clinical examination simplified(hanzal)

والكبد الهضمي الجهاز( م) مدرس

6 -الفيوم جامعة -كلية الطب

دقيقة 45في كله عملي الباطنة

Clinical Examination Simplified

1 كلية الطب جامعة الفيوم -اد د/ سيد احمد حنظل مدرس )م( الجهاز الهضمي والكبد اعد


كوسلة ب لزمالئ االعزاء طالب الدراسات العلا والفرقة السادسة ااهدي هذا الكت

ساعدهم ف عمل خرائط ذهنة تسهل علهم ولسرعة لمراجعة شت وعمل مادة الباطنة

تذكر النقاط االساسة اثناء عمل وكتابة الشت

رب العالمين )قل إن صالتي ( ال شريك له وبذلك 6ونسكي ومحياي ومماتي لل

ل المسلمين ) سورة االنعام )6أمرت وأنا أو

…………….. Page 4 GENERAL Sheet

…………….. Page 7 ABDOMINAL HISTORY & Examination

…………….. Page 12 CHEST HISTORY & Examination

…………….. Page 18 HEART HISTORY & Examination

…………….. Page 24 NEUROLOGY HISTORY & Examination

…………….. 1 JOINT DISEASES HISTORY & Examination

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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


1- Personal history

NAS OMRH +/- handedness

2- Complaint ؟؟؟ا اىي خبثل اىغزشف اى..؟

3- Present H.

ثزحيو شن اىشغ ز ثذاخ شػ اىحبى حز ز اىيحظخ حبىخ اىطه ىيزشخض

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)

فذ present historyىنزبثخ

االعزبع ىيشغ خذا اه عؤاه.....از اخش شح مذ فب عي ..؟؟

ردغ اىقبؽ االدبثخ اىغيجخ ػ اىشن ب زظو ثب

) مزبثخ اىزبسخ اىشػ ثزشرت ص ظ )ػي ئخ قظخ

( ىنو شذ قبؽ الثذ رمشب عيجب مبذ ا ادبثب)زؼشف ػيب الحقب

4- Past H

مو حبدس شػ قذ ىظ ى ػالقخ ثبىشن اىحبىخ

Diseases e.g DM , HTN , Rh fever , bilhaziasis

ز ..؟؟ اىفحص اىؼالج ..؟ ؟ و ر حدض ثبىغزشف ..؟ ؟

Trauma (accident …operation …blood transfusion)

Drug intake اىع ىفزشح ...؟؟؟؟

5- Family H

اىشغ.........حبالد بثيخ ى ف االقبسة

اثب ا.......طيخ قشاثخ ثب

ثبق اىؼبئيخ.....اشاع ضخ رغش ف ػبئيز


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

ثالثة عن

1- Mentality عقله

2- Body built عضله

3- Decubitus عدلته ف السرر

1- color

2- hirsutism

3- texture

-نقاط حسب الترتب االت: 7ثم فحص باق الجسم ف

االعصاب( ←البطن ←القلب ←ثم جهاز جهاز )الصدر ←االطراف االربعة ←الرقبة ←الرأس

1- The head

cranium & appearance of the face → عموما -12- eyes من برة لجوة brows→ lids →(conjunctiva خاصة اللون االصفر( →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

( cyanosisازرق - anemiaالوان )الباهت

غدد لعابة ( –لثة ( .... )لسان اللوز –اسنان –مكونات الحنك )شفاة

2- Neck

skin , swelling , nodding → نظرة -1

rigidity , L.N.s , thyroid , trachea → لمسة -2

neck pulsations→ رعشة -3

Internal Jugular Vein (congestion & pulsation)

Carotid arteries (pulsation & thrill)


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.)

edema (type &level) → برك

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 ٭

رئسة للتشخص عموما جب ذكر ثالث نقاط

1- Anatomical وهو ذكر العضو المتاثر وشكل تاثرهepato spleno megallye.g ,H

2- Etiological ),,.... السبب الذي قد كون )وراث ,ورم , عدوى , عرض

3- Functional من الناحة الوظفة

A. Compensation :-

compensated حث ستطع الجسم التأقلم مع المرض بحاة شبه عادة

decompensated او ال ستطع

B. Complications ذا المرضذكر اي مضاعفات نتجت عن ه


1- Personal history

NAS OMRH (if ♀ menstrual H.) +/- handedness

2- Complaint ا اىي خبثل اىغزشف اى..؟؟؟؟؟

3- Present H.

