Diabetes Mellitus: Presentation and CLinical Examination

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The presentation which won the Best Paper award at the Students' Paper Presentation in Rhapsody 2010. This paper was presented by Dr. Rimesh Pal Medical College Kolkata, 3rd Professional MBBS Student.

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Diabetes Mellitus: Presentation and CLinical Examination

  1. 1. DIABETES MELLITUS<br />PRESENTING COMPLAINTS <br />AND<br />CLINICAL EXAMINATION<br />
  2. 2. PRESENTING COMPLAINTS<br /><ul><li> CARDINAL SYMPTOMS
  3. 3. OTHER COMMON SYPMTOMS
  4. 4. ACUTE SYMPTOMS
  5. 5. UNCOMMON SYMPTOMS
  6. 6. HYPOGLYCEMIC SYMPTOMS</li></li></ul><li>CARDINAL SYMPTOMS<br /><ul><li>POLYURIA
  7. 7. POLYDIPSIA
  8. 8. WEIGHT LOSS</li></li></ul><li>OTHER COMMON SYMPTOMS<br /><ul><li> LETHARGY AND WEAKNESS
  9. 9. WHITE PATCHES IN THE MOUTH/ </li></ul> OROPHARYNX WITH DIFFICULTY<br /> IN DEGLUTITION(CANDIDIOSIS).<br /><ul><li> WHITE VAGINAL DISCHARGE.
  10. 10. RECURRENT SKIN INFECTIONS.
  11. 11. DRY, SCALY SKIN
  12. 12. DELAYED WOUND HEALING.
  13. 13. PALPITATION & BREATHLESSNESS.
  14. 14. CLAUDICATION.
  15. 15. DIZZINESS ON STANDING.
  16. 16. SUDDEN LOSS OF CONSCIOUSNESS.
  17. 17. NUMBNESS/TINGLING/PAIN IN THE </li></ul> EXTREMITIES.<br /><ul><li>CARPAL TUNNEL SYNDROME.
  18. 18. RECURRENT NAUSEA AND VOMITING.
  19. 19. DIARRHOEA/CONSTIPATION.
  20. 20. URINARY INCONTINENCE.
  21. 21. ERECTILE DYSFUNCTION.
  22. 22. BLURRED VISION/FLOATERS/SUDDEN</li></ul> LOSS OF VISION AND DIPLOPIA.<br /><ul><li> SORE AND BLEEDING GUMS.</li></ul>CANDIDIOSIS<br />
  23. 23. COMMON PRESENTING COMPLAINTS<br />
  24. 24. ACUTE SYMPTOMS<br />HYPERGLYCAEMIC HYPEROSMOLAR STATE<br /> DIABETIC KETOACIDOSIS<br />
  25. 25. UNCOMMON SYMTOMS<br /><ul><li> PATIENT MAY PRESENT OTORRHOEA FOR 1-2 WEEKS, FOLLOWED BY OTALGIA WHICH MAY BE FOLLOWED BY FACIAL NERVE PARALYSIS AND FEATURES OF MENINGITIS.</li></ul>MALIGNANT OTITIS EXTERNA.<br /><ul><li> PATIENT MAY PRESENT WITH NASAL OBSTRUCTION AND DISCHARGE FOLLOWED BY HEADACHE/FACIAL PAIN ALONG WITH FEATURES OF MULTIPLE CRANIAL NERVE PALSIES AND PROPTOSIS AND VISION LOSS.</li></ul>RHINOCEREBRAL MUCORMYCOSIS.<br />
  26. 26. HYPOGLYCAEMIC SYMPTOMS<br />
  27. 27. CLINICAL EXAMINATION<br /><ul><li> GENERAL ASSESSMENT
  28. 28. LOCOREGIONAL EXAMINATION</li></li></ul><li>GENERAL ASSESSMENT<br />PATIENTS WITH ALTERED CONSCIOUSNESS<br />MUST CHECK FOR<br /><ul><li> MENTAL STATE
  29. 29. PULSE
  30. 30. BLOOD PRESSURE
  31. 31. RESPIRATION
  32. 32. STATE OF HYDRATION</li></ul>(SKIN & MUCOUS MEMBRANE)<br />KUSSMAUL BREATHING<br />IN THE NON-ACUTE SETTING, IN ADDITION TO THE ABOVE PARAMETERS,MEASUREMENT OF BMI AND WAIST TO HIP RATIO IS OF GREAT IMPORTANCE.<br />ORTHOSTATIC BP SHOULD ALSO BE MEASURED.<br />LOSS OF SKIN TURGOR—INDICATIVE OF DEHYDRATION<br />
  33. 33. LOCOREGIONAL EXAMINATION<br />DIABETES CAN AFFECT ALMOST EVERY SYSTEM OF THE BODY. SO, A PATIENT SUSPECTED OF HAVING DIABETES SHOULD BE EXAMINED THROUGHLY FROM HEAD TO TOE.<br />EXAMINATION OF HEAD AND NECK<br /><ul><li> XANTHELASMA
  34. 34. CRANIAL NERVE PALSY(III, IV, VI AND VII)
  35. 35. EYE MOVEMENTS
  36. 36. PTOSIS
  37. 37. HIRSUTISM
  38. 38. CAROTID PULSE
