This document is a clinical examination guide for medical students covering examination of the gastrointestinal system and liver published by Dr. Ahmed Sayed Hanzal from the Faculty of Medicine at Faiyum University. It provides a structured approach to the medical history and physical examination, with sections covering the presenting complaint, past medical history, family history, vital signs, general appearance, skin examination, and regional examinations of the head, neck, chest, abdomen, and limbs. The guide aims to help students organize the clinical approach and remember key points during history taking and physical examination. It includes common abbreviations and provides a suggested order of examination based on body regions.

1. ‫مدرس‬(‫م‬)‫الجهاز‬‫الهضمي‬‫والكبد‬
‫الطب‬ ‫كلية‬-‫جامعة‬‫الفيوم‬-ٕٓٔ6
‫الباطنة‬ ‫عملي‬‫كله‬‫في‬45‫دقيقة‬
Clinical Examination Simplified

2. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 1

3. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 2
‫الكت‬ ‫هذا‬ ‫اهدي‬‫ا‬‫السادسة‬ ‫والفرقة‬ ‫العلٌا‬ ‫الدراسات‬ ‫طالب‬ ‫االعزاء‬ ً‫لزمالئ‬ ‫ب‬‫كوسٌلة‬
‫الباطنة‬ ‫مادة‬ ً‫وعمل‬ ‫شٌت‬ ‫لمراجعة‬ ‫سرٌعة‬‫ول‬‫علٌهم‬ ‫تسهل‬ ‫ذهنٌة‬ ‫خرائط‬ ‫عمل‬ ً‫ف‬ ‫ٌساعدهم‬
‫الشٌت‬ ‫وكتابة‬ ‫عمل‬ ‫اثناء‬ ‫االساسٌة‬ ‫النقاط‬ ‫تذكر‬
‫ِي‬‫ت‬َ‫ال‬َ‫ص‬ َّ‫ن‬ِ‫إ‬ ْ‫ل‬ُ‫ق‬( َ‫ِين‬‫م‬َ‫ل‬‫ا‬َ‫ع‬ْ‫ل‬‫ا‬ ِّ‫ب‬َ‫ر‬ ِ ّ ِ‫لِل‬ ‫ِي‬‫ت‬‫ا‬َ‫م‬َ‫م‬ َ‫و‬ َ‫اي‬َ‫ي‬ْ‫ح‬َ‫م‬ َ‫و‬ ‫ِي‬‫ك‬ُ‫س‬ُ‫ن‬ َ‫و‬ٔ6َٕ‫ك‬ِ‫ل‬َ‫ذ‬ِ‫ب‬ َ‫و‬ ُ‫ه‬َ‫ل‬ َ‫ك‬‫ي‬ ِ‫ر‬َ‫ش‬ َ‫ال‬ )
( َ‫ِين‬‫م‬ِ‫ل‬ْ‫س‬ُ‫م‬ْ‫ل‬‫ا‬ ُ‫ل‬ َّ‫و‬َ‫أ‬ ْ‫ا‬َ‫ن‬َ‫أ‬ َ‫و‬ ُ‫ت‬ْ‫ِر‬‫م‬ُ‫أ‬ٔ6ٖ(‫االنعام‬ ‫سورة‬
…………….. Page 4GENERAL Sheet
…………….. Page 7
ABDOMINAL HISTORY &
Examination
…………….. Page 12CHEST HISTORY & Examination
…………….. Page 18HEART HISTORY & Examination
…………….. Page 24
NEUROLOGY HISTORY &
Examination
…………….. Page 31
JOINT DISEASES HISTORY &
Examination
https://www.facebook.com/drsayed.hanzal

4. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 3
Bl. P BLOOD PREASURE
DM DIABETAES MELLITUS
DVT DEEP VEINOUS THROMBOSIS
F A H M FEVER , ANOREXIA ,HEADACH , MALAISE
FMF FAMILIAL MEDITRANIAN FEVER
HGE HEMORRHAGE
HSM HEPATO SPLENOMEGALLY
HTN HYPERTENSION
ICT INTRA CRANIAL TENSION
L.L. LOWER LIMB
L.N.s LYMPH NODES
LA LEFT ATRIAL
LT LEFT
LVF LEFT VENTRICULAR FAILURE
MAL MID AXILLARY LINE
MCL MID-CAVICULAR LINE
MS MITRAL STENOSIS
N NERVE
N.s NERVES
NAS OMRH Name , Age , Sex , Occupation , Residency ,
Habits of medical importance
PVL PARA VERTEBRAL LINE
RT RIGHT
SL STERNAL LINE
SLE SYSTEMIC LUPUS
TVF TACTILE VOCAL FREMITUS

5. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 4
1- Personal history
NAS OMRH +/- handedness
2- Complaint ‫اىًٞ٘..؟‬ ٚ‫اىَغزشف‬ ‫خبثل‬ ٜ‫اىي‬ ٔٝ‫ا‬‫؟؟؟‬
3- Present H.
‫ىيزشخٞض‬ ‫اى٘ط٘ه‬ ‫ٍحبٗىخ‬ ٕ٘‫اىيحظخ‬ ٓ‫ٕز‬ ٚ‫حز‬ ٜ‫اىحبى‬ ٔ‫ٍشػ‬ ‫ثذاٝخ‬ ‫ٍْز‬ ‫اىَشٝغ‬ ٙ٘‫شن‬ ‫ثزحيٞو‬
1) Analysis of the complaint Onset , Course , Duration
Related ----symptoms of affected system
------investigations
------medication and its effect
2) Ask for DD of the complaint
3) Other symptoms of other systems (affected or not affected)
‫ىنزبثخ‬present history‫ٍفٞذ‬
‫..؟؟‬ ٌٞ‫عي‬ ‫فٖٞب‬ ‫مْذ‬ ‫ٍشح‬ ‫اخش‬ ٚ‫عؤاه.....اٍز‬ ‫ٗاٗه‬ ‫خٞذا‬ ‫ىيَشٝغ‬ ‫االعزَبع‬
‫ثٖب‬ ‫ٝزظو‬ ‫ٍٗب‬ ٙ٘‫اىشن‬ ِ‫ػ‬ ‫ٗاىغيجٞخ‬ ‫االٝدبثٞخ‬ ‫اىْقبؽ‬ ‫ردَٞغ‬
) ‫قظخ‬ ‫ٕٞئخ‬ ٚ‫(ػي‬ ٌ‫ٍْظ‬ ٍْٜ‫ص‬ ‫ثزشرٞت‬ ٜ‫اىَشػ‬ ‫اىزبسٝخ‬ ‫مزبثخ‬
ّ( ‫اٝدبثب‬ ٗ‫ا‬ ‫مبّذ‬ ‫عيجب‬ ‫رمشٕب‬ ٍِ ‫الثذ‬ ‫ّقبؽ‬ ‫شٞذ‬ ‫ىنو‬)‫الحقب‬ ‫ػيٖٞب‬ ‫زؼشف‬
4- Past H
‫اىحبىٞخ‬ ٙ٘‫ثبىشن‬ ‫ػالقخ‬ ٔ‫ى‬ ‫ىٞظ‬ ٌٝ‫قذ‬ ٜ‫ٍشػ‬ ‫حبدس‬ ‫مو‬ ٕ٘
 Diseases e.g DM , HTN , Rh fever , bilhaziasis
‫؟‬ ‫..؟‬ ٚ‫ثبىَغزشف‬ ٓ‫حدض‬ ٌ‫ر‬ ‫ٕٗو‬ ‫؟‬ ‫..؟‬ ‫ٗاىؼالج‬ ‫ٗاىفح٘ص‬ ‫..؟؟‬ ٚ‫ٍز‬
 Trauma (accident …operation …blood transfusion)
 Drug intake ‫...؟؟؟؟‬ ‫ٗىفزشح‬ ‫اىْ٘ع‬
5- Family H
‫االقبسة‬ ٜ‫ف‬ ٔ‫ى‬ ‫ٍَبثيخ‬ ‫اىَشٝغ.........حبالد‬
‫ثَْٖٞب‬ ‫قشاثخ‬ ‫ٗأٍ.......طيخ‬ ٓ‫اثب‬
ٔ‫ػبئيز‬ ٜ‫ف‬ ٛ‫رغش‬ ‫ٍضٍْخ‬ ‫اىؼبئيخ.....اٍشاع‬ ٜ‫ثبق‬

6. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 5
1- Vital signs 2- General observation 3- Skin
1- Temperature
2- Res. (rate &rhythm)
3- Bl. P (palp & ausc)
4- Pulse(4 limbs &carotid)
Rhythm, Rate ,Volume
Wall condition
Equality on both sides
Special characters
‫عٌن‬ ‫ثالثة‬
1- Mentality ‫عقله‬
2- Body built ‫عضله‬
3- Decubitus ‫السرٌر‬ ً‫ف‬ ‫عدلته‬
1- color
2- hirsutism
3- texture
ً‫ف‬ ‫الجسم‬ ً‫باق‬ ‫فحص‬ ‫ثم‬7:ً‫االت‬ ‫الترتٌب‬ ‫حسب‬ ‫نقاط‬-
‫الرأس‬←‫الرقبة‬←‫االربعة‬ ‫االطراف‬←‫(الصدر‬ ‫جهاز‬ ‫جهاز‬ ‫ثم‬←‫القلب‬←‫البطن‬←)‫االعصاب‬
1- The head
1- ‫عموما‬ → cranium & appearance of the face
2- eyes ‫لجوة‬ ‫برة‬ ‫من‬ brows→ lids →(conjunctiva ‫االصفر‬ ‫اللون‬ ‫(خاصة‬ →cornea
3- nose &cheeks → +/- working ala nasi +/- nasal discharge
→ nasolabial fold (lost in 7th
N. paralysis)
→ butter fly area (SLE , MS)
4- ear → tophi & discharge +/- parotid swelling
5- mouth & throat
‫(الباهت‬ ‫الوان‬anemia-‫ازرق‬cyanosis)
‫(شفاة‬ ‫الحنك‬ ‫مكونات‬–‫اسنان‬–‫اللوز‬ ‫(لسان‬ .... ) ‫لثة‬–) ‫لعابٌة‬ ‫غدد‬
2- Neck
1- ‫نظرة‬ → skin , swelling , nodding
2- ‫لمسة‬ → rigidity , L.N.s , thyroid , trachea
3- ‫رعشة‬ →neck pulsations
Internal Jugular Vein (congestion & pulsation)
Carotid arteries (pulsation & thrill)

7. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 6
3- Upper and lower limbs N.B :- No limb examination without pulsation
1- for both limbs → Shape , Skin , nails (Color & Clubbing)
2- upper limb only → hand grip , involuntary movement (fine &coarse)
3- lower limb only ‫انهار‬ → vessels (Varicose V. &arterial puls.)
‫برك‬ → edema (type &level)
4- Chest If no abnormalities detected
‫٭‬ Elliptical & symmetrical chest shape ,free chest movement with no over
action of accessory muscles
‫٭‬ Equal TVF on both sides with no tenderness or palpable adventious sounds
‫٭‬ Resonant chest taking in consideration (cardiac ,hepatic &splenic ) dullness
‫٭‬Normal vesicular breathing with no crepitations ,wheezes or pleural rub.
5- Heart If no abnormalities detected
‫٭‬ No precordial pulge or scars or pulsations
‫٭‬Apex located at 5th
left intercostal space MCL
‫٭‬ Normally auscultated S1& S2 , no thrill or murmurs could be detected.
6- Abdomen If no abnormalities detected
‫٭‬ Preserved waist & slightly scaphoid abd . freely mobile with respiration
‫٭‬ Inverted centrally located umbilicus .No scars ,masses or impulse on cough
at hernia orifices
‫٭‬ No HSM or ascites
7- Neurological If no abnormalities detected
‫٭‬ Fully conscious oriented for time ,place & persons
‫٭‬ No weakness, rigidity or abnormal movements of the limbs
‫٭‬ symmetrical face with optimal general &special sensations
‫نقاط‬ ‫ثالث‬ ‫ذكر‬ ‫ٌجب‬ ‫عموما‬ ‫للتشخٌص‬‫رئٌسٌة‬
1-Anatomical‫تاثره‬ ‫وشكل‬ ‫المتاثر‬ ‫العضو‬ ‫ذكر‬ ‫وهو‬epato spleno megallye.g ,H
2-Etiological),,.... ً‫عرض‬ , ‫عدوى‬ , ‫,ورم‬ ً‫(وراث‬ ‫ٌكون‬ ‫قد‬ ‫الذي‬ ‫السبب‬
3-Functional‫الوظٌفٌة‬ ‫الناحٌة‬ ‫من‬
A. Compensation :-
compensated ‫عادٌة‬ ‫شبه‬ ‫بحٌاة‬ ‫المرض‬ ‫مع‬ ‫التأقلم‬ ‫الجسم‬ ‫ٌستطٌع‬ ‫حٌث‬
decompensated ‫ٌستطٌع‬ ‫ال‬ ‫او‬
B. Complications ‫ه‬ ‫عن‬ ‫نتجت‬ ‫مضاعفات‬ ‫اي‬ ‫ذكر‬‫المرض‬ ‫ذا‬

8. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 7
1- Personal history
NAS OMRH (if ♀ menstrual H.) +/- handedness
2- Complaint ‫اىًٞ٘..؟؟؟؟؟‬ ٚ‫اىَغزشف‬ ‫خبثل‬ ٜ‫اىي‬ ٔٝ‫ا‬
3- Present H.
‫ثذاٝخ‬ ‫ٍْز‬ ‫اىَشٝغ‬ ٙ٘‫شن‬ ‫ثزحيٞو‬ ‫ىيزشخٞض‬ ‫اى٘ط٘ه‬ ‫ٍحبٗىخ‬ ٕ٘‫اىيحظخ‬ ٓ‫ٕز‬ ٚ‫حز‬ ٜ‫اىحبى‬ ٔ‫ٍشػ‬
1) Analysis of the complaint Onset , Course , Duration
Related ----symptoms of affected system
------investigations
------medication and its effect
‫ٍ٘خ٘دح‬ ‫غٞش‬ ‫مبّذ‬ ‫ارا‬ ‫ثبىغيت‬ ٘‫ٗى‬ ٚ‫حز‬ ‫رمشٕب‬ ‫ٝدت‬ ٜ‫ٗاىز‬ ِ‫اىجط‬ ‫ىشٞذ‬ ‫اىََٞضح‬ ‫االػشاع‬
Pain
swelling
‫ٗرحذ‬ ‫ف٘ق‬
upper GIT symptoms → nausea , vomiting , hematemesis , dysphagia , dyspepsia
lower GIT symptoms → ‫اىََشاد‬ → change in bowel habits
(constipation , diarrhea , dysentery )
→ ‫ٍْٖب‬ ‫ٝخشج‬ ‫ٍب‬ → flatulence , worms
blood (fresh or melena)
stool (color , consistency , odor ,….)
2×2
Hepato ∕ biliary → jaundice ‫ثبىزفظٞو‬ ْٔ‫ػ‬ ‫..اعبه‬ ‫ٗخذ‬ ُ‫ا‬
→ Symptoms of liver cell failure
Uro ∕ genital ‫اىزج٘ه‬ ‫ٍشبمو‬ → dysuria or any micturition disturbances
‫اىج٘ه‬ → volume , color , content
‫اىج٘ىْٞب‬ → Uremic symptoms ٚ‫اىني‬ ٚ‫ٍشػ‬ ٜ‫ف‬ ‫خبطخ‬ ‫ٍَٖخ‬
sexual disorders

9. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 8
L.L. edema
Constitutional symptoms
If liver cirrhosis , malignancy ,or TB peritonitis → fever , fatigue , sweating ,
loss of weight , decreased appetite
If splenomegaly → bone pains , L.N.s , bleeding tendency (skin , orifices)
2) Ask for DD of the complaint
3) Other symptoms of other systems (affected or not affected)
‫ىنزبثخ‬present history‫ٍفٞذ‬
‫..؟؟‬ ٌٞ‫عي‬ ‫فٖٞب‬ ‫مْذ‬ ‫ٍشح‬ ‫اخش‬ ٚ‫عؤاه.....اٍز‬ ‫ٗاٗه‬ ‫خٞذا‬ ‫ىيَشٝغ‬ ‫االعزَبع‬
‫ثٖب‬ ‫ٝزظو‬ ‫ٍٗب‬ ٙ٘‫اىشن‬ ِ‫ػ‬ ‫ٗاىغيجٞخ‬ ‫االٝدبثٞخ‬ ‫اىْقبؽ‬ ‫ردَٞغ‬
ٌ‫ٍْظ‬ ٍْٜ‫ص‬ ‫ثزشرٞت‬ ٜ‫اىَشػ‬ ‫اىزبسٝخ‬ ‫مزبثخ‬) ‫قظخ‬ ‫ٕٞئخ‬ ٚ‫(ػي‬
4- Past H
‫اىحبىٞخ‬ ٙ٘‫ثبىشن‬ ‫ػالقخ‬ ٔ‫ى‬ ‫ىٞظ‬ ٌٝ‫قذ‬ ٜ‫ٍشػ‬ ‫حبدس‬ ‫مو‬ ٕ٘
 Diseases e.g. DM , HTN , Rh fever , bilhaziasis
‫؟‬ ‫..؟‬ ٚ‫ثبىَغزشف‬ ٓ‫حدض‬ ٌ‫ر‬ ‫ٕٗو‬ ‫؟‬ ‫..؟‬ ‫ٗاىؼالج‬ ‫ٗاىفح٘ص‬ ‫..؟؟‬ ٚ‫ٍز‬
 Trauma (accident …operation …blood transfusion)
 Drug intake ‫...؟؟؟؟‬ ‫ٗىفزشح‬ ‫اىْ٘ع‬
5- Family H
‫االقبسة‬ ٜ‫ف‬ ٔ‫ى‬ ‫ٍَبثيخ‬ ‫اىَشٝغ.........حبالد‬
‫ثَْٖٞب‬ ‫قشاثخ‬ ‫ٗأٍ.......طيخ‬ ٓ‫اثب‬
ٔ‫ػبئيز‬ ٜ‫ف‬ ٛ‫رغش‬ ‫ٍضٍْخ‬ ‫اىؼبئيخ.....اٍشاع‬ ٜ‫ثبق‬

10. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 9
1- Vital signs 2- General observation 3- Skin
1- Temperature
2- Res. (rate &rhythm)
3- Bl. P (palp & ausc)
4- Pulse(4 limbs &carotid)
Rhythm, Rate ,Volume
Wall condition
Equality on both sides
Special characters
‫عٌن‬ ‫ثالثة‬
1- Mentality ‫عقله‬
2- Body built ‫عضله‬
4- Decubitus ‫السرٌر‬ ً‫ف‬ ‫عدلته‬
1. color
2. hirsutism
3. texture
‫تنسى‬ ‫ال‬
*spider naevi
*palmer
erethema
ً‫ف‬ ‫الجسم‬ ً‫باق‬ ‫فحص‬ ‫ثم‬7:ً‫االت‬ ‫الترتٌب‬ ‫حسب‬ ‫نقاط‬-
‫الرأس‬←‫الرقبة‬←‫االربعة‬ ‫االطراف‬←‫(الصدر‬ ‫جهاز‬ ‫جهاز‬ ‫ثم‬←‫القلب‬←‫االعصاب‬←)‫البطن‬
4 The head
1- ‫عموما‬ → cranium & appearance of the face
2- eyes ‫لجوة‬ ‫برة‬ ‫من‬ brows→ lids →(conjunctiva ‫االصفر‬ ‫اللون‬ ‫(خاصة‬ →cornea
puffy eye lids , jaundice , xanthelasma ‫تنساهم‬ ‫ال‬
3- nose &cheeks → +/- working ala nasi +/- nasal discharge
→ nasolabial fold (lost in 7 th N. paralysis)
→ butter fly area (SLE,MS)
4- ear → tophi & discharge +/- parotid swelling
5- mouth & throat
‫(الباهت‬ ‫الوان‬anemia-‫ازرق‬cyanosis)
‫(شفاة‬ ‫الحنك‬ ‫مكونات‬–‫اسنان‬–‫اللوز‬ ‫(لسان‬ .... ) ‫لثة‬–) ‫لعابٌة‬ ‫غدد‬
‫تذكر‬foeter hepaticus
5 Neck
1- ‫نظرة‬ → skin , swelling , nodding
2- ‫لمسة‬ → rigidity , L.N.s , thyroid , trachea
3- ‫رعشة‬ →neck pulsations
Internal Jugular Vein (congestion & pulsation)
Carotid arteries (pulsation & thrill)

11. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 11
6 Upper and lower limbs N.B :- No limb examination without pulsation
1- for both limbs → shape , skin , nails (color &clubbing)
2- upper limb only → hand grip , involuntary movement (fine &coarse)
3- lower limb only ‫انهار‬ → vessels (Varicose V. &arterial puls.)
‫برك‬ → edema (type &level)
7 Chest If no abnormalities detected
‫٭‬ Elliptical & symmetrical chest shape ,free chest movement with no over
action of accessory muscles
‫٭‬ Equal TVF on both sides with no tenderness or palpable adventious sounds
‫٭‬ Resonant chest taking in consideration (cardiac ,hepatic &splenic ) dullness
‫٭‬Normal vesicular breathing with no crepititions ,wheezes or pleural rub.
8 Heart If no abnormalities detected
‫٭‬ No precordial pulge or scars or pulsations
‫٭‬Apex located at 5th
left intercostal space MCL
‫٭‬ Normally auscultated S1& S2 , no thrill or murmurs could be detected.
9 Neurological If no abnormalities detected
‫٭‬ Fully conscious oriented for time ,place & persons
‫٭‬ No weakness, rigidity or abnormal movements of the limbs
‫٭‬ symmetrical face with optimal general &special sensations
10 Abdominal local ex.
Inspection ) ‫لتحت‬ ‫فوق‬ ‫من‬ ‫ثم‬ ‫(عموما‬exposure from nipple to knee
General insp. Contour of the abdomen
movement with respiration
visible veins
Skin (scars , striae , scratch marks , haemorrhage as petichae)
Specific insp. Breast (gynecomastia ♂ or atrophy in ♀ )
Subcostal angle
Epigastric pulsation
Divarication of recti
Umbilicus (site , shape , skin +/- hernia)
Dilated veins
Suprapubic hair
hernia orifices
External genitalia & Back of the patient

12. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 11
Palpation
Liver , spleen , kidneys & others
(Gall bladder , urinary bladder , colon , Aorta & para-aortic L.N.s )
Percussion
Ascites transmitted fluid thrill (tense ascites)
shifting dullness ≥ 1,5 liter ….on both sides
knee-elbow position ≥.5 liter
liver (upper border → heavy percussion , but Lower is Light )
spleen (for impalpable spleen also percuss Traub's area)
Auscultation
Intestinal sounds
Venous hum & Arterial bruit ‫دم‬
Ausc. For ascietes & Sucussion splash ‫ماء‬
Pulmonary area ‫هواء‬
‫نقاط‬ ‫ثالث‬ ‫ذكر‬ ‫ٌجب‬ ‫عموما‬ ‫للتشخٌص‬‫رئٌسٌة‬
1-natomicalA‫تاثره‬ ‫وشكل‬ ‫المتاثر‬ ‫العضو‬ ‫ذكر‬ ‫وهو‬epato spleno megallye.g ,H
2-Etiological),,.... ً‫عرض‬ , ‫عدوى‬ , ‫,ورم‬ ً‫(وراث‬ ‫ٌكون‬ ‫قد‬ ‫الذي‬ ‫السبب‬
3-Functional‫الوظٌفٌة‬ ‫الناحٌة‬ ‫من‬
A. Compensation :-
compensated ‫عادٌة‬ ‫شبه‬ ‫بحٌاة‬ ‫المرض‬ ‫مع‬ ‫التأقلم‬ ‫الجسم‬ ‫ٌستطٌع‬ ‫حٌث‬
decompensated ‫ٌستطٌع‬ ‫ال‬ ‫او‬
B. Complications ‫المرض‬ ‫هذا‬ ‫عن‬ ‫نتجت‬ ‫مضاعفات‬ ‫اي‬ ‫ذكر‬

13. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 12
1- Personal history
NAS OMRH +/- handedness
2- Complaint ‫اىَغزش‬ ‫خبثل‬ ٜ‫اىي‬ ٔٝ‫ا‬‫اىًٞ٘..؟؟؟‬ ٚ‫ف‬
3- Present H.
‫ٍْز‬ ‫اىَشٝغ‬ ٙ٘‫شن‬ ‫ثزحيٞو‬ ‫ىيزشخٞض‬ ‫اى٘ط٘ه‬ ‫ٍحبٗىخ‬ ٕ٘‫اىيحظخ‬ ٓ‫ٕز‬ ٚ‫حز‬ ٜ‫اىحبى‬ ٔ‫ٍشػ‬ ‫ثذاٝخ‬
1) Analysis of the complaint Onset , Course , Duration
Related ----symptoms of affected system
------investigations
------medication and its effect
٘‫ٍ٘خ‬ ‫غٞش‬ ‫مبّذ‬ ‫ارا‬ ‫ثبىغيت‬ ٘‫ٗى‬ ٚ‫حز‬ ‫رمشٕب‬ ‫ٝدت‬ ٜ‫ٗاىز‬ ‫اىظذس‬ ‫ىشٞذ‬ ‫اىََٞضح‬ ‫االػشاع‬‫دح‬
‫ثغججٖب‬ ‫ٝخشج‬ ‫ٍٗب‬ ‫اىنحخ‬
Cough ‫اىغْخ‬ ‫ثفظ٘ه‬ ‫ٗػالقزٖب‬ ,‫ٝخفؼٖب‬ ٗ‫ا‬ ‫ٍبٝضٝذٕب‬ , ‫(ٗطفٖب‬)
Expectoration )...... ‫اىَشٝغ‬ ‫ث٘ػؼٞخ‬ ٔ‫ٗػالقز‬ ٔ‫ٗسائحز‬ ّٔ٘‫ٗى‬ ٔ‫(مَٞز‬
Hemoptesis
‫ٗخغ‬
Dyspnea
Wheezes
Pressure symp (dyspnea, dysphagia, hoarseness of voice )→ mediastinal Ś
Chest Pain
3C ٜ‫ع‬ ‫ثالثخ‬
Constitutional (toxic ) symptoms ( F A H M)
systemic Congestion symptoms → ( ascites , L.L. edema )
Cyanosis
2) Ask for DD of the complaint
3) Other symptoms of other systems (affected or not affected)

14. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 13
‫ىنزبثخ‬present history‫ٍفٞذ‬
‫..؟؟‬ ٌٞ‫عي‬ ‫فٖٞب‬ ‫مْذ‬ ‫ٍشح‬ ‫اخش‬ ٚ‫عؤاه.....اٍز‬ ‫ٗاٗه‬ ‫خٞذا‬ ‫ىيَشٝغ‬ ‫االعزَبع‬
‫ثٖب‬ ‫ٝزظو‬ ‫ٍٗب‬ ٙ٘‫اىشن‬ ِ‫ػ‬ ‫ٗاىغيجٞخ‬ ‫االٝدبثٞخ‬ ‫اىْقبؽ‬ ‫ردَٞغ‬
ٌ‫ٍْظ‬ ٍْٜ‫ص‬ ‫ثزشرٞت‬ ٜ‫اىَشػ‬ ‫اىزبسٝخ‬ ‫مزبثخ‬) ‫قظخ‬ ‫ٕٞئخ‬ ٚ‫(ػي‬
4) Past H
‫اىحبىٞخ‬ ٙ٘‫ثبىشن‬ ‫ػالقخ‬ ٔ‫ى‬ ‫ىٞظ‬ ٌٝ‫قذ‬ ٜ‫ٍشػ‬ ‫حبدس‬ ‫مو‬ ٕ٘
 Diseases e.g TB ,Bronchial asthma , pneumonia , DM , HTN , Rh fever ,
bilhaziasis
‫؟‬ ‫..؟‬ ٚ‫ثبىَغزشف‬ ٓ‫حدض‬ ٌ‫ر‬ ‫ٕٗو‬ ‫؟‬ ‫..؟‬ ‫ٗاىؼالج‬ ‫ٗاىفح٘ص‬ ‫..؟؟‬ ٚ‫ٍز‬
 Trauma (accident …operation …blood transfusion)
 Drug intake ‫...؟؟؟؟‬ ‫ٗىفزشح‬ ‫اىْ٘ع‬
5) Family H
‫االقبسة‬ ٜ‫ف‬ ٔ‫ى‬ ‫ٍَبثيخ‬ ‫اىَشٝغ.........حبالد‬
‫ثَْٖٞب‬ ‫قشاثخ‬ ‫ٗأٍ.......طيخ‬ ٓ‫اثب‬
ٔ‫ػبئيز‬ ٜ‫ف‬ ٛ‫رغش‬ ‫ٍضٍْخ‬ ‫اىؼبئيخ.....اٍشاع‬ ٜ‫ثبق‬
ِ‫ػ‬ ‫اىغؤاه‬ ٚ‫ػي‬ ‫ّٗشمض‬(TB , B. asthma)

15. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 14
1- Vital signs 2- General observation 3- Skin
1. Temperature
2. Res. (rate, rhythm
,depth , type )
3. Bl. P (palp & ausc)
4. Pulse(4 limbs &carotid)
Rhythm, Rate ,Volume ,
wall condition
Equality on both sides
Special characters
‫على‬ ‫ونركز‬
water hammer pulse in
emphysema
‫عٌن‬ ‫ثالثة‬
1 Mentality ‫عقله‬
2 Body built ‫عضله‬
obese ch. Bronchitis
thin TB
cachectic br. carci
3 Decubitus ‫السرٌر‬ ً‫ف‬ ‫عدلته‬
11 color
12 hirsutism
13 texture
ً‫ف‬ ‫الجسم‬ ً‫باق‬ ‫فحص‬ ‫ثم‬7:ً‫االت‬ ‫الترتٌب‬ ‫حسب‬ ‫نقاط‬-
‫الرأس‬←‫الرقبة‬←‫االربعة‬ ‫االطراف‬←‫(القلب‬ ‫جهاز‬ ‫جهاز‬ ‫ثم‬←‫البطن‬←‫االعصاب‬←)‫الصدر‬
4- The head
1- ‫عموما‬ → cranium & appearance of the face
2- eyes ‫لجوة‬ ‫برة‬ ‫من‬ brows→ lids →(conjunctiva ‫االصفر‬ ‫اللون‬ ‫(خاصة‬ →cornea
‫على‬ ‫نركز‬
puffy lids & sub-congunctival HGE → chronic cough
jaundice in chest diseases ???
3- nose &cheeks → +/- working ala nasi +/- nasal discharge
→ nasolabial fold (lost in 7 th N. paralysis)
→ butter fly area (SLE,MS)
4- ear → tophi & discharge +/- parotid swelling
5- mouth & throat
‫(الباهت‬ ‫الوان‬anemia-‫ازرق‬Cyanosis)
‫(شفاة‬ ‫الحنك‬ ‫مكونات‬–‫اسنان‬–‫(لسان‬ .... ) ‫لثة‬-‫اللوز‬–) ‫لعابٌة‬ ‫غدد‬
‫الفم‬ ‫رائحة‬Fetid odor in suppurative lung syndrome

16. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 15
5- Neck
1- ‫نظرة‬ → skin , swelling , nodding
2- ‫لمسة‬ → rigidity , L.N.s , thyroid , trachea
3- ‫رعشة‬ →neck pulsations
Internal Jugular Vein (congestion & pulsation)
Carotid arteries (pulsation & thrill)
6- Upper and lower limbs N.B :- No limb examination without pulsation
1- for both limbs → shape , skin , nails (color & Clubbing)
2- upper limb only → hand grip , involuntary movement (fine &coarse)
3- lower limb only ‫انهار‬ → vessels (Varicose V. &arterial puls.)
‫برك‬ → edema (type &level)
7- Heart If no abnormalities detected
‫٭‬ No precordial puge or scars or pulsations
‫٭‬Apex located at 5 th left intercostal space MCL
‫٭‬ Normally auscaltated S1& S2 , no thrill or murmers could be detected.
8- Abdomen If no abnormalities detected
‫٭‬ Preserved waist & slightly scaphoid abd . freely mobile with respiration
‫٭‬ Inverted cenrally located umbilicus .No scars ,masses or impulse on cough
at hernia orifices
‫٭‬ No HSM or ascites
Don’t forget → liver , spleen & ascites Ex.
9- Neurological If no abnormalities detected
‫٭‬ Fully conscious oriented for time ,place & persons
‫٭‬ No weakness, rigidity or abnormal movements of the limbs
‫٭‬ Symmetrical face with optimal general &special sensations

17. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 16
10- Local Chest Ex.
Inspection 2S , 2M , P
Shape & Symmetry
Skin &wall
Movement → (type , expansion , accessory muscles , Litten's sign)
Mediastinum → (Apex ) (trachea)
Pulsations
Palpation 2(M , T , P) , 1S ً‫تالق‬ ‫هاتحس‬2‫وزاوٌة‬ ‫مطب‬
Movement ‫امام‬ (supra- , mammary , infra-mammary)
‫خلف‬ (at 10th
thoracic spine → basal expansion )
Mediastinum
TVF (comparative by one hand)
Tenderness
Pulsation
Palpable sounds
Subcostal angle
Percussion
Heart percussion
Chest MCL → from clavicle to 6th
space
MAL → from 4th
to 8th
space ‫راسه‬ ‫فوق‬ ‫ٌده‬ ‫واضع‬ ‫والمرٌض‬
SL +/- PVL → from Lung apex to 10th
space
Percussion of special areas
‫لتحت‬ ‫فوق‬ ‫من‬ Kronig's Isthmus, clavicle , Bare area of the heart , Traub's area
‫وشمال‬ ‫ٌمٌن‬ liver & spleen
Special percussions → shifting dullness

18. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 17
Auscultation
Breath sounds → normal vesicular breathing
→ vesicular bre. with prolonged expiration (COPD & br. Asthma)
→ bronchial breathing (consolidation)
Vocal resonance (to confirm the presence of bronchial breathing)
Added sounds → Crepitations (crackles) ‫موجودة‬ ‫لو‬ (fine , medium ,or coarse)
→ Ronchi (Wheezes)
→ Pleural rub
Special test ‫عملها‬ ‫النادر‬ ‫من‬ → post tussive suction
→ succession splash
→ Coin test
‫نقاط‬ ‫ثالث‬ ‫ذكر‬ ‫ٌجب‬ ‫عموما‬ ‫للتشخٌص‬‫رئٌسٌة‬
1.Anatomical‫تاثره‬ ‫وشكل‬ ‫المتاثر‬ ‫العضو‬ ‫ذكر‬ ‫وهو‬e.g ,Rt basal lung consolidation
2.Etiological),,.... ً‫عرض‬ , ‫عدوى‬ , ‫,ورم‬ ً‫(وراث‬ ‫ٌكون‬ ‫قد‬ ‫الذي‬ ‫السبب‬
3.nalFunctio‫الوظٌفٌة‬ ‫الناحٌة‬ ‫من‬
a) Compensation :-
compensated ‫عادٌة‬ ‫شبه‬ ‫بحٌاة‬ ‫المرض‬ ‫مع‬ ‫التأقلم‬ ‫الجسم‬ ‫ٌستطٌع‬ ‫حٌث‬
decompensated ‫ٌستطٌع‬ ‫ال‬ ‫او‬
b) Complications ‫المرض‬ ‫هذا‬ ‫عن‬ ‫نتجت‬ ‫مضاعفات‬ ‫اي‬ ‫ذكر‬

19. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 18
1- Personal history NAS OMRH +/- handedness
2- Complaint ‫اىي‬ ٔٝ‫ا‬‫اىًٞ٘.؟؟‬ ٚ‫اىَغزشف‬ ‫خبثل‬ ٜ
3- Present H.
‫اىيحظخ‬ ٓ‫ٕز‬ ٚ‫حز‬ ٜ‫اىحبى‬ ٔ‫ٍشػ‬ ‫ثذاٝخ‬ ‫ٍْز‬ ‫اىَشٝغ‬ ٙ٘‫شن‬ ‫ثزحيٞو‬ ‫ىيزشخٞض‬ ‫اى٘ط٘ه‬ ‫ٍحبٗىخ‬ ٕ٘
1) Analysis of the complaint Onset , Course , Duration
Related ----symptoms of affected system
------investigations
------medication and its effect
‫اىقيت‬ ‫ىشٞذ‬ ‫اىََٞضح‬ ‫االػشاع‬‫ٍ٘خ٘دح‬ ‫غٞش‬ ‫مبّذ‬ ‫ارا‬ ‫ثبىغيت‬ ٘‫ٗى‬ ٚ‫حز‬ ‫رمشٕب‬ ‫ٝدت‬ ٜ‫ٗاىز‬
2‫إضمحالل‬ ‫وواحد‬ ‫احتقان‬
Symptoms of pulmonary congestion
Dyspnea (Exertional D , Orthopnea , Paroxysmal nocturnal D , Cardiac
Asthma , Acute Pul. Edema )
Exertional Cough
Hemoptesis
Recurrent Chest Infection
Symptoms of Systemic congestion
hepatic congestion . → Rt. Hypochondrial pain , jaundice
GIT congestion → Dyspepsia
L.L. edema & Ascites
Symptoms of low Cardiac Output
Syncope (transient loss of consciosness) &others
(pallor , easy fatigability , L.L. claudication , oliguria , angina , bl. Of vision)
3P
Palpitation ‫ٗخذد‬ ُ‫ا‬ (onset , duration , rate , rhythm , what ↑ or ↓ )
Chest Pain
Pressure symp. (as in L.A. enlargement, pericardial effusion …….)
ِ‫ػ‬ ‫اعبه‬ brassy cough , dyspnea , dysphagia ….

20. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 19
‫دموية‬ ‫أوعية‬
Symptoms suggestive of ↑ Bl. P.
headache , tinnitus , epistaxis , bl.of vision
Symptoms of systemic embolization
Embolic hemiplegia , sudden blindness , painless hematuria ,
sudden chest or abdominal pain , )
Peripheral artery emb. → pulseless , pallor . pain paralysis
Symptoms of peripheral vascular diseases
Trophic changes → loss hair and sensation , …pallor , cold , ulcers
Raynauds phenomenon
Intermittent claudications
L.L. swelling in DVT
‫ننسى‬ ‫ان‬ ‫يجب‬ ‫وال‬ Fever
2) Ask for DD of the complaint
3) Other symptoms of other systems (affected or not affected)
‫ىنزبثخ‬present history‫ٍفٞذ‬
‫..؟؟‬ ٌٞ‫عي‬ ‫فٖٞب‬ ‫مْذ‬ ‫ٍشح‬ ‫اخش‬ ٚ‫عؤاه.....اٍز‬ ‫ٗاٗه‬ ‫خٞذا‬ ‫ىيَشٝغ‬ ‫االعزَبع‬
‫ثٖب‬ ‫ٝزظو‬ ‫ٍٗب‬ ٙ٘‫اىشن‬ ِ‫ػ‬ ‫ٗاىغيجٞخ‬ ‫االٝدبثٞخ‬ ‫اىْقبؽ‬ ‫ردَٞغ‬
) ‫قظخ‬ ‫ٕٞئخ‬ ٚ‫(ػي‬ ٌ‫ٍْظ‬ ٍْٜ‫ص‬ ‫ثزشرٞت‬ ٜ‫اىَشػ‬ ‫اىزبسٝخ‬ ‫مزبثخ‬
4- Past H
ٕ٘‫اىحبىٞخ‬ ٙ٘‫ثبىشن‬ ‫ػالقخ‬ ٔ‫ى‬ ‫ىٞظ‬ ٌٝ‫قذ‬ ٜ‫ٍشػ‬ ‫حبدس‬ ‫مو‬
 Diseases e.g DM , HTN , Rh fever , bilhaziasis
‫؟‬ ‫..؟‬ ٚ‫ثبىَغزشف‬ ٓ‫حدض‬ ٌ‫ر‬ ‫ٕٗو‬ ‫؟‬ ‫..؟‬ ‫ٗاىؼالج‬ ‫ٗاىفح٘ص‬ ‫..؟؟‬ ٚ‫ٍز‬
 Trauma (accident …operation …blood transfusion)
 Drug intake ‫...؟؟؟؟‬ ‫ٗىفزشح‬ ‫اىْ٘ع‬
5- Family H
‫االقبسة‬ ٜ‫ف‬ ٔ‫ى‬ ‫ٍَبثيخ‬ ‫اىَشٝغ.........حبالد‬
‫ثَْٖٞب‬ ‫قشاثخ‬ ‫ٗأٍ.......طيخ‬ ٓ‫اثب‬
ٔ‫ػبئيز‬ ٜ‫ف‬ ٛ‫رغش‬ ‫ٍضٍْخ‬ ‫اىؼبئيخ.....اٍشاع‬ ٜ‫ثبق‬

21. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 21
1- Vital signs 2- General observation 3- Skin
1. Temperature
2. Res. (rate &rhythm)
3. Bl. P (palp & ausc)
4. Pulse(4 limbs &carotid)
rhythm, rate ,volume
wall condition
equality on both sides
special characters
‫عٌن‬ ‫ثالثة‬
1- Mentality ‫عقله‬
4- Body built ‫عضله‬
5- Decubitus ‫السرٌر‬ ً‫ف‬ ‫عدلته‬
1. color (+/-
cyanosis)
2. hirsutism
3. texture
ً‫ف‬ ‫الجسم‬ ً‫باق‬ ‫فحص‬ ‫ثم‬7:ً‫االت‬ ‫الترتٌب‬ ‫حسب‬ ‫نقاط‬-
‫الرأس‬←‫الرقبة‬←‫االربعة‬ ‫االطراف‬←‫(الصدر‬ ‫جهاز‬ ‫جهاز‬ ‫ثم‬←‫القلب‬←‫البطن‬←)‫االعصاب‬
4- The head
1- ‫عموما‬ → cranium & appearance of the face
2- eyes ‫لجوة‬ ‫برة‬ ‫من‬ brows→ lids →(conjunctiva ‫االصفر‬ ‫اللون‬ ‫(خاصة‬ →cornea
3- nose &cheeks → +/- working ala nasi +/- nasal discharge
→ nasolabial fold (lost in 7 th N. paralysis)
→ butter fly area (SLE,MS)
4- ear → tophi & discharge +/- parotid swelling
5- mouth & throat
‫(الباهت‬ ‫الوان‬anemia-‫ازرق‬cyanosis)
‫(شفاة‬ ‫الحنك‬ ‫مكونات‬–‫اسنان‬–‫(لس‬ .... ) ‫لثة‬‫اللوز‬ ‫ان‬–) ‫لعابٌة‬ ‫غدد‬
5- Neck
1- ‫نظرة‬ → skin , swelling , nodding
2- ‫لمسة‬ → rigidity , L.N.s , thyroid , trachea
3- ‫رعشة‬ →neck pulsations
Internal Jugular Vein (congestion & pulsation)
Carotid arteries (pulsation & thrill)

22. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 21
6- Upper and lower limbs N.B:- No limb examination without pulsation
1- for both limbs → shape , skin , nails (color &clubbing), +/- splinter HE
→ nodules ..S.C. in R.F. , Osler's nodes in SBE , xanthomas
in dyslipidemia
2- upper limb only → hand grip , involuntary movement (fine &coarse)
3- lower limb only ‫انهار‬ → vessels (Varicose V. &arterial puls.)
‫برك‬ → edema (type &level)
7- Chest If no abnormalities detected
‫٭‬ Elliptical & symmetrical chest shape ,free chest movement with no over
action of accessory muscles
‫٭‬ Equal TVF on both sides with no tenderness or palpable adventious sounds
‫٭‬ Resonant chest taking in consideration (cardiac ,hepatic &splenic ) dullness
‫٭‬Normal vesicular breathing with no crepititions ,wheezes or pleural rub.
Don’t forget → murmurs of MR (Lt scapular region) ,, coarct. of Aorta
(iner scapular )
→Crepitations of LVF (bil. basal)
→ Ewart's sign → as collapse of Lt lower lobe in pericardial eff.
8- Abdomen If no abnormalities detected
‫٭‬ Preserved waist & slightly scaphoid abd . freely mobile with respiration
‫٭‬ Inverted centrally located umbilicus .No scars ,masses or impulse on cough
at hernia orifices
‫٭‬ No HSM or ascites
Don’t forget → liver , spleen & ascites Ex.
9- Neurological If no abnormalities detected
‫٭‬ Fully conscious oriented for time ,place & persons
‫٭‬ No weakness, rigidity or abnormal movements of the limbs
‫٭‬ symmetrical face with optimal general &special sensations

23. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 22
10- Heart local ex.
Inspection
Chest wall → precordial bulge & dilated veins
2S → Skeletal abnormalities & Scars of previous operations
Pulsations → Apex beat
→ ‫لتحت‬ ‫فوق‬ ‫من‬ (Suprasternal → 1st
Aortic → pul. Area → Rt & Lt
parasternal → Epigastric)
Palpation
Apex beat 2S → (Site & Area Size –diffuse or localized)
3R → (Rate , Rhythm & Rocking )
Character ……normally gentle tap
Thrill
‫لتحت‬ ‫فوق‬ ‫من‬ (Carotids → Suprasternal → 1st
Aortic → pul. Area →
Rt & Lt parasternal → Epigastric)
Percussion
(heavy except bare area percussed lightly) ‫الساعة‬ ‫عقارب‬ ‫اتجاه‬ ‫مع‬
Hepatic dullness (5th
Rt space) → Rt border (4th
3rd
Rt space) →
Aortic area (2nd
Rt space) → Pulmonary area (2nd
Lt space) →
Waist of the heart (3rd
Lt space) → Bare area ( 4th
Lt space) →
Lt border (outside the apex) → Lower third of the sternum
Auscultation
Heart sounds → normal (S1&S2)
→ Additional (Ejection click , Opening snap , S3&S4)
Pericardial rub → in dry pericarditis
Murmurs ً‫االت‬ ‫على‬ ‫علق‬ ‫وجدت‬ ‫ان‬
→ Timing (systolic , diastolic or contiuous)
→ Area of maximal intensity & propagation)
→ Character (soft , harsh , rumbling ……)
→ Intensity (from 1 …to 6)
→ Relation to (posture & respiration)
→ +/- associated thrill

24. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 23
‫نقاط‬ ‫ثالث‬ ‫ذكر‬ ‫ٌجب‬ ‫عموما‬ ‫للتشخٌص‬‫رئٌسٌة‬
1.Anatomical‫تاثره‬ ‫وشكل‬ ‫المتاثر‬ ‫العضو‬ ‫ذكر‬ ‫وهو‬trale.g ,Double mi
2.Etiological),,.... ً‫عرض‬ , ‫عدوى‬ , ‫,ورم‬ ً‫(وراث‬ ‫ٌكون‬ ‫قد‬ ‫الذي‬ ‫السبب‬
3.Functional‫الوظٌفٌة‬ ‫الناحٌة‬ ‫من‬
a. Compensation :-
compensated ‫عادٌة‬ ‫شبه‬ ‫بحٌاة‬ ‫المرض‬ ‫مع‬ ‫التأقلم‬ ‫الجسم‬ ‫ٌستطٌع‬ ‫حٌث‬
decompensated ‫ٌستطٌع‬ ‫ال‬ ‫او‬
b. Complications ‫ذكر‬‫المرض‬ ‫هذا‬ ‫عن‬ ‫نتجت‬ ‫مضاعفات‬ ‫اي‬

25. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 24
1- Personal history
NAS OMRH +/- handedness
2- Complaint ‫اىًٞ٘..؟؟؟؟؟‬ ٚ‫اىَغزشف‬ ‫خبثل‬ ٜ‫اىي‬ ٔٝ‫ا‬
3- Present H.
‫اى٘ط‬ ‫ٍحبٗىخ‬ ٕ٘‫اىيحظخ‬ ٓ‫ٕز‬ ٚ‫حز‬ ٜ‫اىحبى‬ ٔ‫ٍشػ‬ ‫ثذاٝخ‬ ‫ٍْز‬ ‫اىَشٝغ‬ ٙ٘‫شن‬ ‫ثزحيٞو‬ ‫ىيزشخٞض‬ ‫٘ه‬
1) Analysis of the complaint Onset , Course , Duration
Related ----symptoms of affected system
------investigations
------medication and its effect
Symptoms of ↑ ICT ‫ٗقذ‬ ٜ‫ف‬‫الصبح‬) ‫صغييخ‬ ٗ‫ا‬ ‫قٞئ‬ ‫(طذاع‬ ‫ٝحذس‬ ‫ٕو‬
Cranial N.s
1ٌ‫اىش‬ ‫اخجبس‬ ٔٝ‫ا‬
2‫حبخخ‬ ٔٞ‫ف‬ ‫ارغٞش‬ ‫ّظشك‬–‫ٍٗٞغ‬ ٗ‫ا‬ ‫ع٘داء‬ ‫ثقغ‬ ٙ‫رش‬ ‫ٕو‬
3,4,6ِٞ‫حبخز‬ ‫اىحبخخ‬ ‫ثزش٘ف‬2–‫اح٘ىٞذ‬–‫عقؾ‬ ‫خفْل‬
5‫شنشنخ‬ ٗ‫ا‬ ٌ‫اى‬ ٔ‫ث‬ ‫ٗخٖل‬(sensory)‫ارؼ٘ج‬ ‫فنل‬ ٗ‫ا‬ ‫م٘ٝظ‬ ‫ثزَؼغ‬ ....(motor)
7‫م٘ٝظ‬ ‫ػْٞل‬ ‫ثزقفو‬–‫خذك‬ ‫ٗساء‬ ‫ثٞزدَغ‬ ‫امو‬–‫ثزشٝو‬
8‫م٘ٝظ‬ ‫ثزغَغ‬–‫دٗاس‬ ٗ‫ا‬ ‫دٗخخ‬ ‫خبىل‬
9,12‫م٘ٝظ‬ ٌ‫ٗثززني‬ ‫ثزجيغ‬
11ِٞ‫ىيدبّج‬ ‫ساعل‬ ‫حشمخ‬ ٗ‫ا‬ ‫مزفل‬ ‫سفغ‬ ٜ‫ف‬ ‫ٍشنيخ‬ ٍِ ‫ٕو‬
Motor Affection
power → onset .. ً‫اسرطب‬ ‫عجقب‬ ٗ‫ا‬ َٚ‫ح‬ ٍِ ‫حْٖٞب‬ ّٜ‫رؼب‬ ‫مْذ‬ ٙ٘‫اىشن‬ ‫ثذأد‬ ‫ػْذٍب‬
→ Degree ‫اىؼؼالد‬ ٜ‫ف‬ ‫ػؼف‬ ‫ٍدشد‬ ‫ٗال‬ ‫شيو‬ ‫ػْذك‬
→Distribution ‫ٗاىفخز‬ ‫اىنزف‬ ً‫ا‬ ‫االؽشاف‬ ‫ربثشا‬ ‫..االمثش‬ ‫سخيل‬ ً‫ا‬ ‫ٝذك‬ ‫..؟؟‬ ِٝ‫ا‬
→TIA.s ‫ٗخٞضح‬ ‫ىفزشاد‬ ‫ٍَبثيخ‬ ‫ّ٘ثبد‬ ‫ٝأرٞل‬ ُ‫مب‬ ‫رىل‬ ‫قجو‬
Tone ٍْ ‫عبٝجخ‬ ‫ٗال‬ ‫ٍخشجخ‬ ‫ػؼالرل‬ ‫ٕو‬‫ل‬
Muscle state ‫رغٞش‬ ‫ٍفٞش‬ ‫ٗال‬ ‫رخْذ‬ ‫ٗال‬ ‫خغذ‬ ‫ػؼالرل‬
Abnormal movements

26. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 25
Trophic changes
Cerebellum → ‫ثبىَيؼقخ‬ ‫م٘ٝظ‬ ‫...ثزبمو‬ ‫ٍغَغ‬ ‫ٗاّذ‬ ُٗ‫ٍ٘ص‬ ‫رقف‬ ‫رؼشف‬
Sensory Affection
Superficial ٌ‫(اى‬ ‫االحغبط‬ ٜ‫ف‬ ‫رغٞش‬ ٍِ ‫ٕو‬–‫شنشنخ‬–‫ثبىزحذٝذ‬ ٕ٘ ِٝ‫ٗا‬ ) ‫رَْٞو‬
Deep ‫.؟؟‬ ‫اعفْح‬ ‫ػو‬ ‫ٗاقف‬ ‫مأّل‬ ‫؟؟‬ ‫ثزقغ‬ ‫ٍغَغ‬ ‫ٗاّذ‬ ‫..؟؟‬ ‫رؤىَل‬ ‫ػؼالرل‬
Cortical ‫خٞجل‬ ‫ثذاخو‬ ٌٕٗ ُ‫اىَؼذ‬ ْٔٞ‫ٗاىد‬ ‫اىَفزبذ‬ ِٞ‫ث‬ ‫رفشق‬ ‫رؼشف‬‫..؟؟‬
Autonomic (Sphincteric troubles) ‫...؟؟‬ ‫اىدَبع‬ ٗ‫ا‬ ‫اىزجشص‬ ٗ‫ا‬ ‫اىزج٘ه‬ ٜ‫ف‬ ‫ٍشبمو‬ ٜ‫ف‬
2) Ask for DD of the complaint
3) Other symptoms of other systems (affected or not affected)
‫ىنزبثخ‬present history‫ٍفٞذ‬
‫ٗاٗه‬ ‫خٞذا‬ ‫ىيَشٝغ‬ ‫االعزَبع‬‫..؟؟‬ ٌٞ‫عي‬ ‫فٖٞب‬ ‫مْذ‬ ‫ٍشح‬ ‫اخش‬ ٚ‫عؤاه.....اٍز‬
‫ثٖب‬ ‫ٝزظو‬ ‫ٍٗب‬ ٙ٘‫اىشن‬ ِ‫ػ‬ ‫ٗاىغيجٞخ‬ ‫االٝدبثٞخ‬ ‫اىْقبؽ‬ ‫ردَٞغ‬
) ‫قظخ‬ ‫ٕٞئخ‬ ٚ‫(ػي‬ ٌ‫ٍْظ‬ ٍْٜ‫ص‬ ‫ثزشرٞت‬ ٜ‫اىَشػ‬ ‫اىزبسٝخ‬ ‫مزبثخ‬
4- Past H
‫اىحبىٞخ‬ ٙ٘‫ثبىشن‬ ‫ػالقخ‬ ٔ‫ى‬ ‫ىٞظ‬ ٌٝ‫قذ‬ ٜ‫ٍشػ‬ ‫حبدس‬ ‫مو‬ ٕ٘
 Diseases e.g DM , HTN , Rh fever , bilhaziasis
‫؟‬ ‫..؟‬ ٚ‫ثبىَغزشف‬ ٓ‫حدض‬ ٌ‫ر‬ ‫ٕٗو‬ ‫؟‬ ‫..؟‬ ‫ٗاىؼالج‬ ‫ٗاىفح٘ص‬ ‫..؟؟‬ ٚ‫ٍز‬
 Trauma (accident …operation …blood transfusion)
 Drug intake ‫...؟؟؟؟‬ ‫ٗىفزشح‬ ‫اىْ٘ع‬
5- Family H
‫االقبسة‬ ٜ‫ف‬ ٔ‫ى‬ ‫ٍَبثيخ‬ ‫اىَشٝغ.........حبالد‬
ٓ‫اثب‬‫ثَْٖٞب‬ ‫قشاثخ‬ ‫ٗأٍ.......طيخ‬
ٔ‫ػبئيز‬ ٜ‫ف‬ ٛ‫رغش‬ ‫ٍضٍْخ‬ ‫اىؼبئيخ.....اٍشاع‬ ٜ‫ثبق‬

27. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 26
1- Vital signs 2- General observation 3- Skin
5- Temperature
6- Res. (rate &rhythm)
7- Bl. P (palp & ausc)
8- Pulse(4 limbs &carotid)
Rhythm, Rate ,Volume
Wall condition
Equality on both sides
Special characters
‫عٌن‬ ‫ثالثة‬
1- Mentality ‫عقله‬
6- Body built ‫عضله‬
7- Decubitus ‫السرٌر‬ ً‫ف‬ ‫عدلته‬
5- color
6- hirsutism
7- texture
ً‫ف‬ ‫الجسم‬ ً‫باق‬ ‫فحص‬ ‫ثم‬7‫حسب‬ ‫نقاط‬:ً‫االت‬ ‫الترتٌب‬-
‫الرأس‬←‫الرقبة‬←‫االربعة‬ ‫االطراف‬←‫(الصدر‬ ‫جهاز‬ ‫جهاز‬ ‫ثم‬←‫القلب‬←‫البطن‬←)‫االعصاب‬
4- The head
1- ‫عموما‬ → cranium & appearance of the face
2- eyes ‫لجوة‬ ‫برة‬ ‫من‬ brows→ lids →(conjunctiva ‫االصفر‬ ‫اللون‬ ‫(خاصة‬ →cornea
3- nose &cheeks → +/- working ala nasi +/- nasal discharge
→ nasolabial fold (lost in 7 th N. paralysis)
→ butter fly area (SLE,MS)
4- ear → tophi & discharge +/- parotid swelling
5- mouth & throat
‫(الباهت‬ ‫الوان‬anemia-‫ازرق‬cyanosis)
‫(شفاة‬ ‫الحنك‬ ‫مكونات‬–‫اسنان‬–‫اللوز‬ ‫(لسان‬ .... ) ‫لثة‬–) ‫لعابٌة‬ ‫غدد‬
5- Neck
1- ‫نظرة‬ → skin , swelling , nodding
2- ‫لمسة‬ → rigidity , L.N.s , thyroid , trachea
3- ‫رعشة‬ →neck pulsations
Internal Jugular Vein (congestion & pulsation)
Carotid arteries (pulsation & thrill)

28. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 27
6- Upper and lower limbs N.B :- No limb examination without pulsation
1- for both limbs → shape , skin , nails (color &clubbing)
2- upper limb only → hand grip , involuntary movement (fine &coarse)
3- lower limb only ‫انهار‬ → vessels (Varicose V. &arterial puls.)
‫برك‬ → edema (type &level)
7- Chest If no abnormalities detected
‫٭‬ Elliptical & symmetrical chest shape ,free chest movement with no over
action of accessory muscles
‫٭‬ Equal TVF on both sides with no tenderness or palpable adventious sounds
‫٭‬ Resonant chest taking in consideration (cardiac ,hepatic &splenic ) dullness
‫٭‬Normal vesicular breathing with no crepititions ,wheezes or pleural rub.
8- Heart If no abnormalities detected
‫٭‬ No precordial puge or scars or pulsations
‫٭‬Apex located at 5 th left intercostal space MCL
‫٭‬ Normally auscaltated S1& S2 , no thrill or murmers could be detected.
9- Abdomen If no abnormalities detected
‫٭‬ Preserved waist & slightly scaphoid abd . freely mobile with respiration
‫٭‬ Inverted cenrally located umbilicus .No scars ,masses or impulse on cough
at hernia orifices
‫٭‬ No HSM or ascites
10- Neurological
‫الرأس‬ ‫في‬ ‫ثالثة‬
Mental function → Consciousness, Orientation, Mood & behavior,
Memory , Intelligence .
Speech → (Aphasia , Dysarthria)
Cranial Nerves Ex.
1st
Olfactory → ‫مغمض‬ ‫وهو‬ ‫قهوة‬ ‫بن‬ ‫شممه‬ uni or bil. Anosmia or normal
2nd Optic N. → Acuity , field , color , Ophthamoscope
3rd 4th 6th Ocular N.s
Ptosis → ً‫كل‬ ‫وال‬ ً‫حزئ‬ + ‫البؤبؤ‬ ‫حجم‬
Pupils → 3 reflexes (Accommodation ,light , ciliospinal)
Extra-Ocular muscles
Nystagmus

29. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 28
5th Trigeminal
Sensory → (Ophthalmic , maxillary , mandibular )
Motor → ‫(المضغ‬ Temporalis ,Masseter ,Pterigoids)
Reflexes → Superficial …. (Cornial & Conjunctival)
Deep reflex (Jaw R.)
7th Facial N.
Motor → Mucles of face expression (upper & lower face )
Sensory → taste over ant. 2∕3 of the tongue (by Corda tympani)
Reflexes → Glabellar-nasopalpebral R. (aff. 7 ,eff.7)
8th Cochleo-Vestibular N.
Cochlear part → test for hearing acuity
Vestibular part → (caloric test ,rotating chair,Nystagmus)
9th 10th Glossopharyngeal & Vagus
Motor → palate & uvula ......‫ال‬ ‫على‬ ‫وبص‬ ‫ه‬ ‫ه‬ ‫ااه‬ ‫ٌقول‬ ‫خلٌه‬
Sensory → taste over posterior 1∕3 of the tongue
Reflexes → Palatal R. (aff. 5 ,eff.10)
Pharyngeal R. (aff. 9 ,eff.10)
11th Accessory N.
Cranial Accessory → distributed with Vagus
Spinal Accessory → test for (Sternomastoid & Traprzius)
12th Hypoglossal N → Tongue muscles
Examination of the motor system
Inspection → State of muscles , Fasciculations , Involuntary
movements , Skeletal deformities , Trophic changes
‫الدكتور‬ muscle Tone
‫المريض‬ Muscle power → ‫والبطن‬ ‫والمنكبٌن‬ ‫االربعة‬ ‫االطراف‬
‫الشاكوش‬ Reflexes
Deep R. → (reinforcement) ‫نعمل‬ ‫ٌظهر‬ ‫لم‬ ‫واذا‬ ‫الجانبٌن‬ ‫على‬ ‫نعمله‬
Upper L. e.g. Biceps , triceps , Brachioradialis ………
Lower L. e.g. Knee , Ankle , Planter
Clonus ....‫ال‬ ‫تنسى‬ ‫ال‬
Superficial R. → ‫لتحت‬ ‫فوق‬ ‫من‬
Corneal , palatal , Pharyngeal
Abdominal
Cremasteric , Anal , Gluteal
Planter …….(Babinski ( ‫لعمله‬ ‫طرٌقة‬ ‫اشهر‬

30. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 29
Examination of the Sensory system
Superficial → Pain , Touch & Temp.
Deep → Vibration, joint, muscle, Nerve senses & Rombergrism
Cortical Sen. → done if Sup. & Deep Sen. Are intact ‫مغمضتٌن‬ ‫والعٌنٌن‬
(Tactile localization ,tactile discrimination)
(Perceptual rivalery)
(Stereognosis , graphothesia)
Examination of the Coordination
‫لتحت‬ ‫فوق‬ ‫من‬
Examination of the Cranium ‫والحجم‬ ‫الشكل‬
Examination of the Neck →for meningeal irritation signs
Examination of the Back & Spine
Examination of the Gait ‫رجلٌه‬ ‫على‬ ‫ٌقف‬ ‫ٌقدر‬ ‫(لو‬)
‫نقاط‬ ‫ثالث‬ ‫ذكر‬ ‫ٌجب‬ ‫عموما‬ ‫للتشخٌص‬‫رئٌسٌة‬
1.Anatomical‫تاثره‬ ‫وشكل‬ ‫المتاثر‬ ‫العضو‬ ‫ذكر‬ ‫وهو‬epato spleno megallye.g ,H
2.Etiological),,.... ً‫عرض‬ , ‫عدوى‬ , ‫,ورم‬ ً‫(وراث‬ ‫ٌكون‬ ‫قد‬ ‫الذي‬ ‫السبب‬
3.Pathological‫المشكلة‬ ‫مظهر‬focal , systemic , disseminated
4.Functional‫الوظٌفٌة‬ ‫الناحٌة‬ ‫من‬
a) Compensation :-
compensated ‫عادٌة‬ ‫شبه‬ ‫بحٌاة‬ ‫المرض‬ ‫مع‬ ‫التأقلم‬ ‫الجسم‬ ‫ٌستطٌع‬ ‫حٌث‬
decompensated ‫ٌستطٌع‬ ‫ال‬ ‫او‬
b) Complications ‫المرض‬ ‫هذا‬ ‫عن‬ ‫نتجت‬ ‫مضاعفات‬ ‫اي‬ ‫ذكر‬

31. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 31
1- Personal history
NAS OMRH +/- handedness
2- Complaint ‫اىًٞ٘..؟‬ ٚ‫اىَغزشف‬ ‫خبثل‬ ٜ‫اىي‬ ٔٝ‫ا‬‫؟؟؟؟‬
3- Present H.
‫اىيحظخ‬ ٓ‫ٕز‬ ٚ‫حز‬ ٜ‫اىحبى‬ ٔ‫ٍشػ‬ ‫ثذاٝخ‬ ‫ٍْز‬ ‫اىَشٝغ‬ ٙ٘‫شن‬ ‫ثزحيٞو‬ ‫ىيزشخٞض‬ ‫اى٘ط٘ه‬ ‫ٍحبٗىخ‬ ٕ٘
4) Analysis of the complaint Onset , Course , Duration
Related ----symptoms of affected system
------investigations
------medication and its effect
Pattern of joint affection → mono. ,poly. ,or oligoarticular
Precipitating Factors
Description of pain →Site & Type
→ Aggravating & Relieving Factors
→Diurenal variations & Episodic Arthritis
→ Associated Articular symptoms
(morning stiffness in Rh Arthritis)
→ Associated Non articular symptoms
(Skin symptoms …. SLE)
(Abd. Pain & Fever …. FMF)
5) Ask for DD of the complaint
6) Other symptoms of other systems (affected or not affected)
‫ىنزبثخ‬present history‫ٍفٞذ‬
‫..؟؟‬ ٌٞ‫عي‬ ‫فٖٞب‬ ‫مْذ‬ ‫ٍشح‬ ‫اخش‬ ٚ‫عؤاه.....اٍز‬ ‫ٗاٗه‬ ‫خٞذا‬ ‫ىيَشٝغ‬ ‫االعزَبع‬
‫ثٖب‬ ‫ٝزظو‬ ‫ٍٗب‬ ٙ٘‫اىشن‬ ِ‫ػ‬ ‫ٗاىغيجٞخ‬ ‫االٝدبثٞخ‬ ‫اىْقبؽ‬ ‫ردَٞغ‬
ٚ‫(ػي‬ ٌ‫ٍْظ‬ ٍْٜ‫ص‬ ‫ثزشرٞت‬ ٜ‫اىَشػ‬ ‫اىزبسٝخ‬ ‫مزبثخ‬) ‫قظخ‬ ‫ٕٞئخ‬

32. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 31
4- Past H
‫اىحبىٞخ‬ ٙ٘‫ثبىشن‬ ‫ػالقخ‬ ٔ‫ى‬ ‫ىٞظ‬ ٌٝ‫قذ‬ ٜ‫ٍشػ‬ ‫حبدس‬ ‫مو‬ ٕ٘
 Diseases e.g DM , HTN , Rh fever , bilhaziasis
‫؟‬ ‫..؟‬ ٚ‫ثبىَغزشف‬ ٓ‫حدض‬ ٌ‫ر‬ ‫ٕٗو‬ ‫؟‬ ‫..؟‬ ‫ٗاىؼالج‬ ‫ٗاىفح٘ص‬ ‫..؟؟‬ ٚ‫ٍز‬
 Trauma (accident …operation …blood transfusion)
 Drug intake ‫...؟؟؟؟‬ ‫ٗىفزشح‬ ‫اىْ٘ع‬
 Raynauds phenomenon
 Psoriasis ….in psoriatic arthritis
5- Family H
‫االقبسة‬ ٜ‫ف‬ ٔ‫ى‬ ‫ٍَبثيخ‬ ‫اىَشٝغ.........حبالد‬
‫ثَْٖٞب‬ ‫قشاثخ‬ ‫ٗأٍ.......طيخ‬ ٓ‫اثب‬
ٔ‫ػبئيز‬ ٜ‫ف‬ ٛ‫رغش‬ ‫ٍضٍْخ‬ ‫اىؼبئيخ.....اٍشاع‬ ٜ‫ثبق‬

33. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 32
1- Vital signs 2- General observation 3- Skin
1. Temperature
2. Res. (rate &rhythm)
3. Bl. P (palp & ausc)
4. Pulse(4 limbs &carotid)
rhythm, rate ,volume
wall condition
equality on both sides
special characters
‫عٌن‬ ‫-ثالثة‬
1- Mentality ‫عقله‬
2- Body built ‫عضله‬
3- Decubitus ‫السرٌر‬ ً‫ف‬ ‫عدلته‬
1. color
2. hirsutism
3. texture
ً‫ف‬ ‫الجسم‬ ً‫باق‬ ‫فحص‬ ‫ثم‬7:ً‫االت‬ ‫الترتٌب‬ ‫حسب‬ ‫نقاط‬-
‫الرأس‬←‫الرقبة‬←‫االربعة‬ ‫االطراف‬←‫(الصدر‬ ‫جهاز‬ ‫جهاز‬ ‫ثم‬←‫القلب‬←‫البطن‬←)‫االعصاب‬
4- The head
1- ‫عموما‬ → cranium & appearance of the face
2- eyes ‫لجوة‬ ‫برة‬ ‫من‬ brows→ lids →(conjunctiva ‫االصفر‬ ‫اللون‬ ‫(خاصة‬ →cornea
+/- dry eye → Sjogrns Ś
3- nose &cheeks → +/- working ala nasi +/- nasal discharge
→ nasolabial fold (lost in 7 th N. paralysis)
→ butter fly area (SLE,MS)
4- ear → tophi & discharge +/- parotid swelling
5- mouth & throat
‫(الباهت‬ ‫الوان‬anemia-‫ازرق‬cyanosis)
‫(شفاة‬ ‫الحنك‬ ‫مكونات‬–‫اسنان‬–‫اللوز‬ ‫(لسان‬ .... ) ‫لثة‬–) ‫لعابٌة‬ ‫غدد‬
5- Neck
1- ‫نظرة‬ → skin , swelling , nodding
2- ‫لمسة‬ → rigidity , L.N.s , thyroid , trachea
3- ‫رعشة‬ →neck pulsations
Internal Jugular Vein (congestion & pulsation)
Carotid arteries (pulsation & thrill)

34. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 33
6- Upper and lower limbs N.B :- No limb examination without pulsation
1- for both limbs → shape , skin , nails (color &clubbing)
2- upper limb only → hand grip , involuntary movement (fine &coarse)
3- lower limb only ‫انهار‬ → vessels (Varicose V. &arterial puls.)
‫برك‬ → edema (type &level)
7- Chest If no abnormalities detected
‫٭‬ Elliptical & symmetrical chest shape ,free chest movement with no over
action of accessory muscles
‫٭‬ Equal TVF on both sides with no tenderness or palpable adventious sounds
‫٭‬ Resonant chest taking in consideration (cardiac ,hepatic &splenic ) dullness
‫٭‬Normal vesicular breathing with no crepititions ,wheezes or pleural rub.
8- Heart If no abnormalities detected
‫٭‬ No precordial puge or scars or pulsations
‫٭‬Apex located at 5 th left intercostal space MCL
‫٭‬ Normally auscaltated S1& S2 , no thrill or murmers could be detected.
9- Abdomen If no abnormalities detected
‫٭‬ Preserved waist & slightly scaphoid abd . freely mobile with respiration
‫٭‬ Inverted cenrally located umbilicus .No scars ,masses or impulse on cough
at hernia orifices
‫٭‬ No HSM or ascites
10- Neurological If no abnormalities detected
‫٭‬ Fully conscious oriented for time ,place & persons
‫٭‬ No weakness, rigidity or abnormal movements of the limbs
‫٭‬ Symmetrical face with optimal general &special sensations
11- Examination of Arthritis
Inspection
Distribution of affected joints
Description → if ..swollen , red , painful
→ Range of active movement +/- abnormal movements
→ Overlying Skin
→ Joint surrounding (muscles & bursa)
Deformities
Complications → Tendon rupture

35. ‫اعد‬‫والكبد‬ ‫الهضمي‬ ‫الجهاز‬ )‫(م‬ ‫مدرس‬ ‫حنظل‬ ‫احمد‬ ‫سيد‬ /‫د‬ ‫اد‬-‫الفيوم‬ ‫جامعة‬ ‫الطب‬ ‫كلية‬ 34
Palpation ‫المفصل‬ ‫لجوة‬ ‫برة‬ ‫من‬ ً‫االت‬ ‫عن‬ ‫ابحث‬
Tenderness & Hotness
S.C. nodules
Thick Synovial membrane
Effusion
Range of movement & Joint Stability
‫نقاط‬ ‫ثالث‬ ‫ذكر‬ ‫ٌجب‬ ‫عموما‬ ‫للتشخٌص‬‫رئٌسٌة‬
1.Anatomical‫تاثره‬ ‫وشكل‬ ‫المتاثر‬ ‫العضو‬ ‫ذكر‬ ‫وهو‬RT knee Effusione.g ,
2.Etiological),,.... ً‫عرض‬ , ‫عدوى‬ , ‫,ورم‬ ً‫(وراث‬ ‫ٌكون‬ ‫قد‬ ‫الذي‬ ‫السبب‬
3.Functional‫الوظٌفٌة‬ ‫الناحٌة‬ ‫من‬
a) Compensation :-
compensated ‫عادٌة‬ ‫شبه‬ ‫بحٌاة‬ ‫المرض‬ ‫مع‬ ‫التأقلم‬ ‫الجسم‬ ‫ٌستطٌع‬ ‫حٌث‬
decompensated ‫ٌستطٌع‬ ‫ال‬ ‫او‬
b) Complications ‫المرض‬ ‫هذا‬ ‫عن‬ ‫نتجت‬ ‫مضاعفات‬ ‫اي‬ ‫ذكر‬