This post is a kind of practice checklist for the PLAB candidates and provides the things to be looked for during 30 seconds general survey.
Let’s check out these points!
1 - READ INSTRUCTIONS CAREFULLY
2 - CLUES IN THE PATIENT'S SURROUNDINGS
- Inhalers or Nebulizer
- Sputum pots
- Chest drain
- Urinary catheter
- Walking aids, Wheelchair
- ECG Monitor
3 - CLUES WITHIN THE PATIENT ON GENERAL LOOK
- Hoarse Voice (Hypothyroid, Bronchogenic Ca, Retrosternal Goitre)
- Flexed adducted upper limb in hemiplegia
- Myotonia – usually noted on shaking hands. Difficult to let go of your hand.
- Excessive coughing (Bronchiectasis)
- Stacatto speech (Cerebellar diseases) / Slurred speech (UML)
- Medic Alert bracelet (Steroids)
4 - FACE
- Lipo-atrophy (Mesangio-capillary glomerulonephritis)
- Plethoric, Rounded face (Cushingoid)
- Uremic frost (Renal Failure)
- Expressionless face & infrequent blinking (Parkinson’s disease)
- Unlined face, with drooping of mouth (Myopathy, Myasthenia gravis)
- Loss of hair (SLE, Hypothyroid, Alopecia areata/totalis= autoimmune diseases)
- Butterfly-rash (SLE)
- Prominent nasal ridge, Prognathism (Acromegaly)
- Puffiness around eyes, Loss of eyebrows particularly lateral 1/3rd, over-weight (Hypothyroidism)
- Puffy eye-lids (Nephrotic syndrome)
- Frontal baldness, ptosis (Myotonic Facies)
- Upward slanting of eyes, low set ears (Down Syndrome)
- Epicanthal folds, Hypertelorism, Low set ears (Noonan Facies)
- Webbed neck, Shield chest (Turner Syndrome)
5 - EYES
- Prominent supra-orbital ridge
- Staring look (Graves disease)
- Xanthelasma (Hypercholesterolemia)
- Puffiness around eyelids (Nephrotic syndrome, Hypothyroidism)
- Ptosis, Miosis (Horner)
- Ptosis, Mydriasis, Eye down & out (3rd cranial nerve palsy)
- Squint / Strabismus
- Nystagmus
6 - EARS
- Low set ears
- Large ears
- Hearing Aid
7 - NOSE
- Lupus pernio
- Butterfly rash (SLE)
8 - CHEEKS
- Butterfly rash – doesn’t cross nasolabial fold (SLE)
- Rash crossing nasolabial fold (Lupus Pernio)
- Malar flush of Mitral Stenosis
- Facial flushing in Carcinoid syndrome
- Prominent Zygoma & Maxilla
9 - LIPS
- Large lips (Acromegaly)
- Prognathism
- Ulcers
10 - TEMPORALIS WASTINGS
- Myotonia dystrophic
- Chronic liver disease (CLD)
11 - PAROTID ENLARGEMENT
- Sarcoidosis
- Chronic liver disease
12 - NECK
- Using accessory muscles of inspiration
- Wasted Sternocleidomastoid muscles (Myotonia dystrophic)
- Enlarged Thyroid
- Radiation tattoo & burn
- Spider nevi
- Webbed neck
- Prominent Pulsations (AR)
- Central lines
- Medic alert necklace
13 - CHEST
- Tachypnea
- Any asymmetry
- Skin (Color, scar & Rash)
- Gynecomastia (CLD, Amiodarone, Digoxin, Spironolactone, Klinefelter)
- Scars
- Central lines
- Hair (sparse hair in CLD)
- Spider naevi
- Tattoos, Radiation tattoos
- Intercostals indrawing (Obstructive airway disease)
14 - ABDOMEN
- Distension
- Flank fullness
- Shift of umbilicus downwards (increased intra-abdominal pressure)
- Scars
- Dilated Veins
15 - ARMS
- Medic alert bracelet
- Tattoos
- Nails
- Scars
- Purpura/Ecchymosis
- A-V fistula
- Amputations
- Clubbing
- Uremic frost
- Splinter hemorrhage (Infective endocarditis, traumatic)
- Janeway/Osler nodules (Infective endocarditis)
16 - LEGS
- Unilaterally Swollen (DVT)
- Bilaterally swollen (Edema, Myxedema)
- Erythema nodosum
- Necrobiosis lipoidica diabeticorum
- Pyoderma gangrenosum
- Diabetic dermopathy
- Nails
- Stasis dermatitis of venous insufficiency
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