General Physical Examination : General Physical Examination Dr Preamala.G
HTJ,Seremban. Slide 2: DOCTORS SHOULD BE OBSERVANT,LIKE A DETECTIVE;
Look at the patients general appearance…at the face ,hands and body
Each examining system can be described using four elements;
- assessment of function First impressions….. : First impressions….. Decide how sick is your patient?
Is she well,sitting up and talking?
Or ill totally not aware of her surroundings? VITAL SIGNS : VITAL SIGNS PULSE
Should be assessed immediately once you discover that your patients unwell.
They provide important basic physiological information. Weight,body habitus and posture : Weight,body habitus and posture Obesity,BMI >30.
Any wasting of muscles?
Always observe when the patient walks into the examination room. hydration : hydration Mild-2.5L deficit
-mild thirst,dry mucous membranes,concentrated urine
Moderate – 4L deficit
-as above with moderate thirst,reduced skin turgor(especially the arms,forehead,chest and abdomen) , tachycardia
Severe – 6L
-great thirst,reduced skin turgor and decreased eyeball pressure
-collapsed veins,sunken eyes,postural hypotension,oligu FACIES : FACIES Specific diagnosis can be made by just looking at a patient’s face.
Some facial characteristics are so typical of certain diseases that they immediately suggest the diagnosis….so called diagnostic facies…… Important diagnostic facies : Important diagnostic facies Acromegaly
parkinsonism acromegaly : acromegaly Acromegaly hands : Acromegaly hands Downs syndrome : Downs syndrome Cushing’s syndrome : Cushing’s syndrome JAUNDICE : JAUNDICE It is the yellowish discolouration of a patient’s skin and sclerae that results from hyperbilirubinemia.
It happens when the serum bilirubin level rises twice above the normal upper limit.
It is deposited in the tissues of the body that contains elastin. jaundice : jaundice CYANOSIS : CYANOSIS Blue discolouration of the skin and mucous membranes;it is due to the presence of deoxygenated haemoglobin in the superficial blood vessels.
Occurs when there is more than 50g/L of deoxygenated haemoglobin in the capillary blood.
Types-central and peripheral
Central cyanosis- abnormal amount of deoxygenated haemoglobin in the arteries and that a blue discolouration is present in parts of the body with good circulation.eg;tongue.
Peripheral cyanosis-occurs when blood supply to a particular part of body is reduced,eg;lips in cold weather becomes blue but the tongue is spared. cyanosis : cyanosis Causes of cyanosis : Causes of cyanosis Central cyanosis
1)Decreased arterial oyygen saturation.
-right to left cardiac shunt
3)Haemoglobin abnormalities;methaemoglobinemia,sulphaemoglobinemia Peripheral cyanosis
1)All the causes of central cyanosis
2)Exposure to cold
3)Reduced cardiac output
-left ventricular failure
4)Arterial or venous obstruction PALLOR : PALLOR Deficiency of haemoglobin can produce pallor of the skin.
Should be noticeable especially in the mucous membranes of the sclerae if the anaemia is severe- Hb of less than 7g/L.
Facial pallor can also be seen in patients with shock,due to the reduction of cardiac output. These patients usually appear cold and clammy and significantly hypotensive. Causes of anaemia : Causes of anaemia MICROCYTIC ANAEMIA
1)Iron deficiency anaemia
4)Longstanding anaemia of chronic blood loss Macrocytic anaemia : Macrocytic anaemia Megaloblastic bone marrow
1)Vitamin B12 defiency due to
-ileal disease;crohns disease,ileal resection
-poor diet in vegetarians Slide 26: 2) Folate deficiency due to
-dietary defiency in alcoholics
-increased cell turnover eg;pregnancy,leukemia,chronic haemolysis
-anti folate drugs – phenytoin,methotrexate,sulphasalazine
non megaloblastic bone marrow
-alcohol,cirrohis of the liver,hypothyroidism,myelodysplastic syndrome Normochromic anaemia : Normochromic anaemia Bone marrow failure
Anaemia of chronic disease
-malignancies,chronic renal failure
Haemolytic anaemia Oral cavity : Oral cavity The teeth and breath
Check the oral cavity looking for
-Aphtous,drugs and trauma
-gastrointestinal disease;inflammatory bowel disease,coeliac disease
-infections;herpes zoster,simplex,syphilis,tuberculosis Behcets ulcers : Behcets ulcers Gum hypertrophy : Gum hypertrophy Phenytoin
Scurvy(vitamin C deficiency;gums become swollen,spongy,red and bleeds easily)
leukemia Pigmentation in the mouth : Pigmentation in the mouth Heavy metals-lead,bismuth,iron;haemochromatosis there is blue grey pigmentation in the hard palate
Drugs-antimalarials,OCPs(brown/black pigmentation anywhere in the mouth)
Malignant melanoma HAIR : HAIR ALOPECIA
-scalp ring worm
-burns,radiation,lupoid erythema,sarcoidosis Alopecia areata : Alopecia areata Traction alopecia : Traction alopecia Alopecia totalis : Alopecia totalis NECK;lymphadenopathy,goitre : NECK;lymphadenopathy,goitre During palpation of lymph nodes the following features should be considered;
-Localised or generalised?
-palpable lymph node areas are;
Epitrochlear,axillary,cervical and occipital,supraclavicular,para-aortic,inguinal and popliteal. Slide 41: SIZE
-hard are suggestive of carcinoma
-soft may be normal
-rubbery may be due to lymphoma
-Acute infection of inflammation
-If fixed to the underlying structures its most likely malignant
-if inflammed then its suggestive of infection,teethered suggests carcinoma. Cervical lymphadenopathy : Cervical lymphadenopathy CAUSES OF LYMPHADENOPATHY : CAUSES OF LYMPHADENOPATHY GENERALISED
-connective tissue disease
-drugs;phenytoin localised : localised Local or acute infection
Metastasis from carcinoma or other solid tumour
Lymphoma especially hodgkin’s disease NAILS : NAILS CLUBBING
-Increase in the soft tissue of the distal part of the fingers or toes.
-cyanotic congenital heart disease,IE
5)Familial clubbing : clubbing Slide 50: Blue nails-cyanosis,wilson ds
Red nails-polycythaemia,CO poisoning
Yellow nails- yellow nail syndrome
Koilonychia-iron def anaemia,fungal infection,raynauds
Terry’s nails-CRF,cirrohis Plummer wilson : Plummer wilson psoriasis : psoriasis Thank you. : Thank you.