General examination

Question 1

Background

Answer 1

Examine patient from RHS bed from soon as you walk in (first impressions, pallor, unwell, dress, hygiene, posture and gait)
Introduction, explain nature of exam- hello my name is im a, today i’ve been asked by one of the drs to perform a general examination-n this will involve me having a look at you from the end of the bed, your hands,
HANDWASHING

Question 2

Procedure

Answer 2

prepare patient using sensitive approach, ensuring setting is appropriate.
There should be adequate exposure of relevant body part, for minimum time necessary- most exams at 45 degrees
ABCD

Question 3

A- Appearance

Answer 3

Ill/well?
Comfortable/ distressed?
Any recognisable syndrome?
Well nourished/hydrated?
Any other striking observations from bedside?

Question 4

B- Behaviour

Answer 4

How is patient behaving?

Calm? Sedated? Anxious? Restless? Confused?

Question 5

C- Connections to environment

Answer 5

Observe how patient connected to environment- surroundings: O2 mask, inhalers, sputum container, IV fluids/drips, walking aid?

Question 6

D- Detailed inspection of hands and face (hands)

Answer 6

Observe hands and face carefully
Hands- clubbing (, examine nails: pitting? splinter haehorrages from trauma or infective endocarditis?
Skin creases- pale palmar crease, anaemia
Small muscle wasting- thenar/hypothenar eminences, joint swelling (rheumatoid arthritis dorsum wastage)
-Duputyren’s contracture
-Nicotine staining- CO2 retention (warm, distended veins, bounding pulse, xanthoma
Peripheral cyanosis

Question 7

Face and neck

Answer 7

Sclera of eyes for jaundice, conjunctiva/ eyelid for anaemia
Xanthelasma of eyelids
Teeth tongue and mouth-
Central cyanosis- lips mucousal membrane
Neck for lymphadenopathy&raquo_space; full systems review