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clinical examination

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clinical examination

  1. 1. CMMUNITY BASED MEDICAL COLLEGE,BANGLADESH DEPARTMENT OF MEDICINE DR.TOFAYEL UDDIN AHMED REGISTRAR MU-2
  2. 2. CASE HISTORY <ul><li>PARTICULARIS OF THE PATIENT </li></ul><ul><li>HISTORY </li></ul><ul><li>PHYSICAL EXAMINATION </li></ul>
  3. 3. A . PARTICULARIS OF THE PATIENT <ul><li>NAME </li></ul><ul><li>AGE </li></ul><ul><li>SEX </li></ul><ul><li>RELIGION </li></ul><ul><li>OCCUPATION </li></ul><ul><li>MARITAL STATUS </li></ul><ul><li>ADDRESS </li></ul><ul><li>DATE OF ADMISSION </li></ul><ul><li>DATE OF EXAMINATION </li></ul>
  4. 4. B. HISTORY <ul><li>PRESENTING COMPLAINTS </li></ul><ul><li>HISTORY OF PRESENT ILLNESS </li></ul><ul><li>HISTORY OF PAST ILLNESS </li></ul><ul><li>TREATMENT HISTORY </li></ul><ul><li>DRUG AND TRANSFUSION HISTORY </li></ul><ul><li>FAMILY HISTORY </li></ul><ul><li>SOCIOECONOMIC HISTORY / INCLUDING OCCUPATION </li></ul><ul><li>PERSONAL HISTORY/ habit, hobby, diet, sleep, bowel, bladder etc </li></ul><ul><li>HISTORY OF TRVELLING </li></ul><ul><li>HISTORY OF IMMUNIZATION </li></ul>
  5. 5. C. PHYSICAL EXAMINATION <ul><li>GENERAL EXAMINATION </li></ul><ul><li>SYSTEMIC EXAMINATION </li></ul>
  6. 6. GENERAL EXAMINATION <ul><li>APPEARANCE </li></ul><ul><li>DECUBITUS </li></ul><ul><li>Posture of patient in bed </li></ul><ul><li>INTELLIGENCE </li></ul><ul><li>Educational and occupational history </li></ul><ul><li>COOPERATION </li></ul><ul><li>BODY BUILD </li></ul><ul><li>Heavy/average/small </li></ul><ul><li>NUTRITION </li></ul><ul><li>HEIGHT </li></ul><ul><li>WEIGHT </li></ul>
  7. 7. GENERAL EXAMINATION <ul><li>ANAEMIA – type/site/eg </li></ul><ul><li>JUNDICE </li></ul><ul><li>CYANOSIS </li></ul><ul><li>OEDEMA </li></ul><ul><li>CLUBBING </li></ul><ul><li>KOILONYCHIA </li></ul><ul><li>SKIN AND BODY HAIR </li></ul><ul><li>NECK VEINE </li></ul><ul><li>LYMPHNODES </li></ul><ul><li>PULSE </li></ul><ul><li>BP </li></ul><ul><li>TEMP </li></ul><ul><li>DEHYDRATION </li></ul>
  8. 8. SYSTEMIC EXAMINATION <ul><li>CARDIOVASCULAR SYSTEM </li></ul><ul><li>RESPIRATORY SYSTEM </li></ul><ul><li>GASTROINTESTINAL SYSTEM </li></ul><ul><li>NERVOUS SYSTEM </li></ul>
  9. 9. CARDIOVASCULAR SYSTEM <ul><li>PULSE </li></ul><ul><li>RATE </li></ul><ul><li>Tachycardia >100bpm-fever,anaemia,thyrotoxicosisCCF,shock,drug-sulbitamol </li></ul><ul><li>bradycardia<50/bpm-in.MI,myxoedema,hypothermia,obstructive jundice,drug-beta-blockers,amioderon,vrapamil </li></ul><ul><li>RHYTHM </li></ul>
  10. 10. <ul><li>VOLUME </li></ul><ul><li>SYMMETRY </li></ul><ul><li>CHARACTER </li></ul><ul><li>CONDITION OF VESSEL WALL </li></ul><ul><li>RADIO-FEMORAL DELAY </li></ul>
  11. 11. CARDIOVASCULAR SYSTEM <ul><li>BP </li></ul><ul><li>NECK VEINE </li></ul><ul><li>OTHER PULSATION </li></ul>
