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#TUNING FORK FOR MEDICAL STUDENTS SKIN#

Palpate the pulse to confirm its presence and then compare pulse strength between the feet.The posterior tibial pulse can be located posterior to the medial malleolus of the tibia.Absence of peripheral pulses is suggestive of peripheral vascular disease. Palpate the posterior tibial and dorsalis pedis pulse to briefly assess peripheral perfusion.

A cool and pale limb is indicative of poor arterial perfusion.

In healthy individuals, the lower limbs should be symmetrically warm, suggesting adequate perfusion.

Place the dorsal aspect of your hand onto the patient’s lower limbs to assess and compare temperature:

Venous guttering: veins that have very little blood within them due to poor blood supply to the limb, hence the “guttered” appearance.

Foot calluses: often caused by an abnormal gait and/or poorly fitting footwear.

Hair loss: occurs due to chronic impairment of tissue perfusion in PVD.

Scars: may indicate previous surgical procedures (e.g.

Missing limbs, toes, fingers: due to amputation secondary to critical ischaemia.

red, black) and breakdown of the associated tissue.

#TUNING FORK FOR MEDICAL STUDENTS SKIN#

Typical appearances include a change in skin colour (e.g. Gangrene: tissue necrosis secondary to inadequate perfusion.These ulcers most commonly develop in the most peripheral regions of a limb (e.g. Arterial ulcers: typically small, well-defined, deep ulcers that are very painful.

These ulcers most commonly develop over the medial aspect of the ankle. Venous ulcers: typically large and shallow ulcers with irregular borders that are only mildly painful.Peripheral pallor: a pale colour of the skin that can indicate poor perfusion.may be present in PVD due to poor perfusion). Peripheral cyanosis: bluish discolouration of the skin associated with low SpO 2 in the affected tissues (e.g.Inspect the lower limbs for relevant pathology, making sure to look at the posterior aspect of each leg and between each of the toes for hidden ulcers: Violins, cellos, and other stringed instruments have similar relations between their strings.You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.Then use the 5th fret of the D string to find the pitch for the G string, and continue the process for the rest of the guitar. Tune the D string until it sounds the same as the A string, 5th fret. Since the D string is the next string above the A, it should produce the same note as the A string, 5th fret. If you press the 5th fret of the A string, it produces a D note. To tune a guitar by ear, for example, you can use the A string to find the pitch for the D string, the string above it. All instruments are stringed differently and have a different process for tuning by ear.Use your A string as a reference to tune the rest of the instrument. Playing the 5th fret of a string produces the same note as the string above it. Most stringed instruments in standard tuning are tuned in fifths, meaning that the strings are 5 notes apart. With the A string in tune, you can now tune the rest of the strings by ear. Tune the rest of your strings in relation to the A string.