PHYSICAL EXAMINATION
   IN HEMATOLOGY

    Pensri Pootrakul MD.

 Thalassemia Research Center
 Institute of Molecular Bios...
DIAGNOSIS
DIAGNOSIS

Chief complaint
DIAGNOSIS

Chief complaint

History :   Present history
            Past history
DIAGNOSIS

Chief complaint

History :   Present history
            Past history
Physical examination
DIAGNOSIS

Chief complaint

History :     Present history
              Past history
Physical examination

Lab. tests:    ...
PHYSICAL EXAMINATION
PHYSICAL EXAMINATION



     Inspection
PHYSICAL EXAMINATION



     Inspection

     Palpation
PHYSICAL EXAMINATION



     Inspection

     Palpation

     Percussion
PHYSICAL EXAMINATION



     Inspection

     Palpation

     Percussion

     Auscultation
GENERAL APPEARANCE
GENERAL APPEARANCE

Figure,malformation
GENERAL APPEARANCE

Figure,malformation
Dressing
GENERAL APPEARANCE

Figure,malformation
Dressing
Severity of symptoms and signs
GENERAL APPEARANCE

Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight
GENERAL APPEARANCE

Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight
Development
GENERAL APPEARANCE

Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight
Development...
GENERAL APPEARANCE

Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight
Development...
GENERAL APPEARANCE

Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight
Development...
Vital Signs
Vital Signs

Temperature
Vital Signs

Temperature

Pulse
Vital Signs

Temperature

Pulse

Respiratory rate,rhythm
Vital Signs

Temperature

Pulse

Respiratory rate,rhythm

Blood pressure
Problems in Hematology
Problems in Hematology
Anemia
Problems in Hematology
Anemia          Gum hypertrophy
Problems in Hematology
Anemia           Gum hypertrophy
Jaundice
Problems in Hematology
Anemia           Gum hypertrophy
Jaundice         Hepato-splenomegaly
Problems in Hematology
Anemia           Gum hypertrophy
Jaundice         Hepato-splenomegaly
Cyanosis
Problems in Hematology
Anemia           Gum hypertrophy
Jaundice         Hepato-splenomegaly
Cyanosis         Clubbing fing...
Problems in Hematology
Anemia               Gum hypertrophy
Jaundice             Hepato-splenomegaly
Cyanosis             ...
Problems in Hematology
Anemia               Gum hypertrophy
Jaundice             Hepato-splenomegaly
Cyanosis             ...
Problems in Hematology
Anemia               Gum hypertrophy
Jaundice             Hepato-splenomegaly
Cyanosis             ...
Problems in Hematology
Anemia               Gum hypertrophy
Jaundice             Hepato-splenomegaly
Cyanosis             ...
Problems in Hematology
Anemia                 Gum hypertrophy
Jaundice               Hepato-splenomegaly
Cyanosis         ...
Problems in Hematology
Anemia                  Gum hypertrophy
Jaundice                Hepato-splenomegaly
Cyanosis       ...
ANEMIA
ANEMIA
Symptom, not disease and found in many diseases
ANEMIA
Symptom, not disease and found in many diseases

     Fatique,weakness,dizzy,easily tired
ANEMIA
Symptom, not disease and found in many diseases

      Fatique,weakness,dizzy,easily tired

Signs : color of conjun...
JAUNDICE

Sclera, mucosa, skin
CYANOSIS
CYANOSIS
Lip, tounge, mucosa,
      nail, skin
CYANOSIS
Lip, tounge, mucosa,
      nail, skin

   Clubling of finger
Clubling of finger
EDEMA
EDEMA

Dorsum of foot, ankle,medial side of tibia
EDEMA

Dorsum of foot, ankle,medial side of tibia
  Pitting edema
EDEMA

Dorsum of foot, ankle,medial side of tibia
  Pitting edema

  Non-pitting edema : local ,thick & rough skin
EDEMA

Dorsum of foot, ankle,medial side of tibia
  Pitting edema

  Non-pitting edema : local ,thick & rough skin


   Se...
EDEMA
EDEMA




Severe edema
HEAD, FACE, NECK
HEAD, FACE, NECK

Head : Start from up to down, skull, hair, Scalp,
HEAD, FACE, NECK

Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance
HEAD, FACE, NECK

Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance

Pha...
HEAD, FACE, NECK

Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance

Pha...
HEAD, FACE, NECK

Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance

Pha...
HEAD, FACE, NECK

Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance

Pha...
Angular stomatitis
Hypotrophy of tongue
Tongue ulcer
Tongue ulcer
Hereditary hemorrhagic telangectasia



Tongue ulcer
Gum hypertrophy
Gum hypertrophy
Gum hypertrophy   Gum hypertrophy with poor
                       mouth hygene
Ulcer at base of tongue
Ulcer at base of tongue   Ulcer at sublingual
Inflammation
Inflammation   Infection
Koilonychia
LYMPH NODES
LYMPH NODES

