Examination Stations

Overview

Examinations

• Respiratory

• Cardiovascular

• Abdominal

• Cranial nerve, upper limb or lower limb

Skills Examined

1. Performance of examination

2. Signs elicited

3. Intepretation of signs

4. Understanding of diagnosis

Given the relatively limited number of exams available, these should well rehearsed and executed. 

Timings

Total: 10 minutes

• • Examination: 6 minutes

  • Examiner discussion- presentation and questions: 4 minutes

Reasonable to aim to complete the examination in 5 minutes during practice to allow for 1 minute of processing time or 4 minutes on a co-operative volunteer without signs. 

Sources of delay

• Variable actors/ patients

• Adequate exposure

• Unclear signs

Examination 

Performance

Beginning

• Hand Gel

• Introduce yourself- good morning/ afternoon Mr Jones, my name is ... 

• I would like to examine your: ___ , this would involve ____ , would that be? ____ Thank you

• Ask if they have any pain

• Ensure adequate exposure and bed at 45 degrees

• I'm going to start my examination by looking from the end of the bed

During

• Slickness: the examiners will expect you to complete the examination effectively and quickly

• Explain what you are doing to the patient- these can be useful pointers to yourself too

• Ensure adequate exposure and then cover up once that area is used

• Ensure you're not causing pain, this could be a reason to be failed

• Be wary that repeating examinations can give the impression of a lack of competence, however may be necessary if you are not sure

• Highligting signs

  • Draw over scars with finger tip

Ending

• Thank the patient for their time

• Hand gel

• Attempt to begin presentation in head

• Smile 

• Help them to redress as appropriate

Common Signs

End of bed-ogram

• Medical alerts ?adrenal insufficiency

• Walking aids

• Core Systemic Conditions

  • Sjogren's Syndrome - Artificial tears or eye drops

  • Systemic Sclerosis- sclerodactyly, telangiectasia

  • Acromegaly- tall, frontal bossing

  • Marfan's- tall, high arched palate, glasses, arachnodactyl (long spider fingers)

  • Addison's- hyperpigmented hands, alarm bracelet

  • Ehlers-Danlos- hyperelasticity skin, tall, joint hypermobilty

  • Diabetes: blood sugar monitoring, insulin pump, blood sugar monitor on skin

Inspection

• Hands

  • Finger clubbing, koilonychia, onychomycosis 

  • Vitiligo in hands: AI conditions (b/l)

• Face

  • Acne Vulgaris, Acne Rosacea 

  • Parotid swelling- alcohol, sarcoid

• Mouth

  • Lichen planus

Presentation

Classical Structure

1. Introduction: usually I examined Ms Jones, can comment on age if young. 

2. State signs and pause

It is very easy to jump into the differentials and be incorrect. Ultimately this is a clinical examination and you should be cautious with your presentation, using phrases suggest as "these signs are consistent with". This allows the examiner to give you marks for the signs and lead the discussion as they see fit. 

Appear non verbally confident about findings. 

If your unsure about a sign, usually best to state is normal but can caveat this if examiner highlights. 

Usually you'll move onto differentials, complications, completing examination with history, observations, investigations and management. 

Try to listen to the examiner's non verbal hints. 

Do the basics well:

• Use the patient's name- if you don't remember this, use 'this gentleman' or 'this lady' NOT: 'he' or 'she'. 

• Speak clearly at an appropriate pace and volume using appropriate medical terminology 

• Maintain eye contact with both examiners, although one will ask the majority of the questions with appropriate formal posture without fidgeting

Tips

• Rehearse at the end of the station

• Practice in front of consultants

• Ensure the logic between signs and differentials is clear and accurate

• Do not be tempted to make up signs, better to state I did not elicit this if unsure

• Try to remember all of the positive signs

• Do not highlight your errors, omissions or signs you are unsure of as they may easily be missed by the examiner

• Some examiners will interrupt the presentation with questions +++, whereas others will allow you to present

Examiner Questions

The most unpredictable part of the station. 

The examiner will want to: 

• Be clear about the signs you identified (and perhaps prompt you if you failed to mention ones you found)

• Understand your logic between signs and differentials

• How would oyu complete your assessment

• Examine your understanding of the condition: pathophysiology, investigations, management

Top tips

• If you don't know, don't guess and keep your answers short- far better than saying something totally wrong

• This part will be over quickly- try and hit the key points and avoid too much depth of detail

• Try to answer fully when appropriate- e.g. whilst listing investigations give their results

Written in 2026. 

References