3-the clinical examination

8/14/2019 3-The Clinical Examination

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THE CLINICALTHE CLINICAL

EXAMINATIONEXAMINATION

KEEP THE BASIC PATTERN OFKEEP THE BASIC PATTERN OF

LOOKING,LOOKING,

FEELING,FEELING,TAPPING,TAPPING,

LISTENINGLISTENING



GENERAL ASSESSMENTGENERAL ASSESSMENT

While talking to the pt. you can observe:While talking to the pt. you can observe:

– His face: fitness for age, in pain/comfortableHis face: fitness for age, in pain/comfortable

– His intellectual ability and intelligenceHis intellectual ability and intelligence

– His attitude to his disease, to you,His attitude to his disease, to you,

to treatmentto treatment



GENERAL ASSESSMENTGENERAL ASSESSMENT

Your instructions:Your instructions:

– extremely simple if the pt. is unintelligentextremely simple if the pt. is unintelligent

– gentle if the pt. is shygentle if the pt. is shy

You can observe physical characteristics:You can observe physical characteristics:

– Posture, mobility, weight, color of skin, facialPosture, mobility, weight, color of skin, facialappearance and general body buildappearance and general body build



GENERAL EXAMINATIONGENERAL EXAMINATION

Hold the pt’s hand and examine itHold the pt’s hand and examine it

– Count the pulse,Count the pulse,

– Temperature of the skinTemperature of the skin

– MoistureMoisture

– Color Color

– NailsNails

– CallositiesCallosities



PULSEPULSE

RATERATE

RHYTHMRHYTHMVOLUMEVOLUME



NAILSNAILS

SHAPESHAPE

– KOILONYCHIAS- ANEMIAKOILONYCHIAS- ANEMIA

– CLUBBING- COADCLUBBING- COAD

– BITTEN NAILS- ANXIETYBITTEN NAILS- ANXIETY

COLOURCOLOUR



HANDSHANDS

TEMPERATURE: HOT, COLD, NORMALTEMPERATURE: HOT, COLD, NORMAL

MOISTUREMOISTURE

CALLOSITIES: OCCUPATIONCALLOSITIES: OCCUPATIONCOLOUR:COLOUR:

