Expose the Patient

by Noor Sash, PhD

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    00:00 Okay. So, we’ll start off by washing my hands. Hello. My name is Sasha, one of the doctors. Can I just check your name, please? Tom.

    00:07 What’s your date of birth? 01/03/1980.

    00:09 Great! I’ve got the right person. I was just wondering if there’s any chance I could do an examination of you, Tommy? Would that be all right? This could involve you lying flat. I’m going to have a look and then I’m going to have a look at your hands and your face, then I would have a feel of your tummy if that’s all right? Can I get you to lie flat for me, please? So ideally, I don’t expose the patient. I’d say nipple to knees, but as long as you got adequate exposure.

    00:28 So I’m just going to start by having a look from the end of the bed. I’m kind of looking around the bed for any signs of sick bowls or any lines or tubes or anything else like that. I can’t see anything obvious. Also, just in the end of that examination of the abdomen, I can’t see any obvious scars or any hernias. Can I get you to have, if you lift your head up so that you’re looking towards your feet? That would make any hernias a little bit more obvious. That’s fine. You can relax for me.

    00:52 So I’m going to move on to inspection of the hands. Can I borrow both of your hands first? So I’m just feeling the temperature, a little bit cold. I’m checking capillary refill.

    01:03 That’s fine. I’m looking for any nail signs. So there’s no signs have clubbing or oncholysis. Can I feel your pulses there? Yeah.

    01:13 That’s fine. So pulse is irregular and symmetrical. I’m just going to have a look at your hands as well. There is no palmar erythema and I’m just going to feel across your palms, and there are no contractures or anything else like that. That’s fine. As I move up the arm, I’m just having a look for any signs, excoriation, if there are any skin lesions, if there’s any trap marks, all of those things could tie with liver disease.

    01:34 Now, I’m coming up to your face. Can I get you just to take your specs off for me? That’s great. Would you be able to look up? And I’m just going to draw your low eyelids down.

    01:42 That’s fine if you look down for me. That’s fine. You can put your specs back on again.

    01:47 Wonderful! Can you open your mouth for me? Stick your tongue out. That’s fine. So I couldn’t see any signs in the eyes such as anaemia, and I’m looking in the mouth as well for any signs of aphthous ulcers or a big tongue which might indicate a deficiency of some sort. Do you have any pain in your neck at all? No. That’s fine. So I’m just going to feel just specifically for a node called Virchow’s node which is associated with gastric malignancies.

    02:12 Ideally I’d want to do full lymph node exam. Okay. So I’m going to move on to have a

    About the Lecture

    The lecture Expose the Patient by Noor Sash, PhD is from the course The Physical Exam.

    Author of lecture Expose the Patient

     Noor Sash, PhD

    Noor Sash, PhD

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