Physical Diagnosis
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Physical Diagnosis

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Physical diagnosis: general exam.

Physical diagnosis: general exam.

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Physical Diagnosis Physical Diagnosis Presentation Transcript

  • Physical diagnosis: General Examination Dr. Mohammad Shaikhani. [email_address]
  • Introduce yourself
    • Shake hands.
    • Normal grip.
    • Weak grip:Paralysis,Ill health,Depression.
    • Slow relaxing grip: Myotonia Dystropfica.
    • Comfortness:
    • Comfortable.
    • Mood.
    • Distressed:
    • Dyspniec.
    • Orthopniec: dyspnea on lying down from pulm edem.
    • Acidotic breath(deep sighing respiration or air hunger):
    • Renal failure/Diabetic ketoacidosis/Lactic acidosis/Alcoholic ketoacidosis/Aspirin poisoning.
    • Chynes sokes respiration(apnea-hyperpnea cycles):
    • Head injury/Cerebral hemorrhage/Heart failure.
  • Body built:
    • Normal.
    • Obese.
    • Cachectic:Cancer/Malnutrition/Malabsorbtion/Thyrotoxic/DM.
    • Body habitus:
    • Normal.
    • Short:Familial/GH def/Celiac/Achondroplasis/Chronic disease /Turner.
    • Gigant.
    • Marfanoid.
    • Signs of dehydration: Sunken eyes/Dry tongue/Loss of skin turgor.
    • Personal hygiene.
  •  
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  • Position in bed :
    • Normal
    • Restless:Renal,biliary & intestinal colic.
    • In pain & can not move: peritonitis.
    • Shocked: pale, cold extremities, oliguric,hypotension, dull sensorium
    • Can not move:Peritonitis/Arthritis/Paralysis.
    • Head:
    • Normal.
    • Hydrocephalus.
    • Microcephaly.
    • Scalp:
    • Rash (herpes zoster opthalmicus, psoriasis, seborrhea).
    • Infection(tinea capitis & impetigo).
    • Temporal resetion( sign of weight loss).
    • Tender temporal artery(temporal artritis).
    • Depressed fracture.
    • Lipomas.
  • Eyes:
    • Exopthalmus:Thyrotoxicosis.COPD.Alcoholism.Retrobulbar tumour.
    • Enopthalmus:Horner syndrome.
    • Periorbital oedema:Nephrotic.Real failure. Glomerulonephritis. Hypothyroid.
    • Xanthomas.
    • Artificial eye.
    • Ptosis:Occulomotor palsy.Myasthenia gravis.Horner syndrome.
    • Ears:
    • Red & tender:Otitis externa.Relapsing polychondritis.Tophi(gout).
    • Herpes zoster rash+ facial palsy(ramsi-hunts syndrome).
  •  
  • Conjunctiva : Pallor:Anemia.Shock.Heart failure,hypopituitirism. Plethoric:Polycythemia.Superior vena caval obstruction. Hemorrhage:Trauma.Hypertension.Bleeding tendencies. Sclera: Yellow(jaundice). Blue(osteogenesis imperfecta). Cornea: Opacity. Lens: cataract. Lens dislocation.Marfan.Homocysteinrea. Ulcer: herpetic keratitis. Archus senilis or lipidicus. Kayser flesher ring(Wilson)
  • Facial features: Hypothyroid face.Thyrotoxic face/Acromegalic face.Hypopitutaric face Cushing face.Thalacemic face(mongoloid).Down face(mongoloid). Uremic face(earthy coloure): Anemia.Urochrome retention.Hemociderosis. Sclerodermic face. Sturg Weber (facial hemangioma). Cheeks: Malar flush(MS).Butter-fly rash( SLE).Coalasma(pregnancy). Nose: Rodent ulcer. Saddle-shaped(congenital syphilis). Parrot-peaked nose(scleroderma). Lips: Hare lip.Cyanosis.Talangiectasia or spiders.Pigmentation(Peutz-jagger syndrome).Herpes labialis, angular stomatitis( Vit def).
  • Facial features:
  • Facial features:
  • Facial features:
  •  