شػ اىحبى حز ز اىيحظخ حبىخ اىطه ىيزشخض ثزحيو شن اىشغ ز ثذاخ





االػشاع اىضح ىشذ اىجط اىز دت رمشب حز ى ثبىغيت ارا مبذ غش خدح

Pain

swelling

فق رحذ

upper GIT symptoms → nausea , vomiting , hematemesis , dysphagia , dyspepsia

lower GIT symptoms → اىشاد → change in bowel habits

(constipation , diarrhea , dysentery )

flatulence , worms → ب خشج ب →

blood (fresh or melena)

stool (color , consistency , odor ,….)

2×2

Hepato ∕ biliary → jaundice ا خذ ..اعبه ػ ثبىزفظو

→ Symptoms of liver cell failure

Uro ∕ genital شبمو اىزجه → dysuria or any micturition disturbances

volume , color , content → اىجه

خ خبطخ ف شػ اىني Uremic symptoms → اىجىب

sexual disorders


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)






ػي ئخ قظخ ( مزبثخ اىزبسخ اىشػ ثزشرت ص ظ(

4- Past H


Diseases e.g. DM , HTN , Rh fever , bilhaziasis




5- Family H






1- Temperature 2- Res. (rate &rhythm) 3- Bl. P (palp & ausc)



Wall condition


Special characters

ثالثة عن


2- Body built عضله 4- Decubitus عدلته ف السرر

1. color 2. hirsutism

3. texture

ال تنسى

*spider naevi

*palmer

erethema


البطن( ← االعصاب ←القلب ←ثم جهاز جهاز )الصدر ←االطراف االربعة ←الرقبة ←الرأس

4 The head


puffy eye lids , jaundice , xanthelasma ال تنساهم


→ nasolabial fold (lost in 7 th N. paralysis)

→ butter fly area (SLE,MS)


5- mouth & throat



foeter hepaticus تذكر

5 Neck







6 Upper and lower limbs N.B :- No limb examination without pulsation

1- for both limbs → shape , skin , nails (color &clubbing)




7 Chest If no abnormalities detected





.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




10 Abdominal local ex.

Inspection ) عموما ثم من فوق لتحت(exposure 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


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


1- natomicalA وهو ذكر العضو المتاثر وشكل تاثرهepato spleno megallye.g ,H

2- Etiological ),,.... السبب الذي قد كون )وراث ,ورم , عدوى , عرض

3- Functional من الناحة الوظفة

A. Compensation :-



B. Complications ذكر اي مضاعفات نتجت عن هذا المرض


1- Personal history


2- Complaint ف اى..؟؟؟ا اىي خبثل اىغزش

3- Present H.

ثذاخ شػ اىحبى حز ز اىيحظخ حبىخ اىطه ىيزشخض ثزحيو شن اىشغ ز





دحاالػشاع اىضح ىشذ اىظذس اىز دت رمشب حز ى ثبىغيت ارا مبذ غش خ

اىنحخ ب خشج ثغججب

Cough طفب , بضذب ا خفؼب, ػالقزب ثفظه اىغخ()

Expectoration )...... مز ى سائحز ػالقز ثػؼخ اىشغ(

Hemoptesis

خغ

Dyspnea

Wheezes

Pressure symp (dyspnea, dysphagia, hoarseness of voice )→ mediastinal Ś

Chest Pain

3C ثالثخ ع

Constitutional (toxic ) symptoms ( F A H M)

systemic Congestion symptoms → ( ascites , L.L. edema )

Cyanosis







ػي ئخ قظخ (مزبثخ اىزبسخ اىشػ ثزشرت ص ظ(

4) Past H


Diseases e.g TB ,Bronchial asthma , pneumonia , DM , HTN , Rh fever ,

bilhaziasis




5) Family H




(TB , B. asthma)شمض ػي اىغؤاه ػ



1. Temperature

2. Res. (rate, rhythm

,depth , type )