– BLUISH: CYANOSISBLUISH: CYANOSIS

– REDDISH-BLUE: POLYCYTHEMIAREDDISH-BLUE: POLYCYTHEMIA – PALOR: ANEMIAPALOR: ANEMIA

– NICOTINE-STAINED: HEAVY SMOKERNICOTINE-STAINED: HEAVY SMOKER



PARONYCHIAPARONYCHIA



NICOTINE STAINNICOTINE STAIN



CLUBBINGCLUBBING



CYANOSISCYANOSIS



RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS



ONICOMYCOSISONICOMYCOSIS



EXAMINE THE HEAD AND NECKEXAMINE THE HEAD AND NECK

EYESEYES

–REACTION OF THE PUPILSREACTION OF THE PUPILS

– COLOUR OF THE SCLERACOLOUR OF THE SCLERA

– EXOPHTALMIAEXOPHTALMIA



EXAMINE THE HEAD AND NECKEXAMINE THE HEAD AND NECK

EARS AND NOSEEARS AND NOSE

MOUTH, LIPS AND TONGUEMOUTH, LIPS AND TONGUE

NECK:NECK: – JUGULAR VEINSJUGULAR VEINS

– TRACHEATRACHEA

–THYROID GLANDTHYROID GLAND

– LYMPH NODESLYMPH NODES



TRACHEATRACHEA



LYMPH NODESLYMPH NODES



NECK LUMPSNECK LUMPS



NECK EXAMINATIONNECK EXAMINATION



THYROID NODULETHYROID NODULE



EXAMINE THE CHESTEXAMINE THE CHEST

INSPECTIONINSPECTION

– CYANOSISCYANOSIS

– RR AND RHYTHMRR AND RHYTHM

– CHEST EXPANSIONCHEST EXPANSION

– PARADOXICAL MOVEMENTPARADOXICAL MOVEMENT

– DEFORMITIESDEFORMITIES




PERCUSSIONPERCUSSION

– RESONANT SOUND- NORMALRESONANT SOUND- NORMAL

– HYPERRESONANCE- EXTRA AIRHYPERRESONANCE- EXTRA AIR

– DULNESS- PLEURAL FLUIDDULNESS- PLEURAL FLUID




AUSCULTATIONAUSCULTATION

– VESICULARVESICULAR

BREATHINGBREATHING

– WHEEZEWHEEZE – COARSE CRACKLESCOARSE CRACKLES

– FINE CRACKLESFINE CRACKLES

– PLEURAL RUBPLEURAL RUB



PECTUS EXCAVATUSPECTUS EXCAVATUS



KYPHOSISKYPHOSIS



SCOLIOSISSCOLIOSIS



CHEST EXPANSIONCHEST EXPANSION



CHEST LANDMARKSCHEST LANDMARKS

OF THE LUNGSOF THE LUNGS



CHEST ASCULTATIONCHEST ASCULTATION



BREASTSBREASTS



GYNECOMASTIAGYNECOMASTIA



AXILLARY PALPATIONAXILLARY PALPATION



LYMPHADENOPATHYLYMPHADENOPATHY



EXAMINE THE HEART ANDEXAMINE THE HEART AND

CIRCULATIONCIRCULATION

MEASURE BPMEASURE BP

JUGULAR VEINSJUGULAR VEINSNECK ARTERIESNECK ARTERIES

TRACHEATRACHEA

HEARTHEART



HEART LANDMARKSHEART LANDMARKS



POINT OF MAXIMUM IMPULSEPOINT OF MAXIMUM IMPULSE



HEART INSIGHTSHEART INSIGHTS



EXAMINE THE ABDOMENEXAMINE THE ABDOMEN

POSITION OF THE PT.POSITION OF THE PT.

– SUPINE, SLIGHTLY FLEXED KNEES,SUPINE, SLIGHTLY FLEXED KNEES,

ARMS AT HIS SIDESARMS AT HIS SIDES

POSITION OF THE EXAMINERPOSITION OF THE EXAMINER

– AT RIGHT-HAND SIDE OF THE PT.AT RIGHT-HAND SIDE OF THE PT.




PALPATIONPALPATION

– FLAT HAND FROM NON-TENDER AREAFLAT HAND FROM NON-TENDER AREA

– SUPERFICIALSUPERFICIAL

– DEEP TENDERNESSDEEP TENDERNESS

– NORMAL VISCERANORMAL VISCERA

– ABNORMAL MASSESABNORMAL MASSES




INSPECTIONINSPECTION – SYMMETRYSYMMETRY

– MOBILITY WITH RESPIRATIONMOBILITY WITH RESPIRATION

– PAIN TO COUGHPAIN TO COUGH – DISTENSIONDISTENSION

– MASSESMASSES

– VISIBLE PERISTALSISVISIBLE PERISTALSIS – SKIN DISCOLORATIONSKIN DISCOLORATION

– SCARS, SINUSES, FISTULAS, STOMASSCARS, SINUSES, FISTULAS, STOMAS





– LIVERLIVER

– SPLEENSPLEEN

– DISTENDED BOWEL- HYPERRESONANCEDISTENDED BOWEL- HYPERRESONANCE

– ASCITIS- SHIFTING DULLNESSASCITIS- SHIFTING DULLNESS

– STIMULATES VISIBLE PERISTALSISSTIMULATES VISIBLE PERISTALSIS




AUSCULTATIONAUSCULTATION

– BOWEL SOUNDSBOWEL SOUNDS

– VASCULAR BRUITSVASCULAR BRUITS



MANDATORYMANDATORY

PR EXAMINATIONPR EXAMINATION

PV EXAMINATIONPV EXAMINATION



FOUR THINGS EASY TO FORGET:FOUR THINGS EASY TO FORGET:

