Abdominal examination Inspection and peripheral signs Position: Patient flat with 1 pillow, top off, and trousers down to pubic symphysis. End of bed observation: Weight loss (cachexia). Abdominal distention. Causes are the 5Fs:  f at,  f luid (ascites),  f aeces (constipation),  f latus,  f etus. Is it central (viscous), or at the flanks (more fluid)? Obvious jaundice. Respiratory rate and pattern. Hands: Perfusion/temperature. Clubbing: IBD, cirrhosis, coeliac, GI lymphoma. Nails: leukonychia (white areas: ↓albumin), koilonychia (spoon-shaped nails: iron-deficiency anaemia). Palmar erythema and Dupuytren's contracture may be seen in chronic liver disease (CLD). Dupuytren's is also linked to phenytoin use and diabetes. Arm: Pulse and BP. Hepatic encephalopathy can cause flapping tremor: ask them to stick hands out and cock wrists. The co-ordinated extensor contraction and flexor relaxation required is not maintained, and as the hand drops they consciously jerk it back, produci

Background  Definitions Bacteriuria: bacteria in urine. May or may not be symptomatic. Significant bacteriuria: ≥10 5  colony forming units (CFU)/ml in mid-stream urine (MSU). UTI: significant bacteriuria + symptoms. Complicated UTI: UTI in the presence of certain risk factors, including renal or urinary tract abnormality, voiding difficulty, ↓kidney function, indwelling catheter, immunosuppression, or virulent organism (e.g.  Staph. aureus ). Recurrent UTI: reinfection (new organism) or relapse by same organism (usually within 2 weeks). No strict definition, but 2-3 per year is a common one. Abacterial cystitis: symptoms without bacteria. Sometimes occurs in women. Pathogens E. coli  (90%). Staph. saprophyticus : occurs in sexually active women. Proteus mirabilis : suggests kidney stones. Enterococcus faecalis : causes prostatitis. Klebsiella : usually in catheterised patients. Staph. aureus : from hematogenous spread. STIs: chlamydia, gonorrhea. Epidemiology Annual incidence: 1/10 wo

Limb motor examination   Mnemonic: O bserve  T he  P atient  R eally  F 'ing  C arefully. O bservation,  T one,  P ower,  R eflexes,  F unction,  C o-ordination. Observation Inspect carefully and for a good amount of time, moving around and crouching to make sure you properly look, including under feet and/or on both sides of hands (turn them over). Look for SWIFT: S carring, and ask if there's any you can't see. W asting I nvoluntary movements. F asciculations: take time, look in plane. T remor Upper limb: Ask if left or right handed. Pronator drift: have them extend arms palms up, eyes closed. If there is an UMN lesion, contralateral pronation is stronger, causing pronation ± drift. If there is a cerebellar lesion, the contralateral arm may drift upwards. Limb rebound: have them push their outstretched, upturned palms against your straight arm. If there is a cerebellar hemisphere lesion, the ipsilateral arm will jump up when you move your arm away. Tone First check there