  • Mouth & tongue: Puckered mouth(scleroderma). Tongue cyanosis. Frenulum pallor or yallowness. Gum hypertrophy:Myelogenous leukemia.Epilepsy.Nifedipine. Tongue fasciculations(motor neuron disease). Smooth tongue (iron & vitamins dificiencies). Painless ulcers (SLE, sero negative arthritis). Painful aphthus ulcer(idiopathic or Behcet disease). Petichae or echemosis. Monilia infection of tongue. Leukoplakia. Tonsils: Normal.Enlarged.Infected. Mouth odor: alcohol, uremic fetor,hepatic fetor
  •  
  • Neck: Goiter.Lymph nodes & other lymph node groups. Vascular pulsation. Short with webs(Turner syndrome). Breasts: Female breasts:Normal.Mass or thickenings or nodularity. Male breasts: Normal.Mass. Gynecomastia:Liver cirrhosis.Drugs as spirinolactone,oestrogen. Puberty.Old age.Hypogonadism.Thyrotoxicosis. Tumours (testicular,adrenals,lung)
  •  
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  • Chest: Obvious chest deformities & scars. Dialated veins or arteries.
  • Abdomen: Distended or not. Rashes & discolorations. Abnormal pulsations. Dilated veins.
  • Pancreatitis:Cullen & turner signs.
  • Hands: Tremor:Rest(parkinsonism).Action(anxiety,thyrotoxic or familial) Flapping(transient laps in maintained posture):organ failure. Chorea:Rheumatic.Huntington.SLE.Pregnancy.Oral contraceptive.Drugs as phenothiazines.Polycythemia. Cerebral pulsy(chorioathetosis). Wasting. Wrist drop(radial nerve pulsy). Claw hand(ulnar nerve pulsy). Duptryn contracture:Liver cirrhosis.Occupational.Idiopathic.RA Rheumatoid hand:Swan neck.Boutonniere. Heberdon nodes(distal IP joints in osteoarthritis). Tophi in gout. Osler nodes(SBE). Warm hands.Wet hands.Cold hands. Tendons & palmar xanthomas. Raynauld phenpmena.Pale creases(anemia)
  • Hands:
  • Nails: Nails clubbing(lung,liver,cyanotic heart,intestinal &inflammatory bowel diseases). what degree? 1.increased base flactuation. 2.loss of nail angle. 3.increased curvature. 4.drum stick. Confirm clubbing by Shamruth sign: Absence of rectangular space on coinsiding corresponding nails of both hands). Cholenychia or spoon nails(flat or concave in iron dificiency). Splinter sunangual hemorrhage(SBE,trauma,valculitis,trichinliasis). White nails:Hypoalbuminemia.Severe chronic illness. Nail pitting in psoriasis. Transverse depression in nails(Beaus lines):Acute severe illness. Onycolysis(elevation of nail end):Thyrotoxicosis.Chronic nail disorders.
  • Hands: Scleroderma hand. Acromegaly. Short metacarpals(hypoparathyroid) Tetany:Hypocalcemia.Hyperventilation.
  • Legs: Wasting Pseudohypertrophy(Hereditary Dushein muscular dystroohy). Swolen&tender(DVT). Ulcers. Erythema nodosum(tender red painful nodules): TB.Streptococcal infections.Sarcoidosis.IBD.Behcet disease. Varicose veins. Coldness in ischemia(compare with other side). Ankle edema: Pitting: Heart failure.Renal failure.Nephrotic syndrome.Liver cirrhosis.Malnutrition. Non-pitting:Lyphedema.
  • Legs: Rashes:Petichae or echemosis, vasculitic rash. Hair changes. Feet: Edema.Swelling.Flat foot.Pes cavus(friedricks ataxia). Rheumatoid foot. Swollen big toe(gout). Ulcers. Gangrene. Achilis tendonitis(sero –ve arthritis). Cold in ischemia(compare with other side). Diabetic foot ulcers or gangrene. Clubbing of toe nails.
  • Legs:
  • Joints: Small &large joints.Swelling.Deformity.Tenderness.Hotness.Restricted movements. Skin: Scratching marks( pruritis,obstructive jaundice)Rashes. Talangiectasia & spider nevi. Petichae & echemosis. Neurofibromas. Vitiligo patches. Allopacia areata or totalis. Hemangiomas. Herpes zoster. Xeroderma. Rose spots(typhoid).Xanthomas.Albinisim. Vital signs: PR,BP,RR,Temp Temperature: Oral .Axillary.Rectal.