The appendix provides a summary of history taking and physical examination
methods that are suitable for professional examinations such as MRCP PACES.
As an example the system of examination of the cardiovascular system is given
below
Cardiovascular
System
General Examination
©
Position
ª Height
and Proportions
¨
Weight and Shape
§
Integument
©
Body Temperature
Head
ª
Mental state
¨ Dimensions,
integument, movement
§
Nose
©
Eyes
ª Face
(scalp, forehead, eyebrows, malar region, chin)
¨ Mouth
(jaw, lips, teeth, gums, buccal mucosa, tongue, palate, fauces, salivary glands)
§
Ears
Hands
©
Dimensions
Dorsum of hands
IS
ª
Nails and skin
LMS
¨ Bones,
joints, tendons and muscles
Palms
IS
§
Skin
LMS
© Bones,
joints, tendons and muscles
CVS
ª Peripheral
circulation
¨
Radial pulse:
Condition of the vessel wall
Transmission (left radial, femoral)
Rate
Rhythm
Volume
Character
CNS
§
Tremor
©
Flapping tremor
Forearms and Upper Arms
Quickly inspect the forearms and upper arms
Brachial Artery
ª
Inspection
¨ Palpation
(character of the pulse, brachio-radial delay)
§ Auscultation
(mention measurement of blood pressure)
Neck
¨
Dimensions
§
Integument
©
Thyroid gland
ª
Sternocleidomastoid muscles
¨ Jugular
venous pressure:
Height
Character
Transmission
Modifying Factors
§
Carotids:
Inspection
Palpation
Auscultation (usually left to be performed in conjunction with auscultation of
the heart)
©
Trachea
Chest
Examine the chest wall and heart
Chest Wall
ª Deformity
(chest wall in general and the praecordium in particular)
¨
Integument:
Scars
Gynaecomastia
Pacemaker
§
Respiratory distress
Heart
Examine the heart
Semi-Recumbent Position
Inspection
© Position
of the apex beat
ª
Pulsations over the praecordium and elsewhere in the chest
Palpation
©
Apex beat:
Position
Rate and Rhythm (not an important point at which rate and rhythm are analysed)
Quantity
Character
Transmission
Modifying factors
ª
Left parasternal heave
¨
Pulsations over the praecordium or elsewhere in the chest
§ Palpable
heart sounds
©
Thrills
Percussion
ª When
indicated percuss the left and right cardiac border.
Cardiac Auscultation
©
Count the rate of the heart sounds
ª
Note the rhythm of the heart sounds
¨ Listen
to the first heart sound. Define whether it is normal in intensity, loud or
soft. Ascertain whether the intensity of the sound varies between beats. Define
its character. Define whether it is single or split and if split whether the
split varies with respiration.
§
Repeat for the second heart sound.
© Listen
in early diastole for an opening snap, opening click or tumour plop
ª Listen
in mid diastole for the presence of a third heart sound or pericardial knock.
¨ Listen
in late diastole for the presence of a fourth heart sound.
§ Listen
in early systole for an opening or ejection click.
©
Listen in mid systole for the presence of a mid-systolic click
ª Listen
in systole for any murmurs. If a murmur is heard define it.
¨ Listen
in diastole for any murmurs. If a murmur is heard define it.
§ Listen
for any extra-cardiac sounds.
Left Lateral Position
Repeat palpation, auscultation
Patient seated up and leaning
forward
Repeat palpation and auscultation (breath held in expiration)
Back
©
Spine
ª
Scapula
¨
Sacral oedema
§
Lung bases
©
Murmurs
Ask to examine the abdomen and lower limbs. Usually not required.
