Introduction to Clinical Examination Flashcards
What is the order of examination techniques?
Inspection
Palpation
Percussion
Auscultation
What are the initial things you would say to the patient?
Identity of yourself and the patient. Check CHI number (date of birth followed by four random numbers)
Consent! (make sure to explain which parts of the body you will examine and why)
What position should the bed be?
45 degrees
What is the first stage of the general examination?
Initial assessment
What would you look out for in the initial assessment?
Conscious level
Facial expressions (pain and or discomfort)
Any signs of distress (fast respiratory rate or distressing cough)
Nutritional status
Build
Medic alert bracelet
Skin abnormalities:
- Excessive sweating
- Skin colour
- Rashes
- Pigmentation
Immediate environment:
- Oxygen masks
- Vomit bowl
- Medication devices
- Nasal tube
- Intravenous infusion
- Monitoring devices
Are they well enough for a detailed examination?
Check charts!
What is the normal range of body temperature?
36 - 37.5 degrees celcius
What do you look for when examining the nails?
Nail bed pale - blood vessels are vacoconstricted - Shock or anaemia
Nail bed is blue - blood is inadequately oxygenated - cyanosis
Leukonychia - Nails themselves go white - injury, liver disease, hypoalbumaenia
Spoon shaped nails - koilonychia - iron deficiency anaemia
Splinter hemorrhages - small areas of bleeding under the nail - trauma, infective endocarditis, vasculitis
Clubbing
Capillary refill - press on the nail bed for 5 seconds (normal = less than or equal to 2 seconds, 4 in the elderly)
How would you examine the patients joints?
Examine shape of joint - deformities or swollen areas
Before moving any of the joints, ask the patient to make a fist and then straighten their fingers - pain free? full movement? Consistency of swellings?
What aspect of the muscle in the hand might you look for?
Muscle wasting
What do you look for when examining the palms?
Palmar erythema - bright red warm palms (carbon dioxide) retention, hyperthyroidism, pregnancy
Pale palms - anaemia, local problem with blood vessels, shock, cold conditions
Palmar creases - pale - anaemia, hyperpigmented - addisons
Sweat and temperature
Contracture
What are the forms of tremor?
Coarse, fine or flapping
How long does it take to check if the patient has a flapping tremor?
15 seconds
What is checked after assessing tremor?
Pulse and breathing rate
What is important to look out for when examining the arms?
Joint deformity
Tattoos/bruising/pigmentation/rashes
Spider naevi
Scars or wounds
Venous damage due to intravenous drug use (track marks)
Assess turgor on forearm to determine hydration status - severe turgor means the patient is dehydrated
What do you look out for when examining the face?
Appearance including facial symmetry, colour and hair distribution
Specific facies (coarse facial features or acromegaly)
Ears - shape, swelling, gout tophi, hearing aid
Eyes - equal pupil size, jandiced sclerae, examine both conjunctivae
Lips - colour, presence of angular stomatitis
Buccal mucosa - pen torch to visualise any pigmentation or ulceration
Fauces - tonsils
Gum margin - swelling, state of dentition
Tongue - colour (central cyanosis), size, shape, movements, surface, texture and degree of moistness
What order do you examine the lymph nodes?
Supraclavicular Anterior cervical chain Submandibular Submental Pre and post auricular Occipital Posterior cervical lymph nodes
What do you check after the lymph nodes?
Anterior chest area
What do you look out for when examining the anterior chest area?
Skin lesions, spider naevi, campbell de morgans
Gynaecomastia
What do you check after the anterior chest area?
Lower limbs
What do you look out for when examining the lower limbs?
Skin - colour, hair distribution, evidence of ulceration or varicose veins
Temperature
Swelling - pitting oedema
Deformities- talipes or hallux valgus
Joint swelling
Skin thickness
Movement of toes
How do you close a general examination?
Let the patient know you have finished
Thank your patient
Give them privacy to redress
Clean you hands
What are the 5 moments for hygiene approach?
Before touching a patient Before a clean / aseptic procedure After body fluid exposure risk After touching a patient After touching a patient surroundings