  39. 39. CAROTID BRUIT
  40. 40. THYROID ENLARGEMENT</li></ul>XANTHELASMA<br />
  41. 41. EXAMINATION OF EYES<br /> VISUAL ACUITY<br /> ANTERIOR SEGMENT EXAMINATION<br /><ul><li> CORNEAL ARCUS
  42. 42. WHITE PUPILLARY REFLEX(CATARACT)
  43. 43. SLUGGISH PUPILLARY LIGHT REFLEX.</li></ul>FUNDAL EXAMINATION<br />CORNEAL ARCUS<br />FEATURES OF NON-PROLIFERATIVE AND PROLIFERATIVE DIABETIC RETINOPATHY.<br />CLINICALLY SIGNIFICANT MACULAR EDEMA.<br />
  44. 44. EXAMINATION OF BUCCAL CAVITY<br />INSPECTION<br />ONE MUST LOOK FOR <br /><ul><li> PUFFY, RED GUMS.
  45. 45. A BUILD UP OF PLAQUE.
  46. 46. OBVIOUSLY DECAYED TEETH.
  47. 47. TYPICAL BAD BREATH OF</li></ul> PERIODONTITIS.<br />A COMPLETE DENTAL EXAMINATION, INCLUDING PERIODONTAL PROBING OF GUM POCKETS, IS NECESSARY TO DETERMINE THE PRESENCE AND SEVERITY OF PERIODONTAL INFECTION.<br />PERIODONTITIS AND GINGIVITIS<br />
  48. 48. EXAMINATION OF SKIN AND NAIL<br /> NECROBIOSIS LIPOIDICA DIABETICORUM<br />(OVER SHIN)<br />GRANULOMA ANNULARE<br />(OVER ELBOW)<br />ACANTHOSIS NIGRICANS<br />(OVER AXILLA)<br />DIABETIC DERMOPATHY<br />(OVER SHIN)<br />BULLOSIS DIABETICORUM<br />(OVER FEET)<br />FUNGAL NAIL INFECTIONS<br />(IN THUMB)<br />
  49. 49. EXAMINATION OF HANDS<br />DUPUYTREN’S CONTRACTURE<br />TRIGGER FINGER<br /> DIABETIC CHEIROARTHROPATHY<br />(PRAYER SIGN)<br />IN ADDITION, SENSORY LOSS AND MUSCLE WASTING MAY BE PRESENT<br />TINEL’S SIGN<br />PHALEN’S SIGN<br />CARPAL TUNNEL SYNDROME<br />
  50. 50. EXAMINATION OF INJECTION SITES<br />AREAS TO BE EXAMINED ARE<br /><ul><li> ANTERIOR ABDOMINAL WALL.
  51. 51. UPPER THIGH/BUTTOCKS.
  52. 52. UPPER OUTER ARM.</li></ul>POSSIBLE FINDINGS<br /><ul><li> BRUISING
  53. 53. LIPODYSTROPHY
  54. 54. LIPOHYPERTROPHY
  55. 55. LIPOATROPHY</li></ul>LIPOATROPHY<br />LIPOHYPERTROPHY<br />
  56. 56. EXAMINATION OF ABDOMEN<br />POSSIBLE FINDINDS<br /><ul><li> HEPATOMEGALY(due to NON-ALCOHOLIC FATTY LIVER DISEASE).
  57. 57. ABDOMINAL TENDERNESS(in DKA).</li></ul>EXAMINATION OF LEGS<br />POSSIBLE FINDINGS<br /><ul><li>CALF AND THIGH MUSCLE WASTING.
  58. 58. SENSORY ABNORMALITY.
  59. 59. DRY SKIN AND HAIR LOSS.
  60. 60. ABSENT/WEAK FEMORAL PULSE.
  61. 61. FEMORAL BRUIT.
  62. 62. LOSS OF KNEE/ANKLE JERKS.</li></ul>ELICITATION OF ANKLE JERK<br />
  63. 63. EXAMINATION OF FEET<br />INSPECTION<br /><ul><li> DEFORMITY LIKE CHARCOT NEUROARTHROPATHY/CLAW TOE.
  64. 64. CALLUS.
  65. 65. LOSS OF PLANTER ARCH.
  66. 66. DIABETIC FOOT ULCER.
  67. 67. DISCOLOURISATION OF SKIN(DUE TO ISCHAEMIA).
  68. 68. FUNGAL INFECTIONS.</li></ul>CHARCOT NEUROARTHROPATHY<br />CLAW TOE<br />DIABETIC FOOT ULCER<br />
  69. 69. EXAMINATION OF FEET(contd….)<br />PERIPHERAL PULSE<br />PALPATED AT <br /><ul><li>POSTERIOR TIBIAL ARTERY
  70. 70. ARTERIA DORSALIS PEDIS</li></ul>ALSO EXAMINE FOR NAILFOLD REFILLING.<br />MAY BE ABSENT.<br />TESTS FOR SENSATION<br /><ul><li> LIGHT TOUCH(USING MONOFILAMENT).
  71. 71. CRUDE TOUCH(USING BLUNT END OF PIN)
  72. 72. PAIN(USING TIP OF PRICK).
  73. 73. TEMPERATURE
  74. 74. VIBRATION(USING 128 Hz TUNING FORK).
  75. 75. PROPRIOCEPTION</li></ul>MAY BE ABNORMAL.<br />PALPATION OF ARTERIA DORSALIS PEDIS PULSE.<br />
  76. 76.
  77. 77. THANK YOU<br />

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