Hands + Arms

Question 1

Colour

Answer 1

e.g. tar staining of fingers

compare left and right

Question 2

Nails

Answer 2

Pitting of the nails
Splinter haemorrhages
Leuconychia (white discoloration on nails)
Peripheral cyanosis (Blueish discoloration)
Koilonychia (Spoon shape)
Clubbing

Question 3

What would you also check in nails?

Answer 3

Capillary refill time

normal time is less than 2 seconds

Question 4

What would you ask patients to do with their hands?

Answer 4

Make a fist, straighten fingers

Check for full movement of joints and if the movements are pain free

Question 5

What would you look for in the palms?

Answer 5

Colour of palm creases (stretch them) and evidence of palmar erythema (reddining of the outside of the palm)

Temperature and sweatiness

Question 6

Check radial pulse

Answer 6

Time for 15 seconds then multiply by 4.

Question 7

Tremor

Answer 7

Fine
Coarse
Flapping (ask patient to extend their arms with wrists flexed for 15 seconds)

Question 8

Inspect both arms for evidence of:

Answer 8

Joint deformity
Tattoos, bruising, pigmentation, rashes
Spider naevi
Scars or wounds
Venous damage due to intravenous drug use or medical intervention
Assess skin turgor on forearm to determine hydration status