CARDIOVASCULAR EXAMINATION

1. Well /unwell
2. Comfortable / in pain / anxious
3. Clues : oxygen mask / nebulizer / sputum pot / others
4. Pale / cyanosed / breathless / coughing
5. Temperature

HANDS

1. Clubbing , splinter hemorrhages, good peripheral perfusion

PULSE

1. Rate, rhythm, volume, character

2. Brachial pulse , carotid, femoral, Peripheral pulses
3. Radio femoral delay

BLOOD PRESSURE & JVP

PALPATION

1. Apex beat : position and character

2. Heave & Thrill

AUSCULTATION OF HEART

1. First and second heart sound

2. Murmur
3. Left lateral position (mitral murmur)
4. Leaning forward in expiration (early diastolic murmur of AR)

AUSCULTATION OF LUNG

1. Pleural effusion, crackles

PERIPHERAL EDEMA (ankle, legs and sacrum)

PERIPHERAL PULSES (RADIAL, BRACHIAL, CAROTID, FEMORAL, POPLITEL, POST TIBIAL, DORSALIS PEDIS)

PALPATE LIVER

1. Enlarged?
2. Pulsatile (tricuspid regurgitation)
3. Ascites

FUNDOSCOPY
RESPIRATORY EXAMNATION

1. Well /unwell
2. Comfortable / in pain / anxious
3. Clues : oxygen mask / nebulizer / sputum pot / others
4. cyanosed
5. respiratory rate and pattern
6. breathlessness at rest
7. signs of respiratory distress – rapid respiratory rate, use of accessory muscles, tracheal tug,
intercostals recession, paradoxical abdomen movement, pursed lips
8. audible wheeze (large expiratory noise) or stridor (inspiratory sound)
9. Temperature
10. Clubbing or wrist tenderness (hypertrophic osteoarthropathy), flapping tremor

Chest inspection

1. Shape of chest wall and spine

2. Scars
3. Prominent vein (SVC obstruction)
4. Respiratory rate and rhythm
5. Chest wall movement (symmetrical or hyperexpanded)
6. Intercostals recession

Palpation

Tendernss, position of apex beat and chest wall expansion

Percussion

Auscultation

1. Breath sound, bronchial breathing, added sounds (crackles, rub, wheeze)

2. Diminishd/ absent sound : effusion, collapse, consolidation, fibrosis, pneumothorax, raised
diaphragam.
3. Bronchial breathing : consolidation, collapse, dense fibrosis above a pleura effusion
4. Vocal resonance and vocal fremitus
GASTROINTESTINAL EXAMINATION

1. Well /unwell
2. Comfortable / in pain / anxious
3. Clues : oxygen mask / nebulizer / sputum pot / others
4. Pale / jaundice / lymphadenopathy
5. Thin / obese
6. Systemic features of illness ( fever, tachycardia, hypotension, postural hypotension,
tachypnoea, dehydration and hypovolemia)
7. Signs of chronic liver disease (spider naevi, gynaecomastia, bruising, parotid hypertrophy,
Dupuytren’s contracture, excoriation, metabolic flap.)
8. Temperature

HAND

1. Clubbing, palmar erythema, Dupuytren’s contracture or metabolic flap.

MOUTH AND TONGUE

1. supraclavicular and other lymphadenopathy (virchow’s node or Troissier’s sign – left

supraclavicular lymphadenopathy due to spread from abdominal carcinoma).

INSPECTION OF ABDOMEN

1. distended, asymmetrical, masses, scars, visible peristalsis, stoma

PALPATION

1. Tenderness, rigidity, rebound tenderness, guarding.

2. Liver, spleen, kidneys

PERCUSSION

1. liver span and traube’s