Which group of lymph nodes enlargement
     single or multiple nodes,multiple groups
LYMPH NODES

Which group of lymph nodes enlargement
      single or multiple nodes,multiple groups

Signs of inflamation, t...
LYMPH NODES

Which group of lymph nodes enlargement
      single or multiple nodes,multiple groups

Signs of inflamation, t...
LYMPH NODES
LYMPH NODES
Group of lymph nodes :
LYMPH NODES
Group of lymph nodes :
 Preauricular,postauricular,occipital,submandibular,
LYMPH NODES
Group of lymph nodes :
 Preauricular,postauricular,occipital,submandibular,
 submentle, cervical
LYMPH NODES
Group of lymph nodes :
 Preauricular,postauricular,occipital,submandibular,
 submentle, cervical
 Cervical: an...
LYMPH NODES
Group of lymph nodes :
 Preauricular,postauricular,occipital,submandibular,
 submentle, cervical
 Cervical: an...
LYMPH NODES
Group of lymph nodes :
 Preauricular,postauricular,occipital,submandibular,
 submentle, cervical
 Cervical: an...
Lymph nodes at the neck
Lymph nodes at the neck
Lymphadenopathy
Thyroid examination from the front
Thyroid examination from the front
Thyroid examination from the front   Thyroid examination from the back
CHEST
CHEST

Chest appearance :
CHEST

Chest appearance : abnormal shapes -
CHEST

Chest appearance : abnormal shapes -
      barrel,cobbler,flat, funnel,pigion
CHEST

Chest appearance : abnormal shapes -
      barrel,cobbler,flat, funnel,pigion
      Spine - kyphosis,scoliosis
CHEST

Chest appearance : abnormal shapes -
       barrel,cobbler,flat, funnel,pigion
       Spine - kyphosis,scoliosis

Pa...
CHEST

Chest appearance : abnormal shapes -
       barrel,cobbler,flat, funnel,pigion
       Spine - kyphosis,scoliosis

Pa...
CHEST

Chest appearance : abnormal shapes -
       barrel,cobbler,flat, funnel,pigion
       Spine - kyphosis,scoliosis

Pa...
CHEST

Chest appearance : abnormal shapes -
       barrel,cobbler,flat, funnel,pigion
       Spine - kyphosis,scoliosis

Pa...
CHEST

Chest appearance : abnormal shapes -
       barrel,cobbler,flat, funnel,pigion
       Spine - kyphosis,scoliosis

Pa...
CHEST

Chest appearance : abnormal shapes -
       barrel,cobbler,flat, funnel,pigion
       Spine - kyphosis,scoliosis

Pa...
Spleen palpation
SPLEEN
SPLEEN
SPLEEN
SPLEEN
Auscultation
Growth retardation
Thalassemic face - Mongoloid face
Thalassemic face - Mongoloid face
Tower skull
Tower skull
Tower skull   Radiography - Hair on end
Tower skull
Tower skull
Tower skull   Radiography - Hair on end
Knock knee
Bone deformity
Hyperpigmentation of skin
Hyperpigmentation of skin
Abdominal enlargement
Bone deformity
Gynecomastia
Gangrene
Skin bleeding
Skin bleeding

 Petichiae
Purpura over the lower limbs in acute leukemia
MASSIVE BLEEDING
MASSIVE BLEEDING




  HEMOPHILIA A
Early urticarial lesion
Early urticarial lesion
Early urticarial lesion   Bleeding with bleb formation
HENOCH-SCHÖNLEIN PURPURA




Early urticarial lesion   Bleeding with bleb formation
Senile purpura
MYCOSIS FUNGOIDES
Herpes Zoster infection
Indurated and confluent purpura of the arm
  Disseminated intravascular coagulation
                  ( DIC )
Peripheral gangrene with swelling and discoloration
     of the skin of the feet in fulminant disease
Massive subcutaneous hemorrhage in
         thrombocytopenia
Severe bleeding
Acute hemarthrosis of Rt. knee joint
wasting of the quadriceps muscles on the left
Acute hemarthrosis of Rt. knee joint
wasting of the quadriceps muscles on the left
Acute hemarthrosis of Rt. knee joint        Severe disability
wasting of the quadriceps muscles on the left
Hemophilia A




    Acute hemarthrosis of Rt. knee joint        Severe disability
wasting of the quadriceps muscles on th...
Midline grannuloma
Kaposiʼs sarcoma
Kaposiʼs sarcoma
in acquired immune deficiency syndrome ( AIDS )
Urine color
C:\Documents And Settings\Bkkqf\Desktop\Physical Examination
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  • C:\Documents And Settings\Bkkqf\Desktop\Physical Examination

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

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