  12. 12. INSPECTION <ul><li>SHAPE </li></ul><ul><li>CARDIAC IMPULSE </li></ul><ul><li>OTHER VISIBLE PULSATION </li></ul><ul><li>ANY SWELLING OR SCAR MARK </li></ul>
  13. 13. PALPATION <ul><li>APEX BEAT </li></ul><ul><li>THRILLS </li></ul><ul><li>LEFT PARASTERNAL LIFT/HEAVE </li></ul><ul><li>PALPABLE HEART SOUND </li></ul><ul><li>OTHER PALPATION </li></ul>
  14. 14. PERCUSSION <ul><li>AREA OF SUPERFICIAL CARDIAC DULLNESS </li></ul>
  15. 15. AUSCULTATION <ul><li>- HEART SOUND </li></ul><ul><li>- MURMUR </li></ul><ul><li>- pericardil rub </li></ul><ul><li>- other sound </li></ul>
  16. 16. RESPIRATORY SYSTEM <ul><li>SHAPE OF THE CHEST </li></ul><ul><li>MOVEMENT OF THE CHEST </li></ul><ul><li>SINGS OF RESPIRATORY DISTRESS </li></ul><ul><li>VISIBLE PULSATION </li></ul><ul><li>ANY SCAR MARK </li></ul><ul><li>RATE AND RHYTHM OF RESPIRATION </li></ul>
  17. 17. PALPATION <ul><li>POSATION OF TRACHEA </li></ul><ul><li>POSATION OF APEX BEAT </li></ul><ul><li>EXPANTION OF THE CHEST WALL </li></ul><ul><li>VOCAL FREMITUS </li></ul><ul><li>LOCALISED TENDERNESS </li></ul>
  18. 18. PERCUSSION <ul><li>POSATION OF TRACHEA </li></ul><ul><li>POSATION OF APEX BEAT </li></ul><ul><li>EXPANSION OF THE CHEST WALL </li></ul><ul><li>VOCAL FREMITUS </li></ul><ul><li>LOCALISED TENDERNESS </li></ul>
  19. 19. PERCUSSION <ul><li>PERCUSSION NOTE ON </li></ul><ul><li>- MID CLAICULAR LINE </li></ul><ul><li>- MID AXILLARY LINE </li></ul><ul><li>- INFACSCAPULAR LINE </li></ul><ul><li>LIMITS OF CARDIAC DULLNESS </li></ul><ul><li>UPPER BORDER OF LIVER DULLNESS </li></ul>
  20. 20. AUSCULTATION <ul><li>BREATH SOUND </li></ul><ul><li>- INTENSITY </li></ul><ul><li>- CHARACTER </li></ul><ul><li>VOCAL RESONANCE </li></ul><ul><li>ADDED SOUNDS </li></ul><ul><li>- RHONCHI </li></ul><ul><li>- CREPITATION </li></ul><ul><li>- PLEURAL RUB </li></ul>
  21. 21. GASTROINTESTINAL SYSTEM <ul><li>MOUTH AND PHARYNX </li></ul><ul><li>ABDOMAN PROPER </li></ul><ul><li>INSPECTION </li></ul><ul><li>- SIZE AND SHAPE </li></ul><ul><li>- MOVEMENT </li></ul><ul><li>- SKIN- SCAR,PROMINENT VEINE,SPIDER NAEVIA </li></ul><ul><li>- POSATION AND SHAPE OF UMBILICUS </li></ul><ul><li>- VISIBLE MASS </li></ul><ul><li>- VISIBLE PERISTALSIS </li></ul><ul><li>- EPIGASTRIC PULSATION </li></ul><ul><li>- PUBIC HAIRS,GROIN,GENITALIA </li></ul><ul><li>- HERNIAL ORIFICES : IMPULSE ON COUGHING </li></ul>
  22. 22. PALPATION <ul><li>SUPERFICIAL </li></ul><ul><li>START IN THE LEFT ILIAC REGION AND THEN GO ANTICLOCKWISE </li></ul><ul><li>TENDERNESS </li></ul><ul><li>RIGIDITY </li></ul><ul><li>HYPERASETHESIA </li></ul><ul><li>RIGIDITY </li></ul><ul><li>FLUID THRILL </li></ul><ul><li>DEEP </li></ul>
  23. 23. PALPATION <ul><li>DEEP </li></ul><ul><li>LEFT KIDENY </li></ul><ul><li>SPLEEN </li></ul><ul><li>RIGHT KIDENY </li></ul><ul><li>LIVER </li></ul><ul><li>URINARY BLADDER </li></ul><ul><li>AORTA AND PARA-AORTIC GLAND AND COMMON FEMORAL VESSELS </li></ul><ul><li>INGUINAL LYMPH GLANDS </li></ul><ul><li>GENITALIA : PEINS/SCROTUMA/SPERMATIC CORD/VULVA </li></ul><ul><li>PER RECTAL EXAMINATION </li></ul>
