Introduction to Clinical Examination

Question 1

What is the order of examination techniques?

Answer 1

Inspection
Palpation
Percussion
Auscultation

Question 2

What are the initial things you would say to the patient?

Answer 2

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)

Question 3

What position should the bed be?

Answer 3

45 degrees

Question 4

What is the first stage of the general examination?

Answer 4

Initial assessment

Question 5

What would you look out for in the initial assessment?

Answer 5

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!

Question 6

What is the normal range of body temperature?

Answer 6

36 - 37.5 degrees celcius

Question 7

What do you look for when examining the nails?

Answer 7

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)

Question 8

How would you examine the patients joints?

Answer 8

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?

Question 9

What aspect of the muscle in the hand might you look for?

Answer 9

Muscle wasting

Question 10

What do you look for when examining the palms?

Answer 10

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

Question 11

What are the forms of tremor?

Answer 11

Coarse, fine or flapping

Question 12

How long does it take to check if the patient has a flapping tremor?

Answer 12

15 seconds

Question 13

What is checked after assessing tremor?

Answer 13

Pulse and breathing rate

Question 14

What is important to look out for when examining the arms?

Answer 14

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

Question 15

What do you look out for when examining the face?

Answer 15

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

Question 16

What order do you examine the lymph nodes?

Answer 16

Supraclavicular
Anterior cervical chain
Submandibular
Submental
Pre and post auricular
Occipital
Posterior cervical lymph nodes

Question 17

What do you check after the lymph nodes?

Answer 17

Anterior chest area

Question 18

What do you look out for when examining the anterior chest area?

Answer 18

Skin lesions, spider naevi, campbell de morgans

Gynaecomastia

Question 19

What do you check after the anterior chest area?

Answer 19

Lower limbs

Question 20

What do you look out for when examining the lower limbs?

Answer 20

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

Question 21

How do you close a general examination?

Answer 21

Let the patient know you have finished

Thank your patient

Give them privacy to redress

Clean you hands

Question 22

What are the 5 moments for hygiene approach?

Answer 22

Before touching a patient
Before a clean / aseptic procedure
After body fluid exposure risk
After touching a patient
After touching a patient surroundings