How to do the exam

Question 1

How do you start the exam?

Answer 1

WIPE

Wash hands
Introduce Yourself
Patient Identity and DoB
Explain and consent. Exposure - nipples to pubic symphasis

Question 2

What do you look for on general inspection at end of the bed?

Answer 2

Surrounding area - drips, oxygen, drains, vomit bowel, catheter

Patient - Body habitus, well/unwell, pain, fever, jaundice

Question 3

What do you look for in the nails?

Answer 3

Koilonychia, Leuconychia, Clubbing

Question 4

What do you look for in the hands?

Answer 4

Dupuytren’s Contractures, palmar erythema, xanthomata,

Question 5

What do you look for in the arms?

Answer 5

Pulse (AV fistula), flapping tremor, track marks, scratch marks, bruising, tattoos

Question 6

What do you look for in the eyes?

Answer 6

Yellowing of sclera, conjunctival pallor, corneal arcus, xanthelasma

Question 7

What do you look for in the mouth?

Answer 7

angular stomatitis, glossitis, ulcers, central cyanosis, foector hepaticus,

Question 8

What do you look for on inspection of the chest?

Answer 8

Neck - Cervical lymph node examination look for Virchow’s Node. JVP.

Gynecomastia

Spider naevi - >5

Question 9

What do you look for on inspection of the abdomen?

Answer 9

Distention, caput medusa, everted umbilicus, scars, hernias, stomas

Question 10

What are 6Fs of causes of distention?

Answer 10

Fat, fluid, foetus, faeces, flatus, flipping big mass

Question 11

What do you do next?

Answer 11

Ask if in pain, then

Palpate - 9 areas, Liver, Spleen, Kidneys, for AAA

Question 12

What do you do next?

Answer 12

Percuss - liver, spleen, bladder (if mass felt), Shifting dullness (if ascites suspected)

Question 13

What do you auscultate?

Answer 13

Bowel sounds, renal bruits, liver bruits (if liver edge felt)

Question 14

How do you finish the exam?

Answer 14

Thank the patient, invite them to dress and wash hands

Offer - DRE, external genitalia exam, examination of legs, JVP, lymph nodes