Checklist
Wash hands, introduce yourself, consent patient.
- OBSERVATION
- End of bed assessment – work of breathing
- Monitors – oxygen requirement
- Drain tubes/catheter bag
- HANDS
- Tremor
- Asterixis
- Clubbing
- Pallor
- VITALS
- NECK
- Tracheal deviation
- JVP
- Cervical nodes
- FACE
- Eyes: Horner’s (ptosis, miosis, anhydrosis)
- Mouth: hydration, central cyanosis, thrush
- Sinus tenderness
- Septum deviation
- POSTERIOR CHEST (note: perform anterior first on the ward/poor mobility
- Inspect: deformities, scars, drain tubes
- Palpate: chest wall expansion, sacral oedema
- Percuss: consolidation
- Auscultate: lung sounds
- ANTERIOR
- Inspect: deformity, scars
- Palpate: apex beat
- Percuss: anterior lung
- Auscultate: anterior lung, heart sounds
- ABDOMEN
- Liver edge
- LEGS
- Peripheral oedema
- Calf tenderness
Omissions
Vocal fremitus. Omitted for brevity – this is probably the longest single system exam you can perform. However Dennis’ “Mechanisms of Clinical Signs” suggests it has a specificity and sensitivity of 82% and 86% respectively. The author has seldom seen this in clinical practice – in the practiced student it is likely to earn extra marks in the exam setting time-permitting.