Examination checklist

    General examination

    The 19-step general examination mark sheet — where technique and sequence carry their own marks — with the head-to-toe signs that point to a system and how to present them.

    Internal Medicine
    General
    All colleges

    Mark sheet

    19 steps · 19 marks

    #StepWellPartlyNot
    1. 1Greets the examiner1½0
    2. 2Greets the patient and establishes rapport1½0
    3. 3Cleans hands1½0
    4. 4Ensures privacy with a screen or chaperone1½0
    5. 5Exposes the patient appropriately1½0
    6. 6Inspects generally — how unwell, posture, cannulas, catheters, dialysis access, pressure sores1½0
    7. 7Examines the hair and scalp1½0
    8. 8Looks for pallor at the conjunctivae, tongue and palms1½0
    9. 9Looks for jaundice in the sclerae in good light1½0
    10. 10Looks for central and peripheral cyanosis1½0
    11. 11Checks the temperature1½0
    12. 12Examines each lymph node group in turn1½0
    13. 13Examines the hands for clubbing and nail changes1½0
    14. 14Tests for pitting oedema at the ankles and sacrum1½0
    15. 15Asks for urinalysis1½0
    16. 16Measures weight, height, BMI and waist circumference1½0
    17. 17Uses correct technique throughout1½0
    18. 18Examines in a logical sequence1½0
    19. 19Thanks the patient1½0

    Summary of findings

    Report positives first, then the relevant negatives, then pull them together into the system most likely involved.

    General examination of my patient revealed a young man who is chronically ill-looking, with conjunctival pallor and bilateral pitting ankle oedema up to the mid-shins. A haemodialysis catheter is in place in the right femoral vein. He is not jaundiced or cyanosed, is afebrile, and has no lymphadenopathy or finger clubbing. My assessment is chronic kidney disease on haemodialysis.

    A sensible order: general appearance → hands and nails → pulse → face, eyes and mouth → neck and lymph nodes → oedema → anthropometry → urinalysis.

    Differential diagnoses

    FindingThink of
    Pallor with oedemaChronic kidney disease, nephrotic syndrome, chronic liver disease, heart failure, malnutrition
    Generalised lymphadenopathyTuberculosis, HIV, lymphoma, chronic lymphocytic leukaemia
    Finger clubbingLung cancer, bronchiectasis, empyema, lung fibrosis, cyanotic heart disease, endocarditis, liver cirrhosis, inflammatory bowel disease, thyroid acropachy
    Koilonychia (spoon nails)Iron deficiency
    Leukonychia (white nails)Low albumin — liver disease, nephrotic syndrome
    Half-and-half nailsChronic kidney disease
    Jaundice with pallorHaemolysis (sickle cell disease), liver disease
    Central cyanosisLung disease, right-to-left cardiac shunt
    Wasting with oral thrushAdvanced HIV

    For a patient on dialysis, see Chronic kidney disease on haemodialysis.

    Investigations

    • Urinalysis — protein, blood, glucose; a simple test that carries a mark
    • Full blood count and film — anaemia and its type
    • Urea, electrolytes and creatinine; liver function with albumin
    • Glucose, HIV test with consent
    • Imaging and specific tests directed by the system identified

    Treatment

    • Treat the underlying condition found
    • Correct nutrition and anaemia appropriately — find the cause before giving blood or iron
    • Counsel on the diagnosis and plan
    • Refer to the relevant specialist team

    Examiner questions

    References

    • Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, et al., eds. Harrison's Principles of Internal Medicine. 22nd ed. New York: McGraw Hill; 2025.

    Updated September 18, 2026