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  • 1. PHYSICAL EXAMINATION IN HEMATOLOGY Pensri Pootrakul MD. Thalassemia Research Center Institute of Molecular Bioscience Mahidol University,Salaya Campus
  • 2. DIAGNOSIS
  • 3. DIAGNOSIS Chief complaint
  • 4. DIAGNOSIS Chief complaint History : Present history Past history
  • 5. DIAGNOSIS Chief complaint History : Present history Past history Physical examination
  • 6. DIAGNOSIS Chief complaint History : Present history Past history Physical examination Lab. tests: Rountine tests Special tests
  • 7. PHYSICAL EXAMINATION
  • 8. PHYSICAL EXAMINATION Inspection
  • 9. PHYSICAL EXAMINATION Inspection Palpation
  • 10. PHYSICAL EXAMINATION Inspection Palpation Percussion
  • 11. PHYSICAL EXAMINATION Inspection Palpation Percussion Auscultation
  • 12. GENERAL APPEARANCE
  • 13. GENERAL APPEARANCE Figure,malformation
  • 14. GENERAL APPEARANCE Figure,malformation Dressing
  • 15. GENERAL APPEARANCE Figure,malformation Dressing Severity of symptoms and signs
  • 16. GENERAL APPEARANCE Figure,malformation Dressing Severity of symptoms and signs Growth : body weight and hight
  • 17. GENERAL APPEARANCE Figure,malformation Dressing Severity of symptoms and signs Growth : body weight and hight Development
  • 18. GENERAL APPEARANCE Figure,malformation Dressing Severity of symptoms and signs Growth : body weight and hight Development Level of conciousness,mood,IQ,
  • 19. GENERAL APPEARANCE Figure,malformation Dressing Severity of symptoms and signs Growth : body weight and hight Development Level of conciousness,mood,IQ, Speaking,voice
  • 20. GENERAL APPEARANCE Figure,malformation Dressing Severity of symptoms and signs Growth : body weight and hight Development Level of conciousness,mood,IQ, Speaking,voice Co-operative
  • 21. Vital Signs
  • 22. Vital Signs Temperature
  • 23. Vital Signs Temperature Pulse
  • 24. Vital Signs Temperature Pulse Respiratory rate,rhythm
  • 25. Vital Signs Temperature Pulse Respiratory rate,rhythm Blood pressure
  • 26. Problems in Hematology
  • 27. Problems in Hematology Anemia
  • 28. Problems in Hematology Anemia Gum hypertrophy
  • 29. Problems in Hematology Anemia Gum hypertrophy Jaundice
  • 30. Problems in Hematology Anemia Gum hypertrophy Jaundice Hepato-splenomegaly
  • 31. Problems in Hematology Anemia Gum hypertrophy Jaundice Hepato-splenomegaly Cyanosis
  • 32. Problems in Hematology Anemia Gum hypertrophy Jaundice Hepato-splenomegaly Cyanosis Clubbing finger
  • 33. Problems in Hematology Anemia Gum hypertrophy Jaundice Hepato-splenomegaly Cyanosis Clubbing finger Growth retardation
  • 34. Problems in Hematology Anemia Gum hypertrophy Jaundice Hepato-splenomegaly Cyanosis Clubbing finger Growth retardation Mongoioid face
  • 35. Problems in Hematology Anemia Gum hypertrophy Jaundice Hepato-splenomegaly Cyanosis Clubbing finger Growth retardation Mongoioid face Lymphadenopathy
  • 36. Problems in Hematology Anemia Gum hypertrophy Jaundice Hepato-splenomegaly Cyanosis Clubbing finger Growth retardation Mongoioid face Lymphadenopathy Bleeding
  • 37. Problems in Hematology Anemia Gum hypertrophy Jaundice Hepato-splenomegaly Cyanosis Clubbing finger Growth retardation Mongoioid face Lymphadenopathy Bleeding Skin : bruise,echymosis, hematoma,pethichiae
  • 38. Problems in Hematology Anemia Gum hypertrophy Jaundice Hepato-splenomegaly Cyanosis Clubbing finger Growth retardation Mongoioid face Lymphadenopathy Bleeding Skin : bruise,echymosis, hematoma,pethichiae Organs bleeding : GI,cerebral,gum
  • 39. ANEMIA
  • 40. ANEMIA Symptom, not disease and found in many diseases
  • 41. ANEMIA Symptom, not disease and found in many diseases Fatique,weakness,dizzy,easily tired