3. Bl. P (palp & ausc)

4. Pulse(4 limbs &carotid)

Rhythm, Rate ,Volume ,

wall condition


Special characters

ونركز على

water hammer pulse in

emphysema

ثالثة عن

1 Mentality عقله

2 Body built عضله

obese ch. Bronchitis thin TB cachectic br. carci

3 Decubitus عدلته ف السرر

11 color

12 hirsutism

13 texture


الصدر( ←االعصاب ←البطن ←ثم جهاز جهاز )القلب ←االطراف االربعة ←الرقبة ←الرأس

4- The head


نركز على

puffy lids & sub-congunctival HGE → chronic cough

jaundice in chest diseases ???





5- mouth & throat

( Cyanosisازرق - anemiaالوان )الباهت

غدد لعابة ( –اللوز -لثة ( .... )لسان –اسنان –مكونات الحنك )شفاة

Fetid odor in suppurative lung syndromeرائحة الفم


5- Neck







1- for both limbs → shape , skin , nails (color & Clubbing)





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 ٭



Inverted cenrally located umbilicus .No scars ,masses or impulse on cough ٭

at hernia orifices


Don’t forget → liver , spleen & ascites Ex.




Symmetrical face with optimal general &special sensations ٭


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 مطب وزاوة 2هاتحس تالق

Movement امام (supra- , mammary , infra-mammary)

( at 10th thoracic spine → basal expansion) خلف

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 والمرض واضع ده فوق راسه

SL +/- PVL → from Lung apex to 10th space

Percussion of special areas

Kronig's Isthmus, clavicle , Bare area of the heart , Traub's area من فوق لتحت

liver & spleen من وشمال

Special percussions → shifting dullness


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) لو موجودة (fine , medium ,or coarse)

→ Ronchi (Wheezes)

→ Pleural rub

Special test من النادر عملها → post tussive suction

→ succession splash

→ Coin test


1. Anatomical وهو ذكر العضو المتاثر وشكل تاثرهe.g ,Rt basal lung consolidation

2. Etiological ),,.... السبب الذي قد كون )وراث ,ورم , عدوى , عرض

3. nalFunctio من الناحة الوظفة

a) Compensation :-



b) Complications ذكر اي مضاعفات نتجت عن هذا المرض


1- Personal history NAS OMRH +/- handedness

2- Complaint خبثل اىغزشف اى.؟؟ ا اىي

3- Present H.

حبىخ اىطه ىيزشخض ثزحيو شن اىشغ ز ثذاخ شػ اىحبى حز ز اىيحظخ





اىز دت رمشب حز ى ثبىغيت ارا مبذ غش خدح االػشاع اىضح ىشذ اىقيت

احتقان وواحد إضمحالل 2

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 ا خذد (onset , duration , rate , rhythm , what ↑ or ↓ )

Chest Pain

Pressure symp. (as in L.A. enlargement, pericardial effusion …….)

.… brassy cough , dyspnea , dysphagia اعبه ػ


أوعية دموية

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

Fever وال يجب ان ننسى







4- Past H






5- Family H






1. Temperature

2. Res. (rate &rhythm)



rhythm, rate ,volume

wall condition

equality on both sides

special characters

ثالثة عن



5- Decubitus السرر عدلته ف

1. color (+/-

cyanosis)

2. hirsutism

3. texture



4- The head






5- mouth & throat


غدد لعابة ( –ان اللوز لثة ( .... )لس –اسنان –مكونات الحنك )شفاة

5- Neck







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










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.



Inverted centrally located umbilicus .No scars ,masses or impulse on cough ٭

at hernia orifices


Don’t forget → liver , spleen & ascites Ex.






10- Heart local ex.

Inspection

Chest wall → precordial bulge & dilated veins

2S → Skeletal abnormalities & Scars of previous operations Pulsations → Apex beat

من فوق لتحت → (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

→ Carotids → Suprasternal → 1st Aortic → pul. Area) من فوق لتحت

Rt & Lt parasternal → Epigastric)

Percussion

(heavy except bare area percussed lightly) مع اتجاه عقارب الساعة

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 