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Comprehensive guide to clinical examination - Basics of medicine
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Complete summary and guide to systems clinical examination with tips to ace your OSCEs.
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Complete guide to clinical examination - Basics of Medicine
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uTest/Sign Performed/Outcome What it Tests forABDOMINAL
Hepatic flap aka asterixis Stretch out the arms in front, separate the Hepatic encephalopathy; can also occur in
fingers and extend the wrists for 15 seconds. cardia/resp/renal failure
Jerky, irregular flexion–extension movement at
the wrist and metacarpophalangeal joints, often
accompanied by lateral movements of the
fingers
Clubbing of nails Cirrhosis, IBD, Coeliacs, AV shunting in lungs,
Leukonychia Nail beds opacify Hypoalbuminaemia in liver disease
Koilonychia Iron deficiency anaemia
“spoon nails”
Palmar erythema Reddening of the palms at the thenar and Hyperdynamic circulation due to increased
hypothenar eminences oestrogen levels in liver disease/pregnancy;
thyrotoxicosis; rheumatoid arthritis
Dupuytren’s contracture Visible and palpable thickening and contraction Familial, alcoholism;
of the palmar fascia causing permanent flexion,
most often of the ring finger
Tachycardia & low volume Blood loss
blood
, uTest/Sign Performed/Outcome What it Tests for
Jaundice Liver disease
Conjunctival pallor Anaemia (eg bleeding, malabsorption)
Periorbital xanthelsama Yellowish plaques in subcutaneous tissue due Hyperlipidaemia (elevated serum cholesterol) in
to deposits of tissue cholestasis; common in people with primary
biliary cirrhosis
Glossitis Soreness of tongue or reddened surface Iron/B12 deficiency; common in alcoholics
, uTest/Sign Performed/Outcome What it Tests for
Stomatitis Inflammation of mouth and lips Iron/B12 deficiency
Leucoplakia White-coloured thickening of the mucosa of the Begin with ‘S’ - sore teeth (poor dental hygiene),
tongue smoking, spirits, sepsis, syphilis
Aphthous (mouth) ulcers IBD
Breath odour Fetor hepaticus (sweet smell); Faeculent in
obstruction; keototis (fruity) in ketoacidosis;
alcohol breath (drunk recently or alcoholic)
, uTest/Sign Performed/Outcome What it Tests for
Gum hypertrophy Phenytoin use; pregnancy; scurvy (vit C
deficiency); gingivitis (may be smoking);
leukaemia
Supraclavicular Abdominal malignancy
lymphadenopathy
(especially Virchow’s node -
in left supraclavicular fossa)
Spider naevi Central arteriole which radiates numerous small >5 is notable
vessels that look like spider’s legs. Usually in Cirrhosis, transiently in viral hepatitis, 2-5mths of
area drained by SVC (arms, neck, chest wall) pregnancy. Often attributed to excess oestrogen
Increased muscle bulk Steroid use (which can also cause liver tumours
and hepatic carcinomas)
Muscle wasting Malabsorption; malnutrition; alcoholism
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