What are the sections of a general exam?
Initial Assessment Introduction and Consent Hands Arms Face Lymph Nodes Anterior Chest Lower Limbs Closure
What do you do in the initial assessment, and introduction?
Initial assessment
- does patient need life-saving intervention?
- are they well enough to proceed with examination?
- inspect environment (oxygen, vomit, sputum, medication)
Introduction
- Clean hands
- My full and role
- Check patient’s full name and date of birth
- Confirm with wristband
- Explain procedure and obtain informed consent
- Position bed at appropriate height and patient at 45deg
- Check charts if available
What do you look for in the hands during a general examination?
Compare with own hands Colour - e.g. tar staining Nails - pitting - splinter haemorrhages - leuconychia, koilonychia - cyanosis - clubbing - capillary refill
Ask patient to make fists - check for pain
Inspect joints for deformities or swelling
Check hands for muscle wasting
Palm colour and crease colour
Temperature and sweatiness of palms
Tremor - fine, coarse, flapping (15 seconds)
Radial pulse and breathing rate
What do you look for in the arms during a general examination?
Joint deformity Bruising, pigmentation, rashes Spider naevi Scars/wounds Venous damage (IVDA, medical) Hydration via skin turgor
What do you look for in the face during a general examination?
Facial symmetry, colour Hair loss Coarse features e.g. acromegaly Ear shape/swelling Eyes - pupil, sclerae colour, conjuctivae, symmetry Lips - colour, angular stomatitis Buccal mucosa - pen torch Tonsils Gums Tongue - size, shape, colour, texture, dryness
What lymph nodes do you feel for in a general examination?
Supraclavicular Anterior cervical chain Tonsillar Submandibular Submental Pre auricular Post auricular Occipital Posterior cervical
What are you looking for in the chest during a general examination?
Inspect
Palpate any lesions
Spider naevi
Gynaecomastia
What are you looking for in the lower limbs during a general examination?
Skin - colour, ulceration Varicose veins Hair distribution Palpate temperature Swelling - oedema Deformities e.g. talipes or hallux valgus Joint swelling Toe movement
