Summary
Summary Physical Examinations for Clinical skills Exam
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These provide an overview of the possible Physical Examinations that you can be asked to be performed during the Clinical Skills Exam in Year 3.
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InspectionSpe cif ic inspe ct ion of he art :
1. Thorax Shape
a. Pectus exacavatum (funnel chest)
i. compression of heart by sternum)
b. Pectus Carinatum (pigeon chest)
2. precordial pulsations and retractions
a. Apex beat
b. Right ventricular impulses & retractions
c. other pulsations & retractions
Auscultation
1. Bre at hing
a. RR --> 20 per minute
Locat ions:
b. >20/min = tachypnoea
• Erb's point --> Left parasternal 3rd ICS
c. <20/min = dyspnoea
• Aortic Orifice --> Right Parasternal 2nd ICS
i. dyspnoea on exertion
• Pulmonary Orifice --> Left parasternal 2nd ICS
ii. dyspnoea ate rest
• Tricuspid Orifice --> Left parasternal 4th/5th ICS
iii. Orthopnoea (lying down)
• Mitral Orifice --> Left Mid Clavicular 4th/5th ICS
2. Oe de ma
a. pitting vs. non-pitting
b. check periosteum, perimalleolar, dorsum of foot Aspe ct s t o Pay At t e nt ion t o:
c. bilateral -> in cardiac problems • Heart Rhythm
3. Colour of skin, lips & t ongue • Heart Rate
a. Peripheral cyanosis (purple/blue) • Bradycardia <60 beats per minute
i. mainly visible in the acra (fingers, toes, nose tip, lips) • Tachycardia >100 Beats per minuet
b. Central Cyanosis • Pulse deficit --> HR & pulse rate are different (e.g. in Atrial fib)
i. visible in well-perfused tissue (mucosa of • Loudness of 1st & 2nd Sound
mouth/throat & tongue)
• Splitting of sounds
4. Pe rspirat ion
a. can indicate cardiogenic shock
i. patient will feel cold & clammy Sounds
S1:
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