  24. 24. PERCUSSION <ul><li>SHIF TING DULLNESS </li></ul><ul><li>PERCUSSION OVER ENLARGED ORGAN AND OTHER MASSES </li></ul><ul><li>UPPER BORDER OF THE LIVER DULLNESS </li></ul>
  25. 25. AUSCULTATION <ul><li>BOWEL SOUND </li></ul><ul><li>BRUITS </li></ul>
  26. 26. NERVOUS SYSTEM <ul><li>MENTAL FUNCTION </li></ul><ul><li>CRANIAL NERVES </li></ul><ul><li>MOTOR FUNCTION </li></ul><ul><li>SENSORY FUNCTION </li></ul>
  27. 27. MENTAL FUNCTION <ul><li>APPEARANCE , BEHAVIOUR AND COMMUNICATION </li></ul><ul><li>EMOTIONAL STATE </li></ul><ul><li>ORINTATION IN PLACE AND TIME </li></ul><ul><li>MEMORY </li></ul><ul><li>SPEECH AND LANGUAGE </li></ul><ul><li>SLEEP </li></ul><ul><li>HALLUCINATION/DELUSION </li></ul><ul><li>INTELLIGENCE </li></ul>
  28. 28. CRANIAL NERVES <ul><li>OLFECTORY </li></ul><ul><li>OPTIC </li></ul><ul><li>OCLOMOTOR, TROCHLEAR AND ABDUCENT </li></ul><ul><li>TRIGEMINAL </li></ul><ul><li>FACIAL NERVE </li></ul><ul><li>VESTIBULOCOCHLERA </li></ul><ul><li>GLOSSOPHARYNGEAL AND VAGUS </li></ul><ul><li>ACCESSORY </li></ul><ul><li>HYPOGLOSSAL </li></ul>
  29. 29. 1 OLFECTORY <ul><li>TEATING OF SMELL EG. </li></ul><ul><li>EFFECT </li></ul><ul><li>– ANOSMIA </li></ul><ul><li>- PAROSMIA </li></ul><ul><li>- OLFACTORY HALLUCINATION </li></ul>
  30. 30. 2 OPTIC <ul><li>VISUAL ACUITY – SNELLEN,S CHART IS USED – DISTANT VISION,NEAR VISION </li></ul><ul><li>FIELD OF VISION – CONFRONTATION TEST </li></ul>
  31. 31. 2 OPTIC <ul><li>COLOR VISION </li></ul><ul><li>OPTHALMOSCOPIC EXAMINATION </li></ul><ul><li>PUPILLARY REFLEXES </li></ul>
  32. 32. 3,4,6 OCLOMOTOR, TROCHLEAR AND ABDUCENT <ul><li>Ocular movement </li></ul><ul><li>Pupil </li></ul><ul><li>- size </li></ul><ul><li>- shape </li></ul><ul><li>- light reflex </li></ul><ul><li>- accommodation reflex </li></ul>
  33. 33. 5 TRIGEMINAL <ul><li>Sensory function </li></ul><ul><li>- pain, touch, temp </li></ul><ul><li>- Corneal reflex </li></ul><ul><li>Motor function </li></ul><ul><li>- muscle of mastication- clench </li></ul><ul><li>Teeth, open mouth aginst pres. </li></ul><ul><li>- jaw jerk </li></ul>
  34. 34. 7 FACIAL <ul><li>MOTOR </li></ul><ul><li>Wrinkling of forehead – frontal belly of occipito – frontalis </li></ul><ul><li>Close eye , don`t let me open – orbicularis occuli </li></ul><ul><li>Ask to whistle – orbicularis oris </li></ul><ul><li>Puff your cheek out – buccinator </li></ul><ul><li>Show me your teeth and a smile </li></ul><ul><li>-levator anguli oris and risorius </li></ul>
  35. 35. 7 FACIAL <ul><li>SENSORY TEST </li></ul><ul><li>- ANTERIOR 2/3 OF TOUNG </li></ul>
  36. 36. 8 VESTIBULOCOCHLERA <ul><li>VESTIBULAR – </li></ul><ul><li>VERTIGO,DIZZINESS </li></ul><ul><li>COCHLEAR DIVISON – </li></ul><ul><li>RUB FINGER </li></ul><ul><li>RINNE`S TEST </li></ul><ul><li>WEBER`S TEST </li></ul>