  • 42. ANEMIA Symptom, not disease and found in many diseases Fatique,weakness,dizzy,easily tired Signs : color of conjunctiva,lip,tongue,nail,palm,skin
  • 43. JAUNDICE Sclera, mucosa, skin
  • 44. CYANOSIS
  • 45. CYANOSIS Lip, tounge, mucosa, nail, skin
  • 46. CYANOSIS Lip, tounge, mucosa, nail, skin Clubling of finger
  • 47. Clubling of finger
  • 48. EDEMA
  • 49. EDEMA Dorsum of foot, ankle,medial side of tibia
  • 50. EDEMA Dorsum of foot, ankle,medial side of tibia Pitting edema
  • 51. EDEMA Dorsum of foot, ankle,medial side of tibia Pitting edema Non-pitting edema : local ,thick & rough skin
  • 52. EDEMA Dorsum of foot, ankle,medial side of tibia Pitting edema Non-pitting edema : local ,thick & rough skin Severe edema - sex organ swelling
  • 53. EDEMA
  • 54. EDEMA Severe edema
  • 55. HEAD, FACE, NECK
  • 56. HEAD, FACE, NECK Head : Start from up to down, skull, hair, Scalp,
  • 57. HEAD, FACE, NECK Head : Start from up to down, skull, hair, Scalp, Face : eyes,ears,nose,sinus,mouth,face appearance
  • 58. HEAD, FACE, NECK Head : Start from up to down, skull, hair, Scalp, Face : eyes,ears,nose,sinus,mouth,face appearance Pharynx : lip,teeth,gum,mucosa,tounge,tonsils
  • 59. HEAD, FACE, NECK Head : Start from up to down, skull, hair, Scalp, Face : eyes,ears,nose,sinus,mouth,face appearance Pharynx : lip,teeth,gum,mucosa,tounge,tonsils Neck : Scar?, Mass - thyroid, lymph node ,trachea,
  • 60. HEAD, FACE, NECK Head : Start from up to down, skull, hair, Scalp, Face : eyes,ears,nose,sinus,mouth,face appearance Pharynx : lip,teeth,gum,mucosa,tounge,tonsils Neck : Scar?, Mass - thyroid, lymph node ,trachea, jugular vein and pressure , carotid artery,
  • 61. HEAD, FACE, NECK Head : Start from up to down, skull, hair, Scalp, Face : eyes,ears,nose,sinus,mouth,face appearance Pharynx : lip,teeth,gum,mucosa,tounge,tonsils Neck : Scar?, Mass - thyroid, lymph node ,trachea, jugular vein and pressure , carotid artery, superior vena cava syndrome
  • 62. Angular stomatitis
  • 63. Hypotrophy of tongue
  • 64. Tongue ulcer
  • 65. Tongue ulcer
  • 66. Hereditary hemorrhagic telangectasia Tongue ulcer
  • 67. Gum hypertrophy
  • 68. Gum hypertrophy
  • 69. Gum hypertrophy Gum hypertrophy with poor mouth hygene
  • 70. Ulcer at base of tongue
  • 71. Ulcer at base of tongue Ulcer at sublingual
  • 72. Inflammation
  • 73. Inflammation Infection
  • 74. Koilonychia
  • 75. LYMPH NODES
  • 76. LYMPH NODES Which group of lymph nodes enlargement single or multiple nodes,multiple groups
  • 77. LYMPH NODES Which group of lymph nodes enlargement single or multiple nodes,multiple groups Signs of inflamation, tenderness, consistency, fix or movable
  • 78. LYMPH NODES Which group of lymph nodes enlargement single or multiple nodes,multiple groups Signs of inflamation, tenderness, consistency, fix or movable Location of infection or inflammation - coresponding the enlarged nodes:
  • 79. LYMPH NODES
  • 80. LYMPH NODES Group of lymph nodes :
  • 81. LYMPH NODES Group of lymph nodes : Preauricular,postauricular,occipital,submandibular,
  • 82. LYMPH NODES Group of lymph nodes : Preauricular,postauricular,occipital,submandibular, submentle, cervical
  • 83. LYMPH NODES Group of lymph nodes : Preauricular,postauricular,occipital,submandibular, submentle, cervical Cervical: anterior, posterior,supraclavicular
  • 84. LYMPH NODES Group of lymph nodes : Preauricular,postauricular,occipital,submandibular, submentle, cervical Cervical: anterior, posterior,supraclavicular Axillary,epitrochlear,mediasternal,hilar
  • 85. LYMPH NODES Group of lymph nodes : Preauricular,postauricular,occipital,submandibular, submentle, cervical Cervical: anterior, posterior,supraclavicular Axillary,epitrochlear,mediasternal,hilar Inguinal,abdominal
