1. PHYSICAL EXAMINATION
IN HEMATOLOGY
Pensri Pootrakul MD.
Thalassemia Research Center
Institute of Molecular Bioscience
Mahidol University,Salaya Campus

2. DIAGNOSIS

3. DIAGNOSIS
Chief complaint

4. DIAGNOSIS
Chief complaint
History : Present history
Past history

5. DIAGNOSIS
Chief complaint
History : Present history
Past history
Physical examination

6. DIAGNOSIS
Chief complaint
History : Present history
Past history
Physical examination
Lab. tests: Rountine tests
Special tests

7. PHYSICAL EXAMINATION

8. PHYSICAL EXAMINATION
Inspection

9. PHYSICAL EXAMINATION
Inspection
Palpation

10. PHYSICAL EXAMINATION
Inspection
Palpation
Percussion

11. PHYSICAL EXAMINATION
Inspection
Palpation
Percussion
Auscultation

12. GENERAL APPEARANCE

13. GENERAL APPEARANCE
Figure,malformation

14. GENERAL APPEARANCE
Figure,malformation
Dressing

15. GENERAL APPEARANCE
Figure,malformation
Dressing
Severity of symptoms and signs

16. GENERAL APPEARANCE
Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight

17. GENERAL APPEARANCE
Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight
Development

18. GENERAL APPEARANCE
Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight
Development
Level of conciousness,mood,IQ,

19. GENERAL APPEARANCE
Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight
Development
Level of conciousness,mood,IQ,
Speaking,voice

20. GENERAL APPEARANCE
Figure,malformation
Dressing
Severity of symptoms and signs
Growth : body weight and hight
Development
Level of conciousness,mood,IQ,
Speaking,voice
Co-operative

21. Vital Signs

22. Vital Signs
Temperature

23. Vital Signs
Temperature
Pulse

24. Vital Signs
Temperature
Pulse
Respiratory rate,rhythm

25. Vital Signs
Temperature
Pulse
Respiratory rate,rhythm
Blood pressure

26. Problems in Hematology

27. Problems in Hematology
Anemia

28. Problems in Hematology
Anemia Gum hypertrophy

29. Problems in Hematology
Anemia Gum hypertrophy
Jaundice

30. Problems in Hematology
Anemia Gum hypertrophy
Jaundice Hepato-splenomegaly

31. Problems in Hematology
Anemia Gum hypertrophy
Jaundice Hepato-splenomegaly
Cyanosis

32. Problems in Hematology
Anemia Gum hypertrophy
Jaundice Hepato-splenomegaly
Cyanosis Clubbing finger

33. Problems in Hematology
Anemia Gum hypertrophy
Jaundice Hepato-splenomegaly
Cyanosis Clubbing finger
Growth retardation

34. Problems in Hematology
Anemia Gum hypertrophy
Jaundice Hepato-splenomegaly
Cyanosis Clubbing finger
Growth retardation Mongoioid face

35. Problems in Hematology
Anemia Gum hypertrophy
Jaundice Hepato-splenomegaly
Cyanosis Clubbing finger
Growth retardation Mongoioid face
Lymphadenopathy

36. Problems in Hematology
Anemia Gum hypertrophy
Jaundice Hepato-splenomegaly
Cyanosis Clubbing finger
Growth retardation Mongoioid face
Lymphadenopathy Bleeding

37. Problems in Hematology
Anemia Gum hypertrophy
Jaundice Hepato-splenomegaly
Cyanosis Clubbing finger
Growth retardation Mongoioid face
Lymphadenopathy Bleeding
Skin : bruise,echymosis, hematoma,pethichiae

38. Problems in Hematology
Anemia Gum hypertrophy
Jaundice Hepato-splenomegaly
Cyanosis Clubbing finger
Growth retardation Mongoioid face
Lymphadenopathy Bleeding
Skin : bruise,echymosis, hematoma,pethichiae
Organs bleeding : GI,cerebral,gum

