Head to Toe

Question 1

1. Introduction

Answer 1

1) Introduce myself
2) Confirm patient name
3) Wash hands and don PPE as appropriate
4) End of bed assessment
5) Level of alertness
6) Mini-mental Ax
Complete observations

Question 2

2) Stand the patient up

Answer 2

1. Assess gait
2. Inspect the spine
3. Palpate the spine from the head to the sacrum, sacroilliac joints and paraspinal muscles
4. Percuss costovertebral angle
5. Movement of spine
6. Rombergs test
7. Protinator drift
   Sterogenosis

Question 3

3) Sit patient on a chair

Answer 3

1. Inspect nail bed, hands, wrists and hold out hands
2. Assess capilary refill time
3. Palpate hands and wrists
4. Palpate radial pulse
5. Describe respiration rate
6. Ask patient to make a fist, splay fingers and squeeze your fingers
7. Active movement wrists
8. Passive movement of wrists and check tone
9. Inspect and palpate radius and ulna
10. Inspect elbow
11. Palpate elbow
12. Active movement of elbow
13. Passive movement of elbow and check tone
14. Inspect shoulder
15. Active movement of shoulder
16. Passive movement of shoulder and check tone
17. Inspect and palpate scalp
18. Palpate temporal pulses
19. Palpate sternocleidomastoid muscles
20. Palpate thyroid
21. Palpate Lymph nodes
22. Palpate Sternoclavicular joint, along the collar bone and acromioclavicular joint
23. Active neck movements
24. Upper limb myotomes
25. Upper limb dermatomes
26. Inspect skin
27. Inspect Face
28. Palpate maxillary sinus and frontal sinus
29. Inspect eyes
30. Inspect mouth + lips
31. Inspect nose
32. Inspect ear
33. Palpate ear
34. Look in ear with otoscope
35. Cranial nerves

Question 4

4) Sit patient on end of bed

Answer 4

1. Inspect posterior chest
2. Palpate posterior chest
3. Posterior chest expansion
4. Posterior tactile fremitus
5. Percuss posterior chest (NB- percussion only penetrates 5-6cm deep)
6. Auscultate posterior chest
7. Palpate for sacral oedema

Question 5

5) Lying patient flat

Answer 5

1. Inspect abdomen
2. Auscultate abdomen (Prevent disturbance of gas and to reduce guarding/ridgity in a peritonitc abdomen)
3. Listen for bruits
4. Percuss all quadrants
5. Percuss the liver
6. Percuss the spleen
7. Percuss the bladder
8. Light palpation of the abdomen
9. Deep palpation of the abdomen
10. Palpate the liver
11. Palpate the gallbladder
12. Palpate the spleen
13. Ballot the kidneys
14. Palpate the bladder
15. Inspect lower limbs
16. Look at feet and ankles
17. Proprioception
18. Feel ankles
19. Active movement of ankles and toes
20. Test power of ankle plantarflexion (S1) and dorsiflexion (L4)
21. Passive movement of ankles and check tone
22. Palpate the doralis pedis pulse and popliteal pulse
23. Inspect calves
24. Palpate calves
25. Look at knee
26. Feel the knee
27. Active movement of the knee
28. Passive movement of the knee
29. Assess power of Knee flexion (S1) and knee extension (L3)
30. Look at the hip
31. Active movement of the hip
32. Assess power of Hip flexion (L2) and Hip extension (L5/S1/S2)
33. Passive movement of the hip
    Assess lower limb dermatome

Question 6

Lie patient at 45’ angle

Answer 6

1. Inspect anterior chest
2. Palpate trachea
3. Palpate anterior chest- chest wall, heaves, thrills and apex
4. Anterior chest expansion
5. Tactile fremitis of anterior chest
6. Percuss the anterior chest
7. Auscultate anterior chest
8. Listen to heart sounds (including auxilla)
9. Auscultate carotid artery
10. Palpate the carotid pulse
11. Measure JVP
12. Co-ordniation test