Introduces self
0
1

Confirms name & age of patient
0
1

Explains & gains consent
0
1

Washes hands
0
1

Exposes patient from nipple to knees and lies them flat
0
1

Asks if patient is in pain
0
1

General inspection around bed and patient for scars, distension, stoma sites, hernias, drains and lines
0
1

Inspects hands for clubbing, leukonychia, koilonychia, dupuytren's contracture, palmer erythema
0
1

Looks for asterixis (liver flap)
0
1

Inspects eyes for jaundice, conjunctival pallor, xanthelasma
0
1

Inspects mouth for Peutz-Jeghers brown freckles, central cyanosis, macroglossis, glositis, dryness, ulcers
0
1

Offers to inspect jugular venous pulse
0
1

Inspects chest for loss of axillary hair, gynecomastia and spider naevi
0
1

Feels Virchow's node in the left supraclavicular fossa
0
1

Inspects abdomen closely for masses, hernias, scars, peristaltic movements
0
1

Asks patient to cough to bring out any hernias
0
1

Palpates all regions lightly whilst looking at patient for signs of pain. Also looks for guarding, rebound tenderness and rigidity
0
1

Palpates deeply for masses and tenderness
0
1

Identifies features of masses (site, size, shape, edge, consistency, percussion note, bowel sounds)
0
1

Palpates for liver from right iliac fossa on deep breathing. If enlarged, describes edge
0
1

Palpates for spleen from right iliac fossa to left hypochondrium
0
1

Ballots kidneys on inspiration
0
1

Feels for an aortic aneurysm
0
1

Percusses for the upper and lower borders of the liver
0
1

Percusses for the spleen asking patient to roll over to percuss behind
0
1

Percusses for suprapubic dullness (bladder distension)
0
1

Percusses for shifting dullness of ascites (waiting 30 seconds after patient rolls over)
0
1

Auscultates for bowel sounds for at least 30 seconds
0
1

Auscultates for renal and aortic bruits
0
1

Thanks patient and offers help to redress
0
1

Washes hands
0
1

Requests full inguinal exam including examination of the external genitalia, digital rectal examination and urinalysis
0
1

Summarise appropriately with only key findings.
0
1

Offer appropriate differential diagnoses.
0
1

Patient global score
0
1
2

Potential differentials
  • Renal transplant (iliac fossa scar with underlying kidney, look for AV fistula and palpable kidneys suggestive of polycystic kidney disease and oral candida/bruising for steroids)
  • Scars - have differentials ready for the common scars
  • Hernias - perform a quick hernia exam
  • Stomas - examine the stoma identifying the type (ileostomy, colostomy)
  • Enlarged liver - cirrhosis (80%), carcinoma, cardiac failure, infectious