General Examination

Question 1

What are the 10 steps during a general examination?

Answer 1

Initial Assessment
Intro, Consent and Position of Patient
Examination of the Hands
Examinations of the Arms
Examination of the Face
Examination of Lymph Nodes
Examination of Anterior Chest Area
Examination of Lower Limbs
Closure
Documentation

Question 2

What does an initial assessment involve?

Answer 2

Check any paperwork
What is the patient’s appearance
Are there any cognitive or mental state changes
Is there anything in the patients enviornment to consider - Medical equipment, waling aids, medication, carer/relative
REFLECT - do they require an urgent assessment (ABCD) or treatment, any steps which could be done to improve consultation

Question 3

What does Intro, Consent and Position of Patient involve?

Answer 3

1. Clean your hands
2. Intro - name + status
3. Ask patient’s name and date of birth - check with ID band(s) + charts
4. Obtain verbal consent - explain what you would like to examine and what this will involve
5. Position the patient semi reclining at 45 degrees
6. Adjust the height of the bed/trolley for your comfort

Question 4

What does examination of the hands involve?

Answer 4

COMPARE R AND L
inspecting:
- colour
- nails
- capillary refill time
- shape of joints - deformities or swollen areas
- muscle wasting
- palms - colour of creases + evidence of palmar erythema
- temp + sweatiness
- contractures
- radial pulse + RR
- Tremor - fine, coarse, flapping

Question 5

What does examination of the arms involve?

Answer 5

inspect for:
- joint deformity
busing/pigmentation/rashes/skin lesions
- scars or wounds
- track marks or medical intervention
Assess skin turgor on forearm to determine hydration status

Question 6

What does examination of the face involve?

Answer 6

• overall appearance including facial symmetry, colour and hair distribution
• specific facies
• ears - shape + localised swelling
• eyes - unequal pupils + jaundiced sclerae, not eyelid position and asymmetry
• Lips - colour + presence/ absence of angular stomatitis
• buccal mucosa - use pen torch to visualise any ulceration or pigmentation
• Fauces - wooden spatula to examine the tonsils
• Gum margins - swelling + state of dentition
• Tongue - abnormal colour (central cyanosis?), size, shape

Question 7

What does examination of lymph nodes involve?

Answer 7

order of:
1. supraclavicular
2. anterior cervical chain (including tonsillar nodes)
3. submandibular
4. submental
5. pre and post auricular
6. occipital
7. posterior cervical

Question 8

during the examination of the lymph nodes where should you be standing?

Answer 8

behind your patient

Question 9

What does examination of the anterior chest area involve?

Answer 9

inspect and palpate any skin lesions
check for gynaecomastia

Question 10

What does examination of the lower limbs involve?

Answer 10

skin - colour, hair distribution, evidence of ulceration or varicose veins
palpate the temp
swelling - examine for pitting oedema
deformities
note any joint swelling, skin thickening and inspect movement of toes
REMEBER TO LOO AT THE SOLES OF THE FEET