mastication Most-tested CN in these papers CN VII — Facial Motor: face muscles; Sensory: anterior 2/3 tongue (taste) UMN vs LMN palsy distinction CN IX — Glossopharyngeal Taste + sensation: posterior 1/3 tongue "Cannot taste posterior tongue" CN III — Oculomotor Most eye movements, pupil constriction, levator palpebrae Ptosis + poor light reflex = CN III CN VI — Abducens Lateral rectus (SO4 LR6) Lateral rectus weakness = CN VI CN IV — Trochlear Superior oblique NOT lateral rectus CN XII — Hypoglossal Tongue movement (motor only) Not taste Meninges (superficial → deep): Dura mater → Arachnoid → Pia mater. Dura is most superficial. Pupillary reflexes: Direct reflex = pupil constricts when light shone into it Consensual = contralateral pupil constricts Accommodation = pupils constrict + converge bilaterally Snellen chart = visual acuity, NOT color blindness UMN vs LMN Facial Palsy: Feature UMN LMN --- --- --- Forehead sparing Yes (bilateral cortical supply) No — whole face affected Causes Stroke, brain tumor Bell's palsy, parotid tumor, infection Tone Spastic Flaccid --- RESPIRATORY EXAMINATION — HIGH-YIELD FACTS Breath sounds: Vesicular = normal; soft, low-pitched, over most of both lungs Bronchial = loud, harsh, pause between I and E; over consolidation Egophony = over consolidation / above pleural effusion level Percussion notes and their conditions: Note Condition --- --- Tympany Pneumothorax Hyperresonance COPD, emphysema, pneumothorax Dullness Consolidation, lobar collapse Stony dullness Pleural effusion Resonance Normal air-filled lungs Adventitious sounds: Stridor = partial obstruction of larynx/trachea — requires urgent attention Monophonic wheeze = focal bronchiole obstruction Rhonchi = widespread airway narrowing (asthma) Pleural friction rub = rubbing/grating; like two pieces of leather; pleuritis Crepitations/crackles = fluid in alveoli Stethoscope: Diaphragm = high-pitched sounds. Bell = low-pitched (heart murmurs, etc.) Consolidation vs Pleural Effusion: Feature Consolidation Pleural Effusion --- --- --- Vocal resonance Increased Reduced/absent Tactile fremitus Increased Reduced Percussion Dull Stony dull Breath sounds Bronchial Reduced/absent Pneumothorax findings: Decreased breath sounds, hyperresonance, decreased tactile fremitus, tracheal deviation away from affected side. Respiratory causes of finger clubbing: Lung cancer (including mesothelioma), pulmonary fibrosis, suppurative lung disease (bronchiectasis, abscess), cystic fibrosis. Bilateral reduced chest expansion causes: Bilateral pleural effusions, end-stage IPF, COPD, bilateral pneumothorax. Common causes of wheeze: Asthma, COPD, cardiac failure, foreign body, tumour. Kyphosis = exaggerated posterior thoracic curvature (hunchback). Lordosis = exaggerated lumbar curvature (swayback). Scoliosis = lateral spinal curvature. Cheyne-Stokes = slow→rapid→slow→apnea cycle; caused by heart failure, opioid OD, renal failure, meningitis. --- CARDIOVASCULAR EXAMINATION — HIGH-YIELD FACTS Heart sounds: S1 = closure of AV valves = start of systole; heard best at apex S2 = closure of semilunar valves = end of systole Lubb (S1) = AV closure; Dubb (S2) = semilunar closure Apex beat: Normal = 5th intercostal space, mid-clavicular line. Displaced laterally = cardiomegaly. JVP (Jugular Venous Pulse) vs Carotid: Arterial = wagging ear lobe, no variation with posture, not pulsatile hepatojugular reflux JVP = fills from above, varies with posture, positive hepatojugular reflux Patient lies at 45°; neck muscles relaxed; good lighting; timing with radial pulse NOT necessary Hepatojugular reflux — elevated in: constrictive pericarditis, right heart failure, restrictive cardiomyopathy. Associated with LEFT ventricular failure = FALSE. High output heart failure causes: Anaemia, sepsis, hyperthyroidism, thiamine deficiency (beriberi), Paget's disease, systemic AV fistula. Iron overload is NOT a classic cause. Narrow pulse pressure: Aortic stenosis, cardiac tamponade. Wide pulse pressure: Aortic regurgitation (collapsing pulse, dancing carotid). Left parasternal heave = right ventricular hypertrophy. Virchow's node = left supraclavicular lymph node; associated with GIT malignancies (especially gastric). Spider naevi: Can be normal in pregnancy; 5 suggest chronic liver disease. Bruit = swishing sound over artery; abnormal narrowing (atherosclerosis). Thrill = vibrating sensation on palpation of artery; abnormal finding. Capillary refill: Normal = less than 2 seconds. Claudication = cramp-like lower limb pain on walking; due to arterial insufficiency. Ischemia = decreased oxygenated blood supply due to arterial narrowing