General Physical Examination :General Physical Examination Dr Preamala.G Medical Department HTJ,Seremban.


Slide 2:DOCTORS SHOULD BE OBSERVANT,LIKE A DETECTIVE; “CONAN DOYLE” Look at the patients general appearance…at the face ,hands and body Each examining system can be described using four elements; - looking/inspection - feeling/palpation - tapping/percussion - listening/auscultation - 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 BLOOD PRESSURE TEMPERATURE RESPIRATORY RATE 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? Tall?short? 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 Cushingnoid Down syndrome Hippocratic Marfanoid Myxoedemetous Thyrotoxic 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. -high altitude -lung disease -right to left cardiac shunt 2)Polycythaemia 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 -shock 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 -chronic bleeding -malabsorption -hookworm -pregnancy 2)Thalassemia minor 3)Sideroblastic anaemia 4)Longstanding anaemia of chronic blood loss


Macrocytic anaemia :Macrocytic anaemia Megaloblastic bone marrow 1)Vitamin B12 defiency due to -pernicious anaemia -gastrectomy -tropical sprue -ileal disease;crohns disease,ileal resection -fish tapeworm -poor diet in vegetarians


Slide 26:2) Folate deficiency due to -dietary defiency in alcoholics -malabsorption -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 -aplastic anaemia -ineffective haematopoiesis -infiltration Anaemia of chronic disease -chronic inflammation -liver disease -malignancies,chronic renal failure Haemolytic anaemia


Oral cavity :Oral cavity The teeth and breath Check the oral cavity looking for MOUTH ULCERS -Aphtous,drugs and trauma -gastrointestinal disease;inflammatory bowel disease,coeliac disease -rheumatological;Behcets syndrome,reiter -erythema multiforme -infections;herpes zoster,simplex,syphilis,tuberculosis


Behcets ulcers :Behcets ulcers


Gum hypertrophy :Gum hypertrophy Phenytoin Pregnancy Scurvy(vitamin C deficiency;gums become swollen,spongy,red and bleeds easily) Gingivitis;smoking 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) Addisons disease Peutz-jeghers syndrome Malignant melanoma


HAIR :HAIR ALOPECIA Non-scarring -alopecia areta -scalp ring worm -traction alopecia Scarring -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; SITE -Localised or generalised? -palpable lymph node areas are; Epitrochlear,axillary,cervical and occipital,supraclavicular,para-aortic,inguinal and popliteal.


Slide 41:SIZE CONSISTENCY -hard are suggestive of carcinoma -soft may be normal -rubbery may be due to lymphoma TENDERNESS -Acute infection of inflammation FIXATION -If fixed to the underlying structures its most likely malignant OVERLYING SKIN -if inflammed then its suggestive of infection,teethered suggests carcinoma.


Cervical lymphadenopathy :Cervical lymphadenopathy


CAUSES OF LYMPHADENOPATHY :CAUSES OF LYMPHADENOPATHY GENERALISED -lymphoma -leukemia -infections -viral;infectious mononucleosis,CMV,HIV -bacterial;tuberculosis,syphilis -protozoal;toxoplasmosis -connective tissue disease -infitration;sarcoidosis -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. CAUSES 1)Cardiovascular -cyanotic congenital heart disease,IE 2) Respiratory -lung carcinoma -bronchiectasis,lung abscess,emphyema -lung fibrosis 3)Gastrointestinal -cirrohis,IBS,Coeliac disease 4)Thyrotoxicosis 5)Familial


clubbing :clubbing


Slide 50:Blue nails-cyanosis,wilson ds Red nails-polycythaemia,CO poisoning Yellow nails- yellow nail syndrome Splinter haemorrhages-IE,vasculitis Koilonychia-iron def anaemia,fungal infection,raynauds Onycholysis-thyrotoxicosis,psoriasis Leuconychia-hypoalbuminemia Nailfold erythema-SLE Terry’s nails-CRF,cirrohis


Plummer wilson :Plummer wilson


psoriasis :psoriasis


Thank you. :Thank you.