General Examination

Question 1

What do we need to look/do for when examining the hands?

Answer 1

1. Colour: tar staining
2. Nails: Look for pitting, splinter haemorrhages, leuconychia, peripheral cyanosis, anaemia and signs of finger clubbing, koilonychia.
3. Check capillary refill
4. Joints: Any deformities or swollen areas, if there is full range of movement in all joints - gouty tophi may be present.
5. Muscle wasting
6. Palms: Colour of the creases and evidence of palmar erythema. Temperature and sweatiness of palms.
7. Contractures (shortened muscles)
8. Radial Pulse and Respiratory rate
9. Tremor: fine, coarse, flapping

Question 2

What 6 things do we look for when examining the arms?

Answer 2

1. Joint deformity
2. Tattoos/bruising/pigmentation/rashes
3. Spider naevi - a broken blood vessel of spider appearance
4. Scars or wounds
5. Track marks
6. Assess skin turgor on forearm to determine patient’s hydration.

Question 3

What do we look for on examination of the ears?

Answer 3

Inspecting for shape and localised swelling.

Question 4

What do we look for on examination of the eyes?

Answer 4

Inspect for unequal pupils and yellow jaundiced sclerae ( white of the eye).
Examine both conjunctivae (by asking patient to look skywards and pulling down eyelids) - if less red appearance then patient may have anaemia.

Question 5

What do we look for on examination of lips?

Answer 5

Angular stomatitis - inflammation of mouth and lips, with or without ulceration.

Question 6

What do we look for inside the mouth?

Answer 6

Check appearance of tonsils - fauces.
Check the buccal mucosa, see if there is any ulceration or pigmentation.
Check for swelling of the gums.
Check the tongue: any abnormal colour (if central cyanosis), size, shape, surface texture and how moist it is.

Question 7

How do we examine the lymph nodes?

Answer 7

Move the fingers in fluid motion across skin so no nodes are missed.

Begin with supraclavicular.
Then move on to the anterior cervical chain (up the neck).
Then submandibular.
Pre and post auricular (behind and in front of ear)
Finally the posterior cervical lymph nodes.

Question 8

How do we examine the chest?

Answer 8

First inspect the area - no need to touch if nothing abnormal is visible.
If something is abnormal, say Campbell de morgan spots (red benign skin lesions), then palpate and inspect.

Question 9

What 6 things do we look for on examination of the lower limbs?

Answer 9

1. Skin: the colour, hair distribution, evidence of ulceration or varicose veins.
2. Palpate the temperature
3. Swelling e.g. pitting oedema
4. Any deformities
5. Soles of the feet - verrucas may be present
6. Joint swelling, skin thickening, inspect movement of toes.

Question 10

What is leuconychia?

Answer 10

White spots appearing on the nails.

Question 11

How would peripheral cyanosis appear on nails?

Answer 11

Bluish discolouration

Question 12

What is palmar erythema?

Answer 12

Reddening appearance.

Potentially due to increased cardiac output, inflammation in area and many others.

Question 13

What is koilonychia?

Answer 13

‘spoon nails’

Abnormally thin nails that have lost convex shape and may appear concave… Is a sign of anaemia.