The introduction of a routine protocol for surgical history taking has helped a lot of students.

The protocol given below is an attempt to produce better, uniform and concise physical examinations. This protocol has been written for the abdomen. For other systems the general examination is the same but clearly the specific system will change [eg for a thyroid you use the protocol in the HX and Ex booklet/Video] You should carry out and present the protocol in the same way every time,only in this way will you avoid making errors and omissions

Physical Examination GENERAL

On examination , patient is : - alert, conscious and orientated - not in distress ( pain, sweating, tachypnoie) - well nourished / cachexia / malnourished - hydration status- is well hydrated - not obviously clinically anaemic (pallor of conjunctive) - not jaundiced [sclera] Mouth no abnormality of mouth ( eg angular stomatitis) - no abnormality of lips (central cyanosis) - no intraoral pathology - dentition is good Hands -

no obvious abnormality of finger nails (clubbing , leukonychia, kolonychia) no palmar crease palor no palmar erythema palms are moist no abnormality of arms (scratch marks, muscle wasting) no other signs of liver failure pulse, BP, RR, Temp, peripheral perfusion

Vital signs:

Neck : no palpable neck swellings or lymph nodes Chest : no obvious signs on chest wall [eg gynaecomastia,spider naevi]

SPECIFIC ; ABDOMEN Abdomen : say: On INSPECTION, the abdomen is moving normally with respiration, abdomen not distended, no evidence of recent weight loss, no scars, no skin discoloration, no obvious mass, no venous dilation or arterial pulsation seen, umbilicus inverted and appears normal. On superficial PALPATION, the abdomen is soft, with no tenderness, rebound tenderness or guarding. On deep palpation ,there is no tenderness, rebound tendernessor guarding and no mass could be defined. Palpation for organomegaly liver , spleen, kidney (if you think the liver or spleen is enlarged then confirm with percussion there and then) Bimanuel palpation to confirm an an enlarged organ or mass is very useful. Remember to describe the organomegaly or mass with standard size ,shape, edge,consistency etc. PERCUSSION for shifting dullness (best if not tightly distended with fluid) and fluid thrill (best if large vol fluid) AUSCULTATION: bowl sound are present and appear normal No abnormality IN groin area (hernia or lymph node) External genitalia: scrotum/testes/penis Rectal examination if indicated Legs

NB If ,on inspection , you identify a scar ask the patient to cough. If you identify an incisional hernia by this manouve you will confirm this by the approriate tests during palaption PL