PACES EXAM SCHEME STATION 1 GASTROINTESTINAL

TIME ALLOCATED 6 MINS

INFORM CANDIDATE AFTER 5 MIN THAT 1 MIN LEFT
1. GREET THE EXAMKNER AND THE PATIENT
2. WASH HAND WITH HAND SANIIZER
3. ASK PERMISSION TO EXAMINE
GENERAL SURVEY
4. POSITIONS PATIENT FLAT ON BED AND EXPOSES MID CHEST UPTO GROIN (FOR
FEMALE), FOR MALE EXPOSE UPPER TORSO COMPLETELY. DONOT EXPOSE
GENITALIA
5. STARTS EXAMINATION WITH HANDS- PALLOR, CAPILLARY REFILLING, NAIL BED
HGE, CLUBBING, CYANOSIS, JAUNDICE, FLAPS, JOINT PAIN
6. LOOKS AT MOUTH (WITH PEN TOCH)FOR JAUNDICE , PALLOR, DENTITION,
ULCERS, THRUSH ETC
7.LOOKS AT EYES FOR PALLOR, JAUNDICE
8.INSPECTION
SCANS THE PATIENT FROM DISTANCE . LOOKS AT NUTRITIONAL STATUS, ABDOMEN
WITH INSPIRATION ND EXPIRATION FOR ANY OBVIOUS MASS, SCARS ( INDICATE
WITH RIGHT INDEX FINGER), VISIBLE PERISTALSIS, VISIBLE PULSES, VENOUS
PROMINENCE, NEDDLE PUNCTURE MARKS FOR ASCITES
9. LIGHT PALPATION
A. KNEELS AT BEDSIDE.
B. ASKS FOR ANY PAIN, PLPALTES 9 QUADRANTS WITH PALM OF HAND FLEXING AT
MCP JOINTS. AVOIDS AREA OF PAIN INITIALLY AND DOES WITH CAUTION AT LAST.
C. IF THERE IS MASS- ASKS TO LIFT HEAD TO MAKE THE ABDOMINAL WALL TENSE
--> ANY SUPERFICIAL MASS WILL BE PROMINENT, DEEP MASS WIH SUBMERGE.
D. ESTIMATES SIZE, SURFACE, TENDERNESS MOBILITY, ATTACHEMTN WITH SKIN,
PULSATILE, PERCUSS IN TW DIRECTIONS AND AUSULTATEON MASS
10. DEEP PALPLATION:
A. LIVER:WITH RIGHT HAND RADIAL BORDER WITH INSPRATION. IF
HEPATOMEGALLY- PERCUSS UPPER AND LOWER PART FOR ESTIMATION OF SIZE
LOWER= FROM RT ILIAC FOSSA UPWARDS , LIGHT PERCUSSION.
UPPER= FROM 4TH ICS MIDCLAVICULAR LINE DOWNWARDS. WHEN DULL ASKS
PATIENT TO TAKE DEEP BREATH AND SE NOW DULL, CONFIRMS UPPER EDGE OF
LIVER. MARKS SPAN IN FINGERS.
B. SPLEEN: PLACES LEFT HAND AT LEFT LOWERCOSTAL MERGIN TO LIFT, WITH
RT HAND TIP OF FINGERS WITH BREATHING PPROACHES FROM RIF.