• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 in gastrointestinal outpatient clinic

Patient: 50 year old women

Your consultant has asked you to perform a full abdominal examination and they will observe you
– Please provide a running commentary whilst you are examining
– After 6 minutes you will be asked a series of questions by the examiner

You are a 50 year old patient who has come to an outpatient gastrointestinal clinic. The consultant as asked if you are happy for a junior doctor to examine you and you are delighted by this. You have been asked not to give a history but to confirm your name and date of birth.

Please feel free to stop the examination is the patient causes pain or discomfort to yourself.

Category Question
Introduction Candidate appropriately introduced themselves with:
Full name
Clarifies who they are talking to
Asks patient for preferred name

Étique Examination étique
Washes hands
Exposes patient correctly
Patient positioned laying flat
Examination from left hand side

Inspection General inspection
General appearance
Well / unwell
Comfortable / in discomfort
IVF / Nutritional lines
Supplemental drinks

Hands Comments on hands
Tendon xanthomata
Dupuyten’s contracture
Palmar erythema
Finger clubbing

Arm/s Arm/s
Asterixis (flapping tremor - Hepatic failure e.g encephalopathy)
IVDU markings (hepatitis B / C)

Face Face
Cushingoid appearance (e.g ‘moon face’, acne, hirsute)
Scleral icterus (jaundice)
Corneal arcus
Episcleritis / conjunctivitis
Conjunctival pallor
Angular stomatitis
Apthous ulcers

Neck Neck
Examines for lymph nodes
Palpates Virchow’s node (left supraclavicular region)

Inspection 2 Closer inspection
Spider naevi
Abdominal distension
Caput medusa

Palpation 1 Palpation 1 - general abdomen
Begins palpation away from area of tenderness
Palpates all 9 areas
Light palpation
Deep palpation
Comments on tenderness, guarding or masses if present

Palpation 2 Palpation 2 - liver
Invites patient to take breaths in and out
Candidate starts palpation in RIF and works up to right costal margin
Candidate palpates for liver edge during inspiration

Palpation 3 Palpation 3 - spleen
Invites patient to take breaths in and out
Candidate starts palpation in RIF and works up to left costal margin

Palpation 4 Palpation 4 - kidneys
Anterior hand firm in the deep palpation position
Attempts to ballot the kidney with the other hand in costophrenic angle
Manoeuvre repeated for the other kidney

Palpation 5 Palpation 5 - AAA
Deep palpation superior to umbilicus

Palpation gen Palpation general technique
Palpation at eye level
Watches patients face during palpation
Invites patient to make candidate aware if any pain or discomfort

Percussion Percussion
Percusses upper and lower borders of liver
Shifting dullness

Auscultation Auscultation
Listens to bowel sounds
Comments if bowel sounds are: active, sluggish or tinkling

Closing Closing examination
Invites patient to get re-dressed
Washes hands

Patient Patient score
Candidate did not cause any pain to patient
Candidate was polite throughout examination

Question What other examinations may be useful in guiding you to a diagnosis?
Groin examination
Genital examination
Digital rectal examination examination

Please review the following image and comment on your finding

Midline laparotomy scar

Question What are the causes of ascites
Transudate - CLD, RHF, hypoalbuminaemia
Exudate - infection, inflammation, malignancy

Question What are the causes of splenomegaly beyond the umbilicus?
Other appropriate answer