  • 86. Lymph nodes at the neck
  • 87. Lymph nodes at the neck
  • 88. Lymphadenopathy
  • 89. Thyroid examination from the front
  • 90. Thyroid examination from the front
  • 91. Thyroid examination from the front Thyroid examination from the back
  • 92. CHEST
  • 93. CHEST Chest appearance :
  • 94. CHEST Chest appearance : abnormal shapes -
  • 95. CHEST Chest appearance : abnormal shapes - barrel,cobbler,flat, funnel,pigion
  • 96. CHEST Chest appearance : abnormal shapes - barrel,cobbler,flat, funnel,pigion Spine - kyphosis,scoliosis
  • 97. CHEST Chest appearance : abnormal shapes - barrel,cobbler,flat, funnel,pigion Spine - kyphosis,scoliosis Palpation :
  • 98. CHEST Chest appearance : abnormal shapes - barrel,cobbler,flat, funnel,pigion Spine - kyphosis,scoliosis Palpation : apex beat , chest movement
  • 99. CHEST Chest appearance : abnormal shapes - barrel,cobbler,flat, funnel,pigion Spine - kyphosis,scoliosis Palpation : apex beat , chest movement Percussion :
  • 100. CHEST Chest appearance : abnormal shapes - barrel,cobbler,flat, funnel,pigion Spine - kyphosis,scoliosis Palpation : apex beat , chest movement Percussion : cardiac dullness , chest dullness
  • 101. CHEST Chest appearance : abnormal shapes - barrel,cobbler,flat, funnel,pigion Spine - kyphosis,scoliosis Palpation : apex beat , chest movement Percussion : cardiac dullness , chest dullness Auscultation :
  • 102. CHEST Chest appearance : abnormal shapes - barrel,cobbler,flat, funnel,pigion Spine - kyphosis,scoliosis Palpation : apex beat , chest movement Percussion : cardiac dullness , chest dullness Auscultation : breath sound,heart sound
  • 103. Spleen palpation
  • 104. SPLEEN
  • 105. SPLEEN
  • 106. SPLEEN
  • 107. SPLEEN
  • 108. Auscultation
  • 109. Growth retardation
  • 110. Thalassemic face - Mongoloid face
  • 111. Thalassemic face - Mongoloid face
  • 112. Tower skull
  • 113. Tower skull
  • 114. Tower skull Radiography - Hair on end
  • 115. Tower skull
  • 116. Tower skull
  • 117. Tower skull Radiography - Hair on end
  • 118. Knock knee
  • 119. Bone deformity
  • 120. Hyperpigmentation of skin
  • 121. Hyperpigmentation of skin
  • 122. Abdominal enlargement
  • 123. Bone deformity
  • 124. Gynecomastia
  • 125. Gangrene
  • 126. Skin bleeding
  • 127. Skin bleeding Petichiae
  • 128. Purpura over the lower limbs in acute leukemia
  • 129. MASSIVE BLEEDING
  • 130. MASSIVE BLEEDING HEMOPHILIA A
  • 131. Early urticarial lesion
  • 132. Early urticarial lesion
  • 133. Early urticarial lesion Bleeding with bleb formation
  • 134. HENOCH-SCHÖNLEIN PURPURA Early urticarial lesion Bleeding with bleb formation
  • 135. Senile purpura
  • 136. MYCOSIS FUNGOIDES
  • 137. Herpes Zoster infection
  • 138. Indurated and confluent purpura of the arm Disseminated intravascular coagulation ( DIC )
  • 139. Peripheral gangrene with swelling and discoloration of the skin of the feet in fulminant disease
  • 140. Massive subcutaneous hemorrhage in thrombocytopenia
  • 141. Severe bleeding
  • 142. Acute hemarthrosis of Rt. knee joint wasting of the quadriceps muscles on the left
  • 143. Acute hemarthrosis of Rt. knee joint wasting of the quadriceps muscles on the left
  • 144. Acute hemarthrosis of Rt. knee joint Severe disability wasting of the quadriceps muscles on the left
  • 145. Hemophilia A Acute hemarthrosis of Rt. knee joint Severe disability wasting of the quadriceps muscles on the left
  • 146. Midline grannuloma
  • 147. Kaposiʼs sarcoma
  • 148. Kaposiʼs sarcoma in acquired immune deficiency syndrome ( AIDS )
  • 149. Urine color