1. CLINICAL SKILLS UNIT EDUCATIONAL LOOPS BY CHSE CSP 020401 GENERAL EXAMINATION

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

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

4. VITAL SIGNS Blood pressure Pulse Respiratory rate Temperature

5. 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

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

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

8. 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

9. 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

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

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

12. 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

13. EDUCATIONAL LOOPS BY CHSE