– PALPATE SUPRACLAVICULAR NODESPALPATE SUPRACLAVICULAR NODES

– PALPATE HERNIA ORIFICESPALPATE HERNIA ORIFICES

– FEEL THE FEMORAL PULSESFEEL THE FEMORAL PULSES

– EXAMINE THE GENITALIAEXAMINE THE GENITALIA



ASCITESASCITES



CAPUT MEDUSACAPUT MEDUSA



ABDOMEN DRAPINGABDOMEN DRAPING



HEPATOMEGALYHEPATOMEGALY



NORMAL ABDOMENNORMAL ABDOMEN



OBESITYOBESITY



PALPATIONPALPATION



ASSYMETRIC ABDOMENASSYMETRIC ABDOMEN



UMBILICAL HERNIAUMBILICAL HERNIA



ABDOMINAL ASCULTATIONABDOMINAL ASCULTATION



EXAMINE THE LIMBSEXAMINE THE LIMBS

BONES AND JOINTSBONES AND JOINTS

MUSCLES AND SOFT TISSUESMUSCLES AND SOFT TISSUES

ARTERIESARTERIES

VEINS AND NERVESVEINS AND NERVES



EXAMINE THE LIMBSEXAMINE THE LIMBS

INSPECTIONINSPECTION

– COLOUR, SCARS, SWELLING,COLOUR, SCARS, SWELLING,

DEFORMITY, WASTING,DEFORMITY, WASTING,

PALPATIONPALPATION – TEMPERATURE, EDEMA, THICKENINGTEMPERATURE, EDEMA, THICKENING

MOVEMENTMOVEMENT

– ACTIVEACTIVE

– PASSIVEPASSIVE



ARTERIESARTERIES

FEEL THE PULSESFEEL THE PULSES

LISTEN FOR BRUITSLISTEN FOR BRUITS

RECORD THE PULSES AND BRUITSRECORD THE PULSES AND BRUITS

ON A SIMPLE DIAGRAMON A SIMPLE DIAGRAM



NERVESNERVES

MOTORMOTOR

SENSORYSENSORY

REFLEXESREFLEXES



CELLULITISCELLULITIS



DVTDVT



EDEMAEDEMA

INGUINO CRURALINGUINO CRURAL



INGUINO- CRURALINGUINO- CRURAL




FEMORAL ARTERY PALPATIONFEMORAL ARTERY PALPATION



DORSALIS PEDIS ARTERYDORSALIS PEDIS ARTERY



POSTERIAL TIBIAL ARTERYPOSTERIAL TIBIAL ARTERY



POPLITEAL ARTERYPOPLITEAL ARTERY



NEUROPATHIC ULCERNEUROPATHIC ULCER



GANGRENEGANGRENE



VENOUS ULCERVENOUS ULCER



KNEE EFFUSSIONKNEE EFFUSSION



INGUINAL HERNIAINGUINAL HERNIA

OC



HYDROCELEHYDROCELE

PR EXAMINATION



PR EXAMINATIONPR EXAMINATION

TESTICULAR EXAMINATION



TESTICULAR EXAMINATIONTESTICULAR EXAMINATION

REMEMBER



REMEMBERREMEMBER

MEASURE THE BP YOURSELFMEASURE THE BP YOURSELF

DO A RECTAL EXAMINATIONDO A RECTAL EXAMINATION

EXAMINE THE FEMALE BREASTSEXAMINE THE FEMALE BREASTS

CHECK WEAK POINTS OF THECHECK WEAK POINTS OF THE

ABDOMEN FOR SMALL HERNIASABDOMEN FOR SMALL HERNIAS

ADVISES TO MEDICAL STUDENTSADVISES TO MEDICAL STUDENTS



ABOUT GOOD HEALTHABOUT GOOD HEALTH

TO DOTO DO

– GET HELP WHEN YOU NEED IT, BEGET HELP WHEN YOU NEED IT, BE

HONEST, AVOID WRONG INFORMATIONHONEST, AVOID WRONG INFORMATION

– DO LAB. TESTS FOR HEPATITIS B,CDO LAB. TESTS FOR HEPATITIS B,C

– REGULAR MEALS AND MODERATEREGULAR MEALS AND MODERATE

ALCOHOL INTAKEALCOHOL INTAKE

– DO PHYSICAL ACTIVITIES, AVOIDDO PHYSICAL ACTIVITIES, AVOIDSTAYING IN FRONT OF YOUR LAPTOPSTAYING IN FRONT OF YOUR LAPTOP

FOR AGESFOR AGES





TO DOTO DO

– DO PHYSICAL ACTIVITIES, AVOIDDO PHYSICAL ACTIVITIES, AVOID

STAYING IN FRONT OF YOUR LAPTOPSTAYING IN FRONT OF YOUR LAPTOPFOR AGESFOR AGES

– BE INTERESTED NOT INTERESTING ANDBE INTERESTED NOT INTERESTING AND

USE YOUR SENSE OF HUMOURUSE YOUR SENSE OF HUMOUR

– ENGAGE IN SOCIAL ACTIVITIES WITHENGAGE IN SOCIAL ACTIVITIES WITH

YOUR FAMILY, FRIENDS AND COMUNITYYOUR FAMILY, FRIENDS AND COMUNITY






NOT TO DONOT TO DO

– SMOKESMOKE

– USE NOT PRESCRIBED DRUGSUSE NOT PRESCRIBED DRUGS

– IGNORE YOUR FAMILY AND FRIENDSIGNORE YOUR FAMILY AND FRIENDS

WHILE SERVING OTHERS OR MEETINGWHILE SERVING OTHERS OR MEETING

THEIR DEMANDSTHEIR DEMANDS – IGNORE YOUR OWN NEEDS FORIGNORE YOUR OWN NEEDS FOR

PERSONAL AND INTELLECTUAL GROWTHPERSONAL AND INTELLECTUAL GROWTH

3-the clinical examination

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