Medical Student Survival Skills

Clinical Examination

Philip Jevon, Elliot Epstein, Sarah Mensforth, Caroline MacMahon

• Publisher: Wiley-Blackwell
• Year: 2019
• Print ISBN: 9781118842010
• eBook ISBN: 9781118842034
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Education

Medical students encounter many challenges on their path to success, from managing their time, applying theory to practice, and passing exams. The Medical Student Survival Skills series helps medical students navigate core subjects of the curriculum, providing accessible, short reference guides for OSCE preparation and hospital placements. These guides are the perfect tool for achieving clinical success.

Medical Student Survival Skills: Clinical Examination provides step-by-step guidance on the physical evaluation of the body and its functions. This portable and concise guide leads readers through each component of a clinical examination, including cardiovascular, respiratory, gastrointestinal and peripheral arterial and venous system exams. OSCE key learning points, exam preparation lists, practical tips, website access for videos and OSCE checklists help medical students and junior doctors efficiently perform a clinical examination.

1
Examination of the cardiovascular system

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NB Systematic approach: inspection, palpation, percussion, and auscultation.

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Preparation

• Cross infection: wash and dry hands, bare below the elbow
• Introductions: yourself and the task; confirm patient's name and age
• Consent: to the procedure
• Pain: is the patient in pain
• Privacy: ensure privacy, e.g. curtains drawn around bed
• Position: ideally on the bed at 45° – if this is not possible, report that back to the observer
• Exposure: from the waist up, may not be appropriate to expose from the start of the exam for female patients

The peripheries

Inspection

• Environment: fluid restriction, glyceryl trinitrate (GTN) spray, oxygen, infusions, cardiac monitor
• Patient: breathlessness, distress, position, orthopnoea, pallor

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  NB Before you take their hand, double check again about pain.

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• Hands
  • Observe colour (pallor or peripheral cyanosis)
  • Feel for temperature
  • Measure capillary refill time (CRT) (Box 1.1): normal CRT < 2 seconds
  • Look for tendon xanthomata (Figure 1.1), tar staining, clubbing, splinter haemorrhages (Figure 1.2), Janeway lesions, and Osler’s nodes

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Box 1.1 Measuring CRT

• Raise extremity (e.g. finger) slightly above the level of the heart
• Blanche the skin for 5 seconds and then release
• Note the CRT (normal is < 2 seconds; prolonged CRT > 2 seconds may be caused by circulatory shock, pyrexia, or a cool ambient temperature

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Figure 1.1 Tendon xanthomata – usually indicates hypercholesterolemia.

Figure 1.2 Splinter haemorrhages – may be seen in infective endocarditis.

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OSCE Key Learning Points

• Stigmata of infective endocarditis include splinter haemorrhages, Janeway lesions/Osle...

Table of contents

• Cover
• Table of Contents
• Acknowledgements
• About the companion website
• 1 Examination of the cardiovascular system
• 2 Examination of the respiratory system
• 3 Examination of the gastrointestinal system
• 4 Examination of the genitourinary system
• 5 Examination of the neurological system – cranial nerves
• 6 Examination of the neurological system – upper limb
• 7 Examination of the neurological system – lower limb
• 8 Examination of musculoskeletal system – the hands
• 9 Examination of the musculoskeletal system – the shoulder
• 10 Examination of the musculoskeletal system – the knee
• 11 Examination of the musculoskeletal system – the hip
• 12 Examination of the peripheral arterial system
• 13 Examination of the peripheral venous system
• 14 Examination of the neck
• 15 Examination of the breast
• Index
• End User License Agreement