APEx 1 - Examination Inspection Steps

CVS Exam → Inspection of Hands, Wrists & Arms

Hands/fingers:

• Cold

• Sweaty

• Clubbing

• Peripheral Cyanosis

• Capillary refill

• Splinter haemorrhages

• Osler nodes

• Xanthomata

• Janeway lesions

• Tar staining

Wrists/Arms:

• Radial pulse

• Radio-radial delay

• Xanthomata

• Brachial pulse

CVS Exam → General Inspection

• Dyspnoea and signs of respiratory distress;

• Body-build;

• Signs of pain or distress;

• Signs of congenital abnormalities that are associated with a particular cardiac disease

CVS Exam → Inspection of Face

Cheeks: Mitral facies

Eyes: Pallor; Jaundice; Pupils (corneal arcus/arcus sinilis); Eyelids (xanthelasma)

Mouth: High arched palate

Lips: Petechiae; Central cyanosis

Tongue: Central cyanosis

Teeth and gums: Dental hygiene

CVS Exam → Inspection of Neck

• Measures JVP

• (Identifies location and measures height); Looks for abdomino-jugular reflux

• Palpates carotid pulse, looks for volume, character and thrills

• Auscultates for carotid bruits

CVS Exam → Inspection of Chest/Precordium

• Scars

• Rashes

• Presence of pacemaker or defibrillator box

• Breathing pattern; Skeletal

• deformities (barrel chest, funnel chest and pigeon chest);

• Apex beat;

• Abnormal Pulsations;

CVS Exam → Inspection of Back/Legs

• Sacral oedema

• Legs: Oedema; Achilles Tendon xanthomata; Hair loss; Change in skin colour; Clubbing (toes/toenails); Cyanosis (toes/toenails); Ulcers; Varicose veins; Osler’s nodes; Janeway lesions Capillary refill; Feels for temperature (cold or warm);

GIT Exam → General Inspection

• Jaundice

• Body build

• Mental state

• Pigmentation

• Lesions

• Obvious pain/distress

• Pallor

• Sweating

GIT Exam → Inspection of Hands, Wrists & Arms

Fingers:

• Leukonychia

• Clubbing

• Muehrcke’s lines

Palms:

• Palmer erythema

• Anaemia

• Dupuytren’s contracture

Arms;

• Bruising (petechial and ecchymosis)

• Scratch marks

• Spider naevi

• Hepatic Flap

• Fine tremor

• Muscle wasting

• Acathosis nigricains

GIT Exam → Inspection of Face & Neck

Eyes:

• Jaundice

• Anaemia

• Kayser-Fleischer rings

• Iritis

• Xanthelasmata

Mouth:

• Breath

• Teeth

• Gums

• Oral mucosa

• Tongue (candidiasis/glossitis)

• Pharynx

• Angular stomatitis

GIT Exam → Inspection of Chest

• Spider naevi

• Gynaecomastia (male)

• Hair loss (male)

GIT Exam → Inspection of Abdomen

• Scars

• Distension

• Swellings

• Prominent veins

• Pulsations

• Visible peristalsis

• Striae

• Scratch marks

• Hernias

• Skin lesions

• Cullen’s/Grey-Turner’s sign

• Asymmetrical movement on breathing

GIT Exam → Inspection of Legs

• oedema

• Bruising

• Scratch Marks

Respiratory Exam → General Inspection

• Dyspnoea

• Use of accessory muscles of respiration and other signs of respiratory distress

• Facial plethora

• Breathing pattern

• Cough

• Stridor

• Wheeze

• Hoarseness

• Pallor

• Hydration

• Body build

• Cigarette packet

• Oxygen mask/nasal prongs

• Puffers

• sputum cup

Respiratory Exam → Inspection of hands, wrists, arms

• Clubbing

• Tar staining

• Peripheral cyanosis

• Muscle weakness

• Muscle wasting

• Flapping tremor

• Fine tremor

• Wrist Tenderness

Respiratory Exam → Inspection of Face and Neck

• Pallor of conjunctiva

• Icterus

• Horner’s syndrome

• Central cyanosis (tongue)

• Plethora

• Paranasal sinuses

• Nose/throat

• Crowding of pharynx

• Teeth

Respiratory Exam → Inspection of Chest

• Shape/deformities

• Symmetry of movements

• Spinal deformities

• Swelling

• Scars;

• Expansion of upper lobes

• Prominent veins

• Rash

• Prominent veins

• Use of accessory muscles of respiration

• Harrison’s sulcus

• Apex beat

Respiratory Exam → Inspection of Legs

Oedema; Cyanosis; Redness/swelling/tenderness

Respiratory Exam → Palpation of Chest

• Chest expansion

• Apex beat

• Rib pain

• Vocal fremitus

• Subcutaneous emphysema

• Hoover’s sign