Head-to-Toe Clinical Examination — Revision OmpathStudy

Head-to-Toe Clinical Examination Use this guide as a systematic revision checklist. Adapt the examination to the patient's age, symptoms and clinical condition, explain each step, obtain consent, preserve privacy and perform hand hygiene. General approach Introduce yourself, confirm the patient's identity and explain the examination. Obtain consent and position the patient appropriately. Assess the patient's general condition, comfort and level of consciousness. Note age, body build, nutritional status and hydration. Look for pallor, jaundice, central or peripheral cyanosis and obvious skin changes. Note pain, respiratory distress, abnormal posture, deformity, mobility aids or unusual odour. Record relevant vital signs before continuing. Head and neck In infants and young children, assess the fontanelles when clinically appropriate. Inspect facial symmetry and assess relevant cranial nerves, including the trigeminal and facial nerves. Examine the eyes for position, proptosis, conjunctival pallor, scleral jaundice, pupil size and reaction, and eye movements. Inspect the external ears for discharge, lesions and congenital abnormalities. Inspect the nose for septal deviation, discharge and obstruction. Examine the lips, oral mucosa, teeth, tongue, palate and tonsils. Palpate the cervical lymph nodes, thyroid and salivary glands when indicated. Chest and cardiovascular system Inspect chest shape and symmetry; look for tracheal deviation, pectus excavatum or pectus carinatum. Assess respiratory rate, pattern, chest expansion and use of accessory muscles. Palpate chest expansion and tactile fremitus when indicated. Percuss the lung fields for resonance or abnormal dullness and hyperresonance. Auscultate for normal breath sounds and added sounds such as wheeze, crackles or stridor. Examine the precordium and auscultate the heart systematically. Examine the breasts only when clinically indicated, with consent and an appropriate chaperone. Abdomen For the abdomen, use the sequence inspection → auscultation → percussion → palpation so palpation does not alter bowel sounds. Inspect the contour, movement, scars, distended veins and signs such as caput medusae. Auscultate bowel sounds and, when indicated, listen for vascular bruits. Percuss for liver span, splenic dullness, masses and ascites. Palpate gently away from pain, progressing from light to deep palpation. Assess the liver, spleen and kidneys for enlargement or tenderness. Test Murphy's sign when gallbladder inflammation is suspected. Assess renal-angle tenderness when urinary or renal disease is suspected. For suspected appendicitis, assess McBurney-point tenderness and consider rebound, Rovsing and psoas signs as clinically appropriate. Perform a digital rectal examination only when indicated, after explanation, consent and provision of a chaperone. Upper and lower limbs Inspect for symmetry, deformity, muscle wasting, tremor, clubbing, peripheral cyanosis and oedema. Palpate relevant lymph nodes, including axillary and inguinal nodes when indicated. Assess peripheral temperature, capillary refill and pulses, comparing both sides. Common pulses include radial, brachial, femoral, popliteal, posterior tibial and dorsalis pedis. Assess joint movement, muscle tone, power, reflexes, coordination and sensation according to the clinical question. When deep-vein thrombosis is suspected, assess for unilateral swelling, warmth and tenderness and use an approved clinical pathway. Homan's sign is unreliable and should not be used to exclude DVT. Completion Thank the patient and help them return to a comfortable position. Perform hand hygiene. Summarise the important positive and negative findings. State any additional focused examinations or investigations required.