Examination Station Sample

• Wash Hands, Introduce, Identify: Confirm the patient’s identity and introduce yourself.
• Explain, Exposure, Chaperone, Consent: Explain the procedure, ensure proper exposure of the abdomen, consider a chaperone if appropriate, and obtain consent.
• Pain: Inquire about the location, intensity, and nature of the pain.
• Position: Position the patient lying flat with arms by their sides for the examination.

• General Appearance: Assess the patient’s overall appearance for signs of distress or discomfort.
• Walking Aids: Check for any mobility aids that might indicate underlying conditions.
• Medications: Review current medications.
• Hands:
  • Flapping Tremor: Check for asterixis, indicating possible hepatic encephalopathy.
  • Clubbing: May suggest chronic liver disease or IBD.
  • Leukonychia, Koilonychia: Signs of chronic liver disease or anemia.
  • Palmar Erythema: May indicate chronic liver disease.
  • Dupuytren’s Contracture: Associated with chronic alcoholism or liver disease.
  • Muscle Wasting: Assess for wasting in the thenar and hypothenar eminences.
  • Pulse: Check for rate, rhythm, and volume.
  • Scratch Marks, Tattoo Marks: Signs of liver disease or IV drug use.
• Face:
  • Pallor: Suggests anemia.
  • Jaundice: Indicates liver dysfunction.
  • Xanthelasma: Suggests hyperlipidemia.
• Mouth:
  • Ulcers, Glossitis: May indicate nutritional deficiencies.
  • Angular Stomatitis: Linked to B12 or iron deficiency.
  • Dental Hygiene: Assess for signs of poor oral health.
  • Oral Candidiasis: Suggests immunosuppression.
• Neck & Chest:
  • Supraclavicular Lymph Nodes (Virchow’s Node): Enlarged node may indicate malignancy.
  • Spider Naevi: Indicative of chronic liver disease.
  • Gynecomastia: Suggests chronic liver disease or hormonal imbalance.
• Legs:
  • Pedal Edema: May indicate hypoalbuminemia or heart failure.

• Shape: Look for distension or abnormal contours.
• Size: Assess for generalized or localized swelling.
• Swelling: Note any masses or visible hernias.
• Dilated Veins: Suggests portal hypertension.
• Caput Medusae: Indicates severe portal hypertension.
• Scars: Look for surgical scars.
• Striae: May indicate rapid weight change or ascites.

• Temperature: Feel for increased warmth, suggesting inflammation.
• Light Palpation: Assess for tenderness, guarding, or rigidity.
• Deep Palpation: Evaluate for deeper masses, organomegaly, or rebound tenderness.
• Liver, Spleen, Ballotable Kidneys: Palpate for hepatomegaly, splenomegaly, or renal masses.
• Murphy’s Sign: Check for pain on deep inspiration while palpating the right upper quadrant (suggestive of cholecystitis).
• Rovsing’s Sign: Pain in the right iliac fossa when palpating the left iliac fossa (indicative of appendicitis).
• Obturator Sign: Pain with internal rotation of the hip, suggesting a pelvic appendix.
• Psoas Sign: Pain on extending the hip, indicating a retrocecal appendix.

• Shifting Dullness: Test for ascites by percussing for dullness and shifting dullness.

• Bowel Sounds: Listen for normal, hyperactive, or absent bowel sounds.
• Bruit: Listen over the abdominal aorta and renal arteries for any vascular sounds.

• Check Inguinal Hernia Orifices: Assess for inguinal or femoral hernias.
• Digital Rectal Examination (DRE): Perform a DRE if indicated to assess for tenderness, masses, or blood.
• Lymph Nodes: Palpate for any enlarged lymph nodes.
• External Genitalia: Assess for any abnormalities if relevant.
• OBS Chart: Monitor vital signs, particularly temperature and heart rate.
• Drug Chart: Review current medications, particularly analgesics and antibiotics.

“Upon inspection, the abdomen appears slightly distended, with no visible scars, masses, or hernias. There is no evidence of surgical stigmata, jaundice, or abdominal distension.
On palpation, there is tenderness in the right iliac fossa with guarding and rebound tenderness, particularly at McBurney’s point. No masses are palpable, and there is no organomegaly.
On percussion, there is localized tenderness in the right iliac fossa, and no shifting dullness is noted.
Auscultation reveals normal bowel sounds.
The findings of localized tenderness, guarding, and rebound tenderness in the right iliac fossa are consistent with acute appendicitis.”

• Gastrointestinal: Mesenteric adenitis, diverticulitis, Meckel’s diverticulitis, Crohn’s disease.
• Gynecological: Ectopic pregnancy, ovarian torsion, pelvic inflammatory disease.
• Urological: Ureteric colic, testicular torsion.

• Laboratory Tests:
  • Leukocytosis: Elevated WBC count.
  • CRP: Elevated in acute inflammation.
• Imaging:
  • Ultrasound: Preferred in children and pregnant women.
  • CT Scan: High sensitivity and specificity; identifies complications.
  • MRI: Alternative for pregnant women.

• Preoperative:
  • NPO
  • IV Fluids
  • Antibiotics: Broad-spectrum to cover Gram-negative and anaerobic bacteria (e.g., piperacillin/tazobactam).
• Surgical:
  • Laparoscopic Appendectomy: Preferred method, minimally invasive.
  • Open Appendectomy: Alternative, especially if perforation or abscess is suspected.