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Flashcards in Introduction to Clinical Examination Deck (22):
1

What is the order of examination techniques?

Inspection
Palpation
Percussion
Auscultation

2

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)

3

What position should the bed be?

45 degrees

4

What is the first stage of the general examination?

Initial assessment

5

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!

6

What is the normal range of body temperature?

36 - 37.5 degrees celcius

7

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)

8

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?

9

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

Muscle wasting

10

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

11

What are the forms of tremor?

Coarse, fine or flapping

12

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

15 seconds

13

What is checked after assessing tremor?

Pulse and breathing rate

14

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

15

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

16

What order do you examine the lymph nodes?

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

17

What do you check after the lymph nodes?

Anterior chest area

18

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

Skin lesions, spider naevi, campbell de morgans
Gynaecomastia

19

What do you check after the anterior chest area?

Lower limbs

20

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

21

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

22

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