How to do an abdominal exam for an OSCE

Key point- Abdominal exam is tight for time so really try and race through the early peripheral signs in hands and face.


The routine for Abdo

Wash hands
Introduce
Consent + Explanation
Explanation of talking to examiner
Pain

Observe from end of bed
Look around
Drains
Lines
Food/drink
Look at patient
Comfort
Well perfused
Alert
Orientated

Hands
Leuconychia
Koilonychia
Clubbing
Tendon xanthomata
(turn over)
Erythema
Dupuytren's
(pigmentation of creases?)

Arms
Asterexis
Pulse
Fistulae
Blood pressure

Axilla hair
Acanthosis nigricans

Face
Eyes
Pallor
ictarus
KF rings
Corneal arcus or xanthalesma

Mouth
Angular stomatitis
Glossitis
Ulcers
Pigmentation
Telangiectasia
Neck
JVP
Lymph nodes

When you have patient up look for scars.

FLATTEN BED!!!

Chest
Gynaecomastia
Hair distribution
Spider naevi
Acanthosis nigricans

Abdomen
Inspect
Scars or stoma
Visible masses, pulsations or peristalsis
Visible veins
Striae
Palpate
ASK ABOUT PAIN AGAIN
For pain, look at patient
For massess

LIVER
Spleen
Kidney
Aorta

Pecuss
Each area
Borders of liver
Spleen
Bladder

Ascultate
Bowel sounds
Bruits
Aortic, renal

Legs
Pedal oedema

To complete
Hernial orifices, external genitalia, DRE

Temp, Urine dip

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