1. Environmentgeneral appearance
2. Hydration
3. Postureweightbody shape
4. Vital signs
5. Nailshands
6. Head
7. Examination tips

Environment

General appearance

• Pre-exam checklist: WIPE:
  • Wash your hands
  • Introduce yourself to pt
  • Position pt
  • Expose the area
• Always examine from the R side of the pt.
• Ask pt. if tenderness anywherebefore start touching them.
• Skin colors. See Skin Colors Reference.

Postureweightbody shape

• If pt. entersexamine gait. See Gait.
• Posturestatureheight..
• Obesity [BMI = kg/m^2. Normal <25].
• Limb amputationsdeformities.
• Physique expected for age.

Hydration

• Sunken orbits.
• Mucus membrane dryness.
• Axillae.
• Skin turgor [pinch skin: normal returns immediately].
• Postural hypotension [less BP when sitstand].
• Peripheral perfusion [press nosetime capillary return].
• Examine weight loss over hours.

Vital signs

• Often logged on ward chart.
• See Taking Vital Signs Reference.

Nails

• Clubbing.
• Nail signs.
• Nail fold.
• See Nails Reference.

Hands

• Palms:
  • Palmar erythema (cirrhosispolycythaemiapregnancy).
  • Pigmentation of crease (Addison'sbut normal in asiansblacks).
  • Pallor of palmar crease. Better results if hyperextend fingersorstretch skin on either side of crease (anemia).
  • Dupuytren's contracture [fibrosiscontracture of palm's fascia] (liverdzepilepsytraumaelderly).
• Joints:
  • HerberdensBouchards (OA).
  • Swollen PIPdistal PIP spared (RA).

Head

• Hair: deficiencyexcess.
• Facial hallmarks (Down'sGrave'sacromegalyCushing'setc).
• Teeth: nicotine stains.

Examination tips

• Initial examination is from the foot of the bed.
• Always ask if any part tenderbefore touching pt.
• Watch pt's head as palpateto look for pain flinches.
• Percussion is R middle finger hitting middle of middle phalynx of L middlefinger.
• To measure circumference of limbschoose the bony landmark on eachmeasure down the correct distancethen take the circumference at thatpoint.

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