OSCE

EXAMINATION
Done by
Mohamed amjed amer
Learning objective:
 General examination

 Abdominal examination

 Abdominal organ examination

General note:
• From head to toe
the exposure from the level of the nipple to the middle thigh
In the exam you should tell the doctor I should expose from the level of the
nipple and to the mid thigh but I can’t do that now.
Always you should hand shake the patient and ask the patient about his name
and what the time and ask him where he is now to ensure that the patient is
conscious and oriented with you.
-you should always stand on the right side of the patient (very important)
-introduce yourself
-make sure that your hands are clean and wash it.
General note:
• Explain to the patient what you want to do and take permission
• The hand shake will give you information about
• 1-temperature
• 2-sweety
• 3-Dupuytren’s contracture(abnormal thickening of tissues in the palm
of the hand
General note:
• At the beginning you should begin with the general inspection
• ABOPE
• A: age EX( mild age male) we also mention the gender here
• B: built EX( obese, thin,)
• O: orientation( if he oriented you should say, oriented to the time place
and person not dyspnic ,not tachypnic,not distress, not depressed ,not
pending forward, not rolling in bed,
• P: postion(sitting comfortable on bed )
• E: expression EX( smiling)
General examination :
• An example: Middle age male patient ,sitting comfortable on
bed ,oriented to time ,place,person , not dyspnic ,not tachypnic,not
distress, not depressed ,not pending forward, not rolling in bed,
smiling .
General examination :
• In the examination we have two postions:
• semi-sitting postion and supine lying
• Steps of general examination :‫ﺑﺎﻟﺘﺮﺗﯿﺐ ﺣﻔﺾ‬
• 1- introduce your self to the patient
• 2-hand shake the patient to get information about his hand
temperature ,sweety,dupuytren’s contracture and ask the patient about his full
name and ensure that the patient is oriented and conscious with you by
asking him about what day today is and where he is now
• 3-at first we begin with the head :
• Hair > normal hair distribution
General examination :
• Skin > any scar ,pigmentation ,discoloration , mass
• Orifices > Eye , ear, nose , oral cavity
General examination :
• Eye examination : jaundice in the upper sclera
• The way is by conracting the upper eye lids

NOTE: always bilateral

even in mild case -the discoloration appear in the upper sclera, before the
discoloration of the skin because its not exposed to the environment
General examination :
• conjunctiva : for pallor
• The way is by using your both hand and by the thumb contract the
lower eye lids
• And always by bilateral
General examination :
• jaundice (on day light > don’t forget ) we examine the jaundice in the
upper sclera why ? because it contain more elastic tissue and not
exposed to the environment.
General examination :
• mouth examination:
• 1- anemia : mucosa of the oral cavity
• 2--cyanosis : tip of the tongue
• 3-mouth hygiene: the clearness of the mouth >>EX: patient with poor
mouth hygiene is more liable for infective endocarditis
• 4-hydration status: ask the patient to protrude his tongue and just look
(don’t touch) to the upper surface of the tongue if its moist or dry if
moist = well hydration status if dry = dehydrated and this is subjective
(rough test)
General examination :
• angular stomatitis:a common inflammatory skin condition. It
affects one or both corners of your mouth and causes irritated,
cracked sores. Look at the mouth corners
• lips: look for pallor –cyanosis –pigmentation associated with familial
polyposis
• Tonsil: especially in acute appendicitisas

• don’t touch the tongue just look

General examination :
• cyanosis lips, tip of the tongue (central)
• Nail (peripheral cyanosis)
General examination :
• lymph nodes examination :

submantal submandibular
General examination :

pre-auricular post- auricular

General examination :

occipital group
General examination :
• This group of lymphbode is called the outer-cicular
• We also have :
• 2-Lower circle : supraclavicular lymph nodes
• 3-Longitudinal group : jugulodigastric lymph node ( along the
sternocleidomastoid muscle )
General examination :
• Neck
• just inspection if there is any scar pigmentation ,discoloration engorged
vein ,mass ,sewlling (if there is any mass > comment >
site,size,shape,overlying skin, tenderness , temperature , consistency )
go to the thyroid exam for more details )  tracheal deviation  cervical
lymphnodes
• Just look
General examination :
• Hand: skin : for discoloration ,scars, hair distribution tips of the fingers
for cyanosis
• nails: for clubbing
• koilonychia :spon shape nail
• palm of the hand:pallor, erythema, dupuytren contracture
• stretch the palm If the pallor increase that means the hemoglobin
concentration less than 7 g/dl (rough measure)
• muscle wasting
General examination :
• Note the following if it presents:
• note : capillary refill to know the tissue perfusion status, press on a
finger nail or skin over bony prominence and then release, the time
how quickly it return to its normal color indicate how quickly blood
flow back to the pressed area
• note : cannula
• note: Presense of redness and swelling with canula Indicate
thrombophlebitis (associated with fever)
• Change the cannula to the other site
General examination :
• feet : clubbing-pulses –pitting edema : press on the skin of tibia for 30
second 5cm-10cm above the medial malleolus

• This examination should be done step by step frome head to toe to

avoid missing
General examination :
• And the last thing og the general examination is the vital signs
• 1- pulse
• 2- respiratory rate
• 3- temperature
• 4- blood pressure
General examination :
• Pulse :pulse rate ,rhythm,volume,state of blood vessel wall
• Ex: 87 bpm ,regular rhythm , normal pulse volume ,no radio-radial or
radio-femoral delay, normal state of blood vessel wall
• Note: irregular rhythm ex: AF
• Radio-femoral delay ex: co-arctaion of aorta
• Cord like blood vessel ex: atherosclerosis
General examination :
• Low pulse volume may indicate there an internal bleeding
• Regular means : constant time between one beat & another pulse
• Volume: how force the pulse is
• Thrill pulse ex: shock , dehydration 
• Bounding pulse : is a strong throbbing felt over one of the arteries in
the body. It is due to a hypertension,VSD , heart failure)
General examination :
• Temperature
• Oral temperature = 37 ± 0.2 (36.8---37.2)
• Axillary temperature = 0.5 less than oral temperature
• Rectal temperature = 0.5 more than oral temperature
General examination :
• 3-respiratory rate : normal range 16-20 cycle / min
• the male respiration is abdominal ( diaphragmatic ) while female
respiration is thoracic
• Dysnea:difficulty in breathing
• Tachyapnea:is increase in respiratory rate
• Apnea : complete absence of breathing
• chyne stoke breath : it is a period of hyperapnea followed by apnea such
in head injury and severe pneumonia
• kausmal breathing : such in uremia ( metabolic acidosis ) , and we
smell the odor of ammonia from their mouths .
General examination :
• 4-Blood pressure:
• Normal Systolic blood pressure (SBP) : 90 - 140 mmHg
• Normal Diastolic blood pressure(DBP) : 60 - 90 mmHg
• what are the factors affecting blood pressure ? age , gender , exercise ,
eating , time of day, disease status , . . . etc
Thank you