39. ANEMIA

40. ANEMIA
Symptom, not disease and found in many diseases

41. ANEMIA
Symptom, not disease and found in many diseases
Fatique,weakness,dizzy,easily tired

42. ANEMIA
Symptom, not disease and found in many diseases
Fatique,weakness,dizzy,easily tired
Signs : color of conjunctiva,lip,tongue,nail,palm,skin

44. JAUNDICE
Sclera, mucosa, skin

45. CYANOSIS

46. CYANOSIS
Lip, tounge, mucosa,
nail, skin

47. CYANOSIS
Lip, tounge, mucosa,
nail, skin
Clubling of finger

49. Clubling of finger

50. EDEMA

51. EDEMA
Dorsum of foot, ankle,medial side of tibia

52. EDEMA
Dorsum of foot, ankle,medial side of tibia
Pitting edema

53. EDEMA
Dorsum of foot, ankle,medial side of tibia
Pitting edema
Non-pitting edema : local ,thick & rough skin

54. EDEMA
Dorsum of foot, ankle,medial side of tibia
Pitting edema
Non-pitting edema : local ,thick & rough skin
Severe edema - sex organ swelling

55. EDEMA

56. EDEMA
Severe edema

57. HEAD, FACE, NECK

58. HEAD, FACE, NECK
Head : Start from up to down, skull, hair, Scalp,

59. HEAD, FACE, NECK
Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance

60. HEAD, FACE, NECK
Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance
Pharynx : lip,teeth,gum,mucosa,tounge,tonsils

61. HEAD, FACE, NECK
Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance
Pharynx : lip,teeth,gum,mucosa,tounge,tonsils
Neck : Scar?, Mass - thyroid, lymph node ,trachea,

62. HEAD, FACE, NECK
Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance
Pharynx : lip,teeth,gum,mucosa,tounge,tonsils
Neck : Scar?, Mass - thyroid, lymph node ,trachea,
jugular vein and pressure , carotid artery,

63. HEAD, FACE, NECK
Head : Start from up to down, skull, hair, Scalp,
Face : eyes,ears,nose,sinus,mouth,face appearance
Pharynx : lip,teeth,gum,mucosa,tounge,tonsils
Neck : Scar?, Mass - thyroid, lymph node ,trachea,
jugular vein and pressure , carotid artery,
superior vena cava syndrome

66. Angular stomatitis

69. Hypotrophy of tongue

71. Tongue ulcer

72. Tongue ulcer

73. Hereditary hemorrhagic telangectasia
Tongue ulcer

75. Gum hypertrophy

76. Gum hypertrophy

77. Gum hypertrophy Gum hypertrophy with poor
mouth hygene

78. Ulcer at base of tongue

79. Ulcer at base of tongue Ulcer at sublingual

82. Inflammation

83. Inflammation Infection

88. Koilonychia

89. LYMPH NODES

90. LYMPH NODES
Which group of lymph nodes enlargement
single or multiple nodes,multiple groups

91. LYMPH NODES
Which group of lymph nodes enlargement
single or multiple nodes,multiple groups
Signs of inflamation, tenderness, consistency,
fix or movable

92. LYMPH NODES
Which group of lymph nodes enlargement
single or multiple nodes,multiple groups
Signs of inflamation, tenderness, consistency,
fix or movable
Location of infection or inflammation - coresponding
the enlarged nodes:

93. LYMPH NODES

94. LYMPH NODES
Group of lymph nodes :

95. LYMPH NODES
Group of lymph nodes :
Preauricular,postauricular,occipital,submandibular,

96. LYMPH NODES
Group of lymph nodes :
Preauricular,postauricular,occipital,submandibular,
submentle, cervical

97. LYMPH NODES
Group of lymph nodes :
Preauricular,postauricular,occipital,submandibular,
submentle, cervical
Cervical: anterior, posterior,supraclavicular

98. LYMPH NODES
Group of lymph nodes :
Preauricular,postauricular,occipital,submandibular,
submentle, cervical
Cervical: anterior, posterior,supraclavicular
Axillary,epitrochlear,mediasternal,hilar

99. LYMPH NODES
Group of lymph nodes :
Preauricular,postauricular,occipital,submandibular,
submentle, cervical
Cervical: anterior, posterior,supraclavicular
Axillary,epitrochlear,mediasternal,hilar
Inguinal,abdominal

100. Lymph nodes at the neck

101. Lymph nodes at the neck

105. Lymphadenopathy

108. Thyroid examination from the front

109. Thyroid examination from the front

110. Thyroid examination from the front Thyroid examination from the back

111. CHEST

112. CHEST
Chest appearance :

113. CHEST
Chest appearance : abnormal shapes -

114. CHEST
Chest appearance : abnormal shapes -
barrel,cobbler,flat, funnel,pigion

115. CHEST
Chest appearance : abnormal shapes -
barrel,cobbler,flat, funnel,pigion
Spine - kyphosis,scoliosis

116. CHEST
Chest appearance : abnormal shapes -
barrel,cobbler,flat, funnel,pigion
Spine - kyphosis,scoliosis
Palpation :

117. CHEST
Chest appearance : abnormal shapes -
barrel,cobbler,flat, funnel,pigion
Spine - kyphosis,scoliosis
Palpation : apex beat , chest movement

118. CHEST
Chest appearance : abnormal shapes -
barrel,cobbler,flat, funnel,pigion
Spine - kyphosis,scoliosis
Palpation : apex beat , chest movement
Percussion :

119. CHEST
Chest appearance : abnormal shapes -
barrel,cobbler,flat, funnel,pigion
Spine - kyphosis,scoliosis
Palpation : apex beat , chest movement
Percussion : cardiac dullness , chest dullness

120. CHEST
Chest appearance : abnormal shapes -
barrel,cobbler,flat, funnel,pigion
Spine - kyphosis,scoliosis
Palpation : apex beat , chest movement
Percussion : cardiac dullness , chest dullness
Auscultation :

121. CHEST
Chest appearance : abnormal shapes -
barrel,cobbler,flat, funnel,pigion
Spine - kyphosis,scoliosis
Palpation : apex beat , chest movement
Percussion : cardiac dullness , chest dullness
Auscultation : breath sound,heart sound

127. Spleen palpation

129. SPLEEN

130. SPLEEN

131. SPLEEN

132. SPLEEN

135. Auscultation

141. Growth retardation

143. Thalassemic face - Mongoloid face

144. Thalassemic face - Mongoloid face

149. Tower skull

150. Tower skull

151. Tower skull Radiography - Hair on end

154. Tower skull

155. Tower skull

156. Tower skull Radiography - Hair on end

160. Knock knee

163. Bone deformity

167. Hyperpigmentation of skin

170. Hyperpigmentation of skin

174. Abdominal enlargement

177. Bone deformity

180. Gynecomastia

188. Gangrene

192. Skin bleeding

193. Skin bleeding
Petichiae

196. Purpura over the lower limbs in acute leukemia

199. MASSIVE BLEEDING

200. MASSIVE BLEEDING
HEMOPHILIA A

203. Early urticarial lesion

204. Early urticarial lesion

205. Early urticarial lesion Bleeding with bleb formation

206. HENOCH-SCHÖNLEIN PURPURA
Early urticarial lesion Bleeding with bleb formation

209. Senile purpura

212. MYCOSIS FUNGOIDES

215. Herpes Zoster infection

218. Indurated and confluent purpura of the arm
Disseminated intravascular coagulation
( DIC )

221. Peripheral gangrene with swelling and discoloration
of the skin of the feet in fulminant disease

224. Massive subcutaneous hemorrhage in
thrombocytopenia

228. Severe bleeding

236. Acute hemarthrosis of Rt. knee joint
wasting of the quadriceps muscles on the left

237. Acute hemarthrosis of Rt. knee joint
wasting of the quadriceps muscles on the left

238. Acute hemarthrosis of Rt. knee joint Severe disability
wasting of the quadriceps muscles on the left

239. Hemophilia A
Acute hemarthrosis of Rt. knee joint Severe disability
wasting of the quadriceps muscles on the left

243. Midline grannuloma

246. Kaposiʼs sarcoma

247. Kaposiʼs sarcoma
in acquired immune deficiency syndrome ( AIDS )

251. Urine color