Examination

Question 1

Initial assessment?

Answer 1

Immediate intervention required?
Comfortable/dressed?
In pain?
Environment (medication/specimens etc.)
Charts
Clean hands

Question 2

General examination?

Answer 2

General appearance
Temp/pulse/resp rate
Skin - sweating, pigmentation changes, rashes, hydration
Colour - pallor, cyanosis, jaundice

Question 3

General examination - hands?

Answer 3

Palmar erythema
Finger clubbing
Tar staining
Wasting
Joint changes/nodes
Pigmented or pale palmar creases
Contractures
Tremor - coarse, fine or flapping

Question 4

General examination - nails?

Answer 4

Pitting
Leukonychia
Koilonychia
Splinter heamorrhages
Clubbing
Capillary refill

Question 5

General examination - arms?

Answer 5

Deformity
Hydration
Venepuncture marks
Scars
Bruising

Question 6

General examination - head and neck?

Answer 6

Face symmetry
Eyes: jaundice of sclera, pale conjunctiva, pupils
Ears, nose, mouth, teeth, gums, mucosa pigmentation
Lymphadenopathy - cervical and head nodes
Thyroid
Chest (necklace area)

Question 7

General examination - lower limbs?

Answer 7

Oedema
Ulceration
Varicosities
Feet

Question 8

Respiratory examination?

Answer 8

Respiratory rate
Shape of chest
Scars, skin lesions
Trachea central/deviated
Movements, expansion
Percussion
Breath sounds (vesicular or bronchial)
Added sounds (wheeze, crackles, rubs)
Vocal resonance

Question 9

Cardiovascular examination?

Answer 9

Radial pulse - rate, rhythm, volume, character
Blood pressure
JVP
Tracheal position
Precordium - apex beat (position), heaves and thrills
Heart sounds (S1 + S2 + 0)
Murmurs
Added sounds
Bruits (carotid, abdominal aorta, renal, femoral)
Aortic aneurysm
Peripheral oedema
Peripheral pulses
Varicose veins

Question 10

GI examination?

Answer 10

Mouth, tongue, fauces, teeth
Spider naevi, gynaecomastia
Abdomen:
- Shape/movement
- Distension (fat, faeces, flatus, fluid or foetus)
- Scars/stoma
- Tenderness/guarding/rebound
- Masses (soft, non-tender abdomen with no palpable masses)
- Palpation/percussion of liver, kidneys, spleen, bladder
- Bowel sounds
“to complete the GI examination I would check the hernial orifices, perform a digital rectal examination and an examination of external genitalia if indicated”

Question 11

Nervous examination?

Answer 11

Conscious level
Cognitive impairment
Speech (dysphasia, dysarthria)
Cranial nerves
Fundi
Upper and lower limbs
Motor: 
- inspection/observation
- tone/power
- co-ordination, reflexes and plantar response
Sensory:
- sensation if appropriate

Question 12

Cranial nerve examinations?

I, II, III, IV, VI

Answer 12

I - Olfactory: ask about sense of smell
II - Optic: visual acuity (snellen) and visual fields
III, IV & VI - Oculomotor, Trochlear and Abducens: pupillary reflexes, eye movements

Question 13

Cranial nerve examinations?

V, VII, VIII

Answer 13

V - Trigeminal: Sensation to divisions on the face, motor function (open jaw against resistance, palpate masseter, jaw jerk)
VII - Facial: muscles of the face, look for signs of facial paralysis, frown, wrinkle forehead, screw eyes shut
VIII - Vestibulocochlear: Hearing, repeat numbers whispered while rubbing opposite tragus, Rinnie’s and Weber’s tests

Question 14

Cranial nerve examinations?

IX, X, XI, XII

Answer 14

IX & X - Glossopharyngeal and vagus: vocalize vowel sounds, cough, observe movements of soft palate, uvula, say “aaah” and gag reflex
XI - Accessory nerve: Sternocleidomastoid bulk and test by pushing face against fist, shrug shoulders against resistance
XII - Hypoglossal: Inspect the tongue, wasting and fasciculations, stick tongue out, push tongue against cheek with resistance