Random Specific Exams Obesity Introduce self Wash hands Obtain consent. Ask patient to dress to underwear Get the patient to put on a hospital gown. Look for central obesity. Weight the patient and measure their height Find out BMI. Measure the circumference. Measure ay the iliac crest Women -> less than 88cm. Men -> less than 105cm. Increases risk of hyperlipoidemia, hypertension and heart disease independent of BMI. Take blood pressure Use a large enough cuff. Look for peripheral edema Distinguish this from adipose tissue by attempting to indent the area gently. Look for varicose veins Look for venous ulcers. Inspect the neck for goitre -> hypothyroidism Look acne and hirsutism on the face in women -> PCOS. Look for deformity signs of osteoarthritis in large weight bearing joints. Most obvious in the knee. Ask the patient to sit in a chair and then get up and walk. Note need for walking aids, because of arthritis or obesity itself. Severe obesity interferes with normal activities Ask for urinalysis, BSL or HBA1c. Liver examination Wash hands. Consent. Look for any obvious signs of liver disease: Caput medusae Ask if there are any parts of the abdomen are tender and if any part of the examination is uncomfortable. Look for signs of jaundice. Look for signs of anaemia. Examine the nails. Clubbing Leukonychia Palmar erythema Examine the hands. Test for palmar erythema Examine the arms Look for any tattoos or needle marks. Look for spider naevi. Look for gynecomastia. Examine the abdomen systematically. Inspection Palpation. Note any distended veins. Percuss Auscultate Look for ascites If present -> shifting dullness on percussion. Look for peripheral edema. Hip test General inspection Examine the hips, the legs and knee and the back look for: Scars Swelling Deformities Alignment Muscle wasting -> esp. glut. Max. Spine alignment Pelvic tilt. Redness Leg length disparity. Gait Note: Symmetry Turning Signs of discomfort Palpate Over the hip and surrounding structures. Palpate trochanteric bursitis Measure leg length Apparent leg length Umbilicus to tip of medial malleolus True leg length ASIS to tip of medial malleolus Movement Active Flexion Extension Adduction Abduction Internal rotation External rotation. Passive Thomas test