  37. 37. 9,10 GLOSSOPHARYNGEAL AND VAGUS <ul><li>OPEN MOUTH AND SAY AAA…. </li></ul><ul><li>ASK THE PATIENT TO COUGH </li></ul><ul><li>SEE THE PALATAL REFLEX </li></ul><ul><li>SENSATION IN THE POSTERIOR 1/3 OF TOUNG </li></ul>
  38. 38. 11 ACCESSORY <ul><li>SHRUG YOUR SHOULDER AGAINST REGISTANCE </li></ul><ul><li>TURN YOUR HEAD TO OTHER SIDE AGAINST RESISTANCE </li></ul>
  39. 39. 12 HYPOGLOSSAL <ul><li>LOOK AT THE TOUNG </li></ul><ul><li>- WASTING </li></ul><ul><li>- FASICULATION </li></ul><ul><li>WAGGLE YOUR TOUNG FROM SIDE TO SIDE </li></ul>
  40. 40. MOTOR FUNCTION <ul><li>BULK OF MUSCLE </li></ul><ul><li>TONE OF MUSCLE </li></ul><ul><li>STRENGTH OF MUSCLES </li></ul><ul><li>REFLEXS </li></ul><ul><li>COORDINATION OF MOVEMENT </li></ul><ul><li>INVOLUNTARY MOVEMENTS </li></ul><ul><li>GAIT </li></ul>
  41. 41. EXAMINATION OF REFLEXES <ul><li>TENDON/DEEP REFLEX </li></ul><ul><li>SUPERFICIAL REFLEXES </li></ul>
  42. 42. TENDON/DEEP REFLEXES <ul><li>KNEE JERK- L3,4 </li></ul><ul><li>ANKLE JERK-S1,2 </li></ul><ul><li>BICEPS JERK-C5,6 </li></ul><ul><li>TRICEPS JERK-C6,7 </li></ul><ul><li>SUPINATOR JERK-C5,6 </li></ul><ul><li>JAW JERK- </li></ul><ul><li>CLONUS :PATELLAR/ANKLE </li></ul>
  43. 43. CLONUS <ul><li>PATELLAR CLONUS – SHARPLY PUSH THE PATELLA TOWARDS THE FOOT </li></ul><ul><li>ANKLE CLONUS – SUPPORT THE FLEXED KNEE WITH ONE HAND IN POPLITEAL FOSSA </li></ul>
  44. 44. SUPERFICIAL REFLEXES <ul><li>ABDOMINAL REFLEX </li></ul><ul><li>CORNEAL REFLEX </li></ul><ul><li>ANAL REFLEX </li></ul><ul><li>PALATAL REFLEX </li></ul><ul><li>CREMASTERIC REFLEX </li></ul>
  45. 45. COORDINATION OF MOVEMENT <ul><li>TEST FOR COORDINATION OF UPPER LIMB </li></ul><ul><li>FINGER NOSE TEST </li></ul><ul><li>RAPID ALTERNATING MOVEMENT </li></ul><ul><li>TEST FOR COORDINATION OF LOWER LIMB </li></ul><ul><li>- HEAL SHIN TEST </li></ul>
  46. 46. INVOLUNTARY MOVEMENT <ul><li>ABSENT IN NORMAL INDIVIDUALS </li></ul><ul><li>- TREMOR </li></ul><ul><li>– CHOREA </li></ul><ul><li>– ATHETOSIS </li></ul><ul><li>– DYSTONIA </li></ul><ul><li>– MYOCLONUS </li></ul><ul><li>– TICS </li></ul><ul><li>– DYSKINESIA </li></ul><ul><li>– HEMIBALLISMUS </li></ul><ul><li>– EPILEPSY </li></ul><ul><li>– TETANY </li></ul><ul><li>- CRAMP </li></ul>
  47. 47. GAIT manner of walking <ul><li>Spastic gait </li></ul><ul><li>Stamping gait </li></ul><ul><li>Drunken gait </li></ul><ul><li>Wadding gait </li></ul><ul><li>High steping gait </li></ul><ul><li>Fastinate gait </li></ul><ul><li>Scissor gait </li></ul><ul><li>Dancing gait </li></ul><ul><li>Hemiplegic gait </li></ul>
  48. 48. SENSORY FUNCTION <ul><li>TACTILE SENSATION: LIGHT TOUCH,PRESSURE,TACTILE LOCALIZATION AND TACTILE DISCRIMINATION </li></ul><ul><li>P0SITION SENSE </li></ul><ul><li>RECOGNITION OF SIZE,SHAPE,WEIGHT AND FORM OF OBJECT </li></ul><ul><li>APPRECIATION OF VIBRATION </li></ul><ul><li>PAIN </li></ul><ul><li>TEMPERATURE </li></ul>

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