Principles of Clinical Examination

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Principles of Clinical Examination.

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  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Greet the patient as he/she enters your room.
    Handshake
    Notice the gait.
    General body & built/physique
    Postural & spinal deformities
    Face (expressions/any swellings)
    Skin changes etc.
  • Certain disease process like thyrotoxicosis, hypothyroidism, Parkinson’s, acromegaly, 3rd & 7th nerve palsies (Diagnostic facies)
    Parotid swellings can be very obvious on the face.
    The cheeks can give a good idea about certain diseases pale in anemia and hypotpituitarism, pale & puffy in nephrotic syndrome, malar flush in mitral stenosis or a butterfly rash in cases of SLE.
  • Dry & inelastic as in dehydration
    Moist
    Thickened and greasy as in acromegaly
    Atrophied as in old age or on glucocorticoid therapy
    It could be pale or cyanosed or yellow, any sort of pigmentation.
    Palmar erythema can also be noted as in cirrhosis, pregnancy or polycythemia.
    Dupuytren's contracture of palmar fascia seen in liver disease, trauma & epilepsy.
    There could be rashes or any swollen coin like lesions
    Hemorrhages or bleeding spots under the skin
    Hair can be examined for any loss on scalp or eyebrows or excessive growth of facial hair.
  • Nails can be seen for :
    Koilonychias (spoon shaped ) in iron deficiency anemia or fungal nail infection
    Onycholysis (nail destruction ) in hyperthyroidism fungal infection and psoriasis
    Pitting is seen in psoriasis and alopecia areata
    Splinter hemorrhages (longitudinal hemorrhagic streaks) maybe seen in infective endocarditis
  • size
    number
    consistency -firm or hard or rubbery
    tenderness
    matting
    mobility
  • Principles of Clinical Examination

    1. 1. Adult General Physical Examination Dr. Seyed Morteza Mahmoudi, MBBS Gulf Medical University, Ajman 2013
    2. 2. Making use of all our senses, Except?
    3. 3. Initial Steps 1- Greet
    4. 4. Initial Steps 2- Introduce yourself
    5. 5. Initial Steps 3- Make sure you have the right patient
    6. 6. Initial Steps 4- Explain
    7. 7. Initial Steps 5- Make sure the environment is appropriate
    8. 8. Initial Steps 6- Consent
    9. 9. Initial Steps 7- Wash hands, safety precautions
    10. 10. Initial Steps 8- Drape and adequately expose
    11. 11. Initial Steps 9- If necessary get a chaperon
    12. 12. Initial Steps 10- Ask about pain
    13. 13. Steps 1- Greet 2- Introduce yourself 3- Make sure you have the right patient 4- Explain 5- Make sure the environment is appropriate 6- Consent 7- Wash hands, safety precautions 8- Drape and adequately expose 9- Chaperon 10- Pain consideration
    14. 14. Start your physical examination as soon as you see the patient
    15. 15. Physical Examination Hand shake Body built Face Clothing Complexion Sounds Odors Posture and gait Movements Spot diagnosis
    16. 16. Useful Pneumonic Pallor Edema Nail changes/clubbing Cyanosis Icterus Lymph nodes Skin changes
    17. 17. SCHAMROTH’S WINDOW TEST
    18. 18. CAUSES OF CLUBBING cyanotic congenital heart disease Sub acute bacterial endocarditis lung carcinoma bronchiectasis Emphysema lung abscess lung fibrosis Pulmonary Tuberculosis cirrhosis IBD Celiac disease Thyrotoxicosis Familial
    19. 19. CAUSES CENTRAL CYANOSIS Abnormal hemoglobin levels Congenital heart disease Hypoventilation Asthma Methmoglobinemia Valvular heart disease COPD Pulmonary embolism Arterial obstruction Heart failure Right to left venous arterial shunts High altitudes Polycythemia
    20. 20. PERIPHERAL CYANOSIS Exposure to cold Reduced cardiac output Arterial or venous obstruction
    21. 21. Skin Changes Dry & inelastic Moist Thickened and greasy Atrophied Colour Dupuytren's contracture Rashes Swellings Hemorrhages Hair
    22. 22. Nail Changes Koilonychias Onycholysis Pitting Splinter hemorrhages
    23. 23. Lymph node Examination Cervical Sub mental Submandibular – Tonsillar (Jugulodigastric)Preauricular Postauricular Occipital Superficial (Anterior) Cervical Posterior cervical Supraclavicular Axillary Inguinal
    24. 24. Massive lymphadenopathy
    25. 25. Tuberculosis Lymphadenopathy

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