Res:

Greet examiner
Consent intro , curtain, chaperone, handwash

45 degre

Pallor, cyanosis
Clubbing
Ask for discomfort, subcutaneous pitting , no ankle edema
Back of bed-
Ask px to breath symmetrical , normal
No scar/ deformity
Resp rate 15 breaths per min
Cough strong/good quality, non productive

Cervical LN- no palpable mass.
Tracheal deviation
Apex no deviation
Expansion normal and symmetrical
Tactile fremitus resonant, normal

Percussion
Supraclav, clav, 3, 2. percussion notes = resonant and similar on both sides.
Back?

Auscultation
Same place vesicular breath sound, no added sound (no wheezing/ crepitation)
Same place 123 vocal resonant, no added sound, normal
Back?
-

Thank

CVS
Greet examiner
Intro
Consent curtain, chaperone
Handwash

45 degree supine

Pallor, jaundice, xantholasma
Tongue/ central cyanosis/ lips peripheral cyanosis

Hands clubbing, cyanosis, Ie signs (splinter haemorrhage, janewaylesion osler node)

Tell px will touch- subcutaneous pitting, no ankle edema

Pulse radial, COLLAPSING PULSE, carotid, JVP visible pulsation of chest /scar, lesion,

[JVP vs carotid filling from above jVP, not palpable, 2 peak, drop with inspiration, visible best at
45 degree, hepatojugular reflux]

Show chest
Scar, deform
Visible apex pulsation


Palpate:
Apex - -
Thrill
Parasternal heave

Auscultate bell apex axilla
4 area diaphragm
Carotid bruit
Apex AR
Crepitation

Thank

GI:
Greet examiner.
Consent- intro (), curtain, chaperone, handwash
SUPINE
- Nipple line to mid thigh exposure

Pallor, jaundice cyanosis
Clubbing atrophy
Bipedal edema ask for pain

Back of bed
Scar, deformity
leison
Visible bowel mvt
Hair distribution

Palpation: - I want to touch and percuss your belly, is there anywhere that you feel pain. ?
KNEEL
Light palpate , deep palpate 9 region no tender, no rigidity,
Palpate liver iliac fossa R- move up when expire; percuss
Palpate spleen iliac fossa R gardners line pull side hook spleen; percuss
Ballot kidney

Percuss shifting dullness, turn to my side

Auscultate 4 quadrants bowel sound and ileocecal valve.
Liver bruit, renal bruit (lateral of both side, above umbilicus), bowel sound.

Inguinal orifice, DRE

Thank and give clothes.

UG exam:
Greet examiner
Consent, curtain, chaperone, handwash + GLOVE
Lithotomy position, remove clothing

Hair, labia majora, clitoris (no megaly), labia minora, perineum; (no discharge no blood no lesion)
Cough no stress incontinence
Bear down - no uterovaginal prolapse, cystocele, no rectocele

Speculum (cusco bivalve speculum)tell, uncomfort, relax, tell pain
45 degree, down, open, lock
Torch lesion/discharge, bleed;
Ayres spatula. (sharp of nulliparous, other for parous 360degree; cervix brush rotate 5 times)
Spread of glass slide
Unlock, pull back slowly

Per vaginal exam - tell px
KY
Posterior cervix, bimanual
Left/ right stimulate reflex.
Adnexa bimanual -- no palpable abnormal mass
Remove finger discharge, blood.

Thank px, dress

Per rectal
Greet examiner
Consent inform, curtain, chaperone, handwash + GLOVE
KY

Left lateral position.
Inspect no lesion/scar/. abnormal mass/ no fistula, nor perineal change.
Tell put into anal canal unconform pain, relax
- Finger into anus slow dilate
Post lateral
Ant firm mass hard nodule, no palpable median sulcus.

Check tone

Check blood and discharge

Thank, Dress up px and explain finding


MSS

swab

ECG

SaO2

handwashing

IV drip