Physical examination

Question 1

What should the physical exam focus on?

Answer 1

It is good practice to perform a brief CVS, RS, abdo, and neuro exam on all patients but focus your examination according to their history

Question 2

What are the first thing to be performed when doing a physical exam?

Answer 2

• Check vital stats (temp, BP, HR, RR, O2 sats)
• Ask a nurse to chaperone you if necessary
• Get consent before touching the patient, ask where it hurts
• First assess briefly whether the patient looks well or ill

Question 3

Purpose of the physical exam

Answer 3

• Can be considered the first investigation rather than an extension of the history
• To confirm, exclude, define, or show the progress of the provisional diagnosis as revealed in the history

Question 4

General things to focus on during physical exam

Answer 4

• End of the bed
• Face and body habitus
• Fluid status

Question 5

End of the bed exam

Answer 5

• Look at the patient as a whole, are they well, in pain (how does the pain make them move around), pattern of breathing, weight, behavior, smell, etc.
• Also take a moment to look around the bed for other clues, eg inhalers, insulin administration kit, walking aids, etc

Question 6

Explain face and body habitus

Answer 6

• Does the patient’s appearance suggest any particular diseases?
• Is there an abnormal distribution of body hair suggestive of endocrine disease?

Question 7

What features should be assessed for all systems?

Answer 7

• Skin colour (e.g. cyanosis, jaundice, pallor, hyperpigmentation)
• Charts (BP, temp, analysis performed)

Question 8

Fluid status importance and how to check for it

Answer 8

• When admitting an unwell patient, don’t forget to assess their hydration, check skin turgor and mucous membranes, look for sunken eyes, and check
  capillary refi ll (if well perfused<2s) and JVP.