CLINICAL SKILLS UNIT EDUCATIONAL LOOPS BY CHSE CSP GENERAL EXAMINATION

FIRST IMPRESSIONS How sick does the patient appear ? - lying in bed - sitting up in bed - walking around Hair distribution Body habitus Posture

HYDRATION approximate estimation mild, moderate, severe Signs: -skin turgor (supraclavicular / back of the hand) - mucous membranes - sunken orbits - collapsed veins - dry cracked lips

VITAL SIGNS Blood pressure Pulse Respiratory rate Temperature

FACIES Acromegaly Acromegaly Cushing’s Cushing’s Down syndrome Down syndrome Marfan’s Marfan’s Mitral facies Mitral facies Turner’s Turner’s Thyrotoxic Thyrotoxic Etc. etc. etc Acromegaly Cushing’s Thyroid stare

HANDS & NAILS abnormalities muscle wasting temperature sweating shape infection Splinter haemorrhages Koilonychia Clubbing Leuconychia

HEAD and NECK 1.EYES arcus senilus xanthelasma xanthelasma jaundice (serum bilirubin > 2x upper limit normal; elastin) pallor (anaemia) cataracts drooping eyelids xanthelasma

HEAD and NECK 2. MOUTH central cyanosis pallor (mucous membranes; frenulum) angular cheilitis (Fe deficiency) smell: sweet breath – liver failure acetone - DKA cigarettes Deoxygenated Hb > 50g/L  bluish tinge

NECK 1.LYMPH NODES 1 sub-mental 2 sub-mandibular 3 cervical (jugular chain) 4 supra-clavicular 5 posterior triangle 6 post-auricular 7 pre-auricular 8 occipital

NECK 1.THYROID Inspection: scars, swelling, mass Palpation: enlarged / mass swelling

NECK AXILLARY NODES A – central / apical B – lateral / brachial C – medial / pectoral D – infraclavicular E – subscapular / posterior

LYMPH DRAINAGE OF GROIN REGION 1.Horizontal or inguinal group inguinal ligament 2.Femoral or vertical group femoral vessels The lower limb. From buttocks and back, Lower abdomen, umbilical region, penis, perineum, lower vagina and anus

EDUCATIONAL LOOPS BY CHSE