Medicine Bedside: General Examination

Question 1

Head

Answer 1

Facial features:

1. Acromegaly
2. Hyper / Hypothyroidism
3. Cushing’s syndrome
4. Erythema —> Lupus, Dermatomyositis, Mitral stenosis

Eye:

1. Ptosis
2. Heliotrope rash —> Dermatomyositis
3. Upper Sclera / Conjunctiva —> Yellow discolouration —> Jaundice
4. Lower Sclera / Conjunctiva —> Pallor
5. Pupil —> Size / Shape —> Pupillary reflex (CN examination)

Mouth:

1. Tight shiny skin around mouth —> Systemic sclerosis
2. Telangiectasia
3. Pallor
4. Central cyanosis
5. Pigmentation
6. Macroglossia —> Acromegaly

Neck:

1. Goitre / Neck mass —> Swallow test
2. Palpate thyroid —> Swallow test —> Movement + Nodules
3. Percuss upper sternum —> Retrosternal extension of goitre

Thyroid:

1. Size consistency —> Soft / Firm / Nodular / Diffusedly enlarged / Move readily on swallowing
2. Cervical LN
   - Normal: Rubbery + Mobile
   - Malignant: Firm + Fixed
   - Enlarged
   - Firm / Hard
   - Separate / Together
   - Attached to superficial / deep tissue
3. Bruit

Question 2

Hand / Upper limb

Answer 2

Joint

1. Deformity
2. Swelling

Nail
1. Pitting
2. Onycholysis
3. Nail fold infarct
4. Splinter haemorrhage
5. Clubbing
- Grade 1: floating sensation / fluctuation / softening of nail bed
- Grade 2: loss of angle between proximal nail fold (nailbed) and nail plate (nail) ∵ ↑ SC tissue
- Grade 3: increased longitudinal curvature of nail
- Grade 4: drumstick appear of fingertips
—> Cyanotic congenital heart disease
—> Infective endocarditis
—> Lung cancer
—> Chronic suppurative lung conditions (e.g. bronchiectasis, empyema) (X TB)
—> Liver conditions
—> GI (Crohn’s, UC)

Skin

1. Colour —> Pigmentation, Jaundice, Palmar erythema
2. Consistency
   - Tight and shiny —> Systemic sclerosis
   - Thin skin with Purpura —> long stem steroid therapy
   - Thick skin —> Acromegaly
3. Lesions
   - Psoriasis
   - Vasculitis
   - Purpura
   - Telangiectasia
   - Tophi
   - Nodules
   - Neurofibroma

Muscle

• Isolated wasting of thenar eminence —> Median nerve palsy
• Generalised wasting + 1st dorsal interosseous —> Ulnar nerve palsy

Hand tremor / fasciculations

1. Motor neuron disease
2. Syringomyelia
3. Polio
4. Dupuytren’s contracture —> contracted palmar aponeurosis

Pulse

LN

1. Epitrochlear LN
2. Axillary LN
   - Central lobe in apex
   - Mid axillary chest wall, medial + inside pectoral muscle
3. Subscapular LN
   - Posterior axillary fold
4. Lateral
   - facing humoral head

Question 3

Lower limb

Answer 3

1. Skin
   - rash
   - ulcers
   - pigmentation
2. Muscle
   - wasting —> neurological / DM / myositis
3. Knee, Ankle, Toes
   - joint swelling / deformity
   - peripheral edema
   —> gentle press on medial malleolus, along tibia
   - sacral edema

Question 4

General

Answer 4

1. Temperature

2. BP