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0. Preparing patient. (5)
- Gain verbal consent,
- perform hand hygeine,
- Ask for exposure from waist up,
- Bed at 45 degrees,
- Approach from right,
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1. General inspection from head of bed. (6)
- pallor,
- body habitus,
- hydration,
- fever,
- pain or distress,
- muscle wasting
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2. Looking around the bed (5)
- medications
- eating/drinking,
- mobility aids,
- feeding tubes,
- NBM, diabetic indications etc.
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3. Examine nails and hands. (8)
- clubbing,
- koilonychia,
- leukonychia,
- palmar erythema
- tremor
- skin temperature
- asteriksis
- pruritis
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5. Blood pressure (1)
Take it!
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5. Examine face (4,1,6)
- pallor,
- jaundice,
- spider naevi,
- parotid swelling
- scleral jaundice
- angular stomatitis,
- glossitis,
- dehydration,
- mouth ulcers,
- dental hygeine
- halitosis
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6a. Lymphadenopathy (11)
- submental, submandibular,
- upper cervical,
- preauricular, postauricular,
- middle cervical, pretracheal,
- lower cervical,
- supraclavicular (and Virchow's node),
- posterior triangle and occipital
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6b. upper thorax (2)
- spider naevi,
- gynaecomastia
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7. Reposition patient (2)
- bed at 0 degrees.
- expose chest.
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8. Examine abdomen (15)
- scars, swellings + distended veins,
- umbilicus
- superficial palpation, watching face
- Deep palpation with flat of fingers
- Palpate for liver then percuss edge,
- Murphy's sign / Couvoisier's law
- Palpate for spleen then percuss edge
- Ballott for kidneys
- Percuss for bladder
- Percuss for ascites.
- shifting dullness if necessary
- Auscultate for bowel sounds
- kidneys bruits.
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9. Check legs (4)
- pitting oedema,
- pyoderma gangrenosum
- sacral oedema if patient well
- kidney tenderness.
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10. To finish examination (7)
- hernial orifices
- external genitalia
- Digital rectal examination
- General observations (HR, BP, temp, RR)
- Stool sample
- Urine sample
- liver function tests
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