General examination
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This presentation is for undergraduate medical students to illustrate general examination with videos and photos
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General examination
- 2. Rule of 7 1. General appearance 2. Vital signs 3. Head examination 4. Neck examination 5. Upper limb examination 6. Lower limb examination 7. Lymph node examination + Breast Shaimaa Elkholy
- 3. 1. General appearance • Consciousness & Orientation (GCS) • Cooperation • Mentality • Memory • Mood • Decubitus • Body built 7 Shaimaa Elkholy
- 10. Body Mass Index (BMI) It is calculated by the formula weight/ height2 (Kg/m2) BMI Underweight <18.5 Normal 18.5-24.9 Overweight 25-29.9 Obese 30-39.9 Morbidly obese >40 Shaimaa Elkholy
- 13. 2. Vital signs 1. Pulse 2. Blood pressure 3. Respiratory rate 4. Temperature Shaimaa Elkholy
- 16. Pulse • Rate • Rhythm • Volume • Special character • Equality on both sides • Peripheral pulsations • State of arterial wall 7 Shaimaa Elkholy
- 17. Pulse • Rate = 60 -100 • < 60 -----------> bradycardia • > 100 ----------> tachycardia Shaimaa Elkholy
- 19. Pulse • Irregular Regular irregularity Irregular irregularity Shaimaa Elkholy
- 22. Pulse Extra systolesAF Can count 4Cannot count 4 Pulse deficit < 10Pulse deficit > 10 NormalRapid NoSystolic expansion of neck veins Exercise - - -Exercise +++ Shaimaa Elkholy
- 24. Pulse • Volume Small Big • Big (hyper dynamic) Anemia AR A-V fistula Pregnancy PDA, VSD LCF Paget disease Thyrotoxicosis Shaimaa Elkholy
- 25. Shaimaa Elkholy
- 26. Pulse • Special character Pulses parvus et tardus (plateau pulse) Water hummer pulse (collapsing) Bisferiens Pulsus alternans Pulsus paradoxicus Shaimaa Elkholy
- 27. Shaimaa Elkholy
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- 29. Pulse • Equality on both sides Shaimaa Elkholy
- 30. unequal pulse ??!! Shaimaa Elkholy
- 31. • Out side • Wall • Inside Shaimaa Elkholy
- 32. Pulse • Peripheral pulsations Shaimaa Elkholy
- 33. Brachial pulse Flex the patient’s elbow Medial to the biceps Shaimaa Elkholy
- 34. Carotid Arteries •At the level of thyroid cartilage Shaimaa Elkholy
- 35. The dorsalis pedis artery Lateral to the extensor hallucis tendon Absent in 10% Shaimaa Elkholy
- 36. The posterior tibial pulse. Shaimaa Elkholy
- 43. Respiratory rate 16 -22 Shaimaa Elkholy
- 44. Temperature 36.5 – 37.2 Shaimaa Elkholy
- 48. Head examination • Facies • Hair • Eye • Nose & cheeks • Mouth • Ear • Parotid 7 Shaimaa Elkholy
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- 67. Causes of puffiness of eye lids Oedema (nephrotic & angioedema) Chronic cough Myxedema S.V.C obstruction (mediastinal S) Cavernous sinus thrombosis Shaimaa Elkholy
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- 76. Bitot spots .>>>Vit A def. Shaimaa Elkholy
- 78. Types of jaundice Prehepatic / Hemolytic jaundice Hepatic jaundice Posthepatic / Obstructive/ Surgical jaundice Shaimaa Elkholy
- 79. Function test Pre-hepatic Jaundice Hepatic Jaundice Post-hepatic Jaundice T.Bil +++ +++ +++ D.BIL N +++ +++ inD.BIL +++ +++ N Urobilinogen N / + ++ -- / -ve Urine Color N Dark (urobilinogen + direct bilirubin) Dark (direct bilirubin) Stool Color N N /Pale Pale ALPH,GGT N +++ Marked +++ AST, ALT N ++++ +++ Conj Bil. Urine Not Present Present Present Shaimaa Elkholy
- 80. Nose & cheeks Shaimaa Elkholy
- 82. Shaimaa Elkholy
- 84. Mouth • Odor • Lips • Tongue • Teeth • Gums • Oral cavity • Palate Shaimaa Elkholy
- 85. Bad odor • Alcohol • Acetone: DKA • Ammonia: CRF • Fetor hepaticus: LCF • Halitosis Dental caries SLS GIT obstructio: Pharyngeal pouch, Achalasia Shaimaa Elkholy
- 86. Lips • 3 colors • Angular stomatitis • Ulcers Shaimaa Elkholy
- 88. Shaimaa Elkholy
- 90. Central cyanosis Peripheral cyanosis Site All the body (tongue) Hands & feet Ears & nose Ext. lips Hands Warm cold Effect of warming ++ --- Effect of O2 Improve No effect Causes Cong., resp.failure, abnormal HB(met Hb) Cold , Shock, Raynaud’s Shaimaa Elkholy
- 92. Angular stomatitis Oral ulcers Shaimaa Elkholy
- 93. Teeth & gums Shaimaa Elkholy
- 94. Shaimaa Elkholy
- 96. Tongue Fiery red (B3) PellagraPale glazed Magenta (B2) Beefy (B12)Shaimaa Elkholy
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- 98. Oral cavity & Palate Shaimaa Elkholy
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- 105. Trachea • Central • Tracheal length • Tracheal tug (A.A, Cambell’s sign) • Mobil or fixed Shaimaa Elkholy
- 106. Vessels (carotid A) Shaimaa Elkholy
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- 113. Carotid pulsation • Medial to sternomastoid • One peak • Unaffected by posture • Unaffected by respiration • Better felt than seen JVP • Lateral to sternomastoid • Wavy pulsation • Prominent on lying down • Decrease by inspiration • Seen and not palpable Shaimaa Elkholy
- 114. Thyroid gland • Inspection • Palpation • Percussion • Auscultation Shaimaa Elkholy
- 115. Shaimaa Elkholy
- 116. Lymph nodes 1. Circular set: -Inner ring (Waldyer’s ring) Retropharyngeal, tonsils, Eustacian tube -Outer ring: Sub mental Submandibular Pre-auricular Post-auricular Occipital Shaimaa Elkholy
- 117. 2. Vertical set: -Superficial group: Along body of sternomastoid -Deep group: • Ant. cervical: infrahyoid, pre –laryngeal, pre-tracheal • Post. Cervical: along border of trapezius • DEEP CERVICAL: upper & lower groups : deep to the sternomastoid : along IJV Supra clavicular LNs Shaimaa Elkholy
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- 122. Hand examination • S (shape, sweating) • T (tremors , temp.) • N (nail, nodule) • Palmer erythema • Pallor Shaimaa Elkholy
- 129. Koilonychia ( spooning) Shaimaa Elkholy
- 133. Signs of infective endocarditis • Splinter hemorrhages : multiple linear, reddish brown marks along the axis of fingernails and toe nails Shaimaa Elkholy
- 135. Half & half nail Shaimaa Elkholy
- 136. Cyanosis in the nails with Clubbing Shaimaa Elkholy
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- 142. Nodules • Janeway lesions: painless, erythematous maculopapules on the palms and soles that do not blanche. They are caused by thrombi in small vessels, without vasculitis • Osler's nodules: painful, red papulo- nodules with a pale center. They are found on the fingertips, and last days to weeks. Caused by microabscesses in the dermis, they may even contain gram-positive cocci. Shaimaa Elkholy
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- 144. Heberden's and Bouchard's Nodes Shaimaa Elkholy
- 145. Skin • Stria • Scratch marks • Scar • Spider nevi • Purpura • Ecchymosis • Thin or thick Shaimaa Elkholy
- 149. DONot BLAnch (Purpiric eruption) Shaimaa Elkholy
- 151. Shaimaa Elkholy Multiple Spider nevi
- 153. • Tendon xanthoma • Injection sites • Epitrochlear LNs • Axillary LNs. Shaimaa Elkholy
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- 156. Epi-trochlear lymph node Shaimaa Elkholy
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- 158. Lower Limb • Oedema • Dorsalis pedis • Post. Tibial • Lax calf muscles • Varicosities • Skin + ulcer • Pretibial myxedema • Erythema nodsum Shaimaa Elkholy
- 159. Pitting seen in the left limb Shaimaa Elkholy
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Editor's Notes
- Fallot tetraology
- Sooooooo wrong
- Causes of puffiness Chronic cough Oedema (renal) SVO obstruction
- D.M, hypocalcemia Cushing S, steroids Wilsons, galactosemia, mytonia atrophica
- Tongue: closed cavity, internal cavity, no sympathetic supply.
- Pink teeth: porphyria Gum hyperplasia: epanutin, monocytic leukemia
- Atrial contraction, atrial relaxation, venous return (filling), opening of T (emptying).
- Broad and thick hands :Acromegaly
- Polydactyly
- Marfan syndrome
- Flapping tremors : failure to maintain extension
- Fe deficiency anemia
- White nails: hypoalbuminemia
- Infection
- Damage of the nails with separation due to infection
- Liver cirrhosis
- In severe stressful conditions as critically ill patients
- Figure 1 ; Osteoarthritis while figure 2 gottron’s nodules in dermatomyosities
- Osteoarthritis
- Scratch marks due to purititis as in renal failure or obstructive jaundice
- They don’t blanch on pressure to differentiate it from the insect bite due to platelet defect (thrombicytopenia or thrombocytopathy)
- It fades on pressing on the central arteriole
- Spider nevi
- Ecchymosis due to coagulation defect as in liver cirrhosis or hemophilia
- Tendon Xanthoma (hypercholesterlolemia)
- Injection sites
- Epi-trochlear lymph node enlargement indicates that almost all lymph nodes of the body are enlarged
- Injection sites
- Varicose Viens
- Erythema nodosum