From some of my notes and thoughts - please comment.

 

Will

 

Examination
Symptoms History has preceded examination and so there may be an indication of what the examiner expects to find.

• Note the age of the patient and hence the likelihood of arteriosclerosis and also if the patient is or was a trained athlete. If so a fairly slow rate may be normal or a "normal" rate may be a little fast.
• Is the patient taking drugs that may affect the pulse rate like beta blockers?

 

Signs note the warmth of the hand and the condition of the nails. A warm hand indicates a good peripheral circulation. It might be very warm suggesting a hyperdynamic circulation as in fever or thyrotoxicosis.

 

The nails may show a number of signs.

1. There may be peripheral cyanosis.
2. Clubbing may indicate other disease. Some clubbing is constitutional and benign.
3. Koilonychia might indicate iron deficiency.

• Palpate the artery wall with the tips of the index and middle fingers. The tips are very sensitive.
• Does the wall feel soft and pliable or is it hard and sclerotic?