The General Examination

Question 1

What are the sections in a General Examination

Answer 1

Initial Assessment
Introduction, Consent and Position of Patient
Examination of Hands
Examination of Arms
Examination of the Face
Examination of Lymph Nodes
Examination of Anterior Chest Area
Examination of Lower Limbs
Clousure

Question 2

What would you do in an Initial Assessment?

Answer 2

Consider any immediate interventions (Conscious level)
Consider if patient is well enough for an examination
Consider if patient is distressed
Examine immediate environment (O2 mask, vomit bowl, sputum pot, medication)

Question 3

What would you do in the Introduction, Consent and Position of Patient Section?

Answer 3

Clean hands
Introduce your name and status
Ask patients name + DOB. Check w/ Wristband/Charts
Obtain verbal consent (explain procedure)
Ask patient to remove necessary clothing
Position patient at 45 degrees
Adjust height of bed/trolley as needed

Question 4

What would you do in Examination of the Hands?

Answer 4

• Colour (tar staining)
• Nails: splinter haemorrhages, pitting, leuconychia, peripheral cyanosis, anaemia, koilonuchia and signs of finger clubbing
• Capillary Refill
• Shape of joints (deformities/swollen?)
• Ask patient to make fist + straighten fingers
• Muscle wasting
• Colour of Palmar Creases + Palmar Eythema
• Temperature of Palms
• Contractures (Duputrens)
• Radial Pulse + RR
• Tremor - fine, coarse, flapping

REMEMBER TO: Compare L+R and with own hands

Question 5

What would you do in Examination of the Arms?

Answer 5

• Joint deformity
• Bruising/Pigmentation/Rashes
• Spider Naevi
• Scars/Wounds
• Venous damage: IV Drugs/Medical Intervention
• Skin turgor on forearm

Question 6

What would you do in Examination of the Face?

Answer 6

• Appearance, Symmetry, Colour, Hair Distribution
• Specific Facies
• Ears - Shape + Swelling
• Eyes: unequal pupils, jaundice sclerae. Conjuntuvae. Eyelid position
• Lips: Colour + Presence of Angular Stomatitis
• Buccal mucosa: any ulceration or pigmentation
• Fauces: Tonsils
• Gum Margins: Swelling + Dentition
• Tongue: Colour, Size, Shape, Movements, Surface Texture and Degree of Moistness

Question 7

What would you do in Examination of Lymph Nodes

Answer 7

Supraclavicular, Anterior Cervical Chain, Tonsillar, Submandibular, Submental, Pre+Post Auricular, Occipital and Posterior Cervical Chain

Question 8

What would you do in Examination of Anterior Chest Area?

Answer 8

• Inspect and palpate any skin lesions e.g. spider nave

- Check for Gynaecomastia

Question 9

What would you do in Examination of the Lower Limbs?

Answer 9

• Skin: Colour, Hair Distribution. Ulceration/Varicose Veins
• Palpate temperature
• Swelling/Oedema
• Deformaties: Talipes or Hallux Valgus
• Joint swelling, skin thickening and inspect movements of toes

Question 10

What would you do in the Closure?

Answer 10

• Tell patient you have finished
• Thank Patient
• Allow them to redress
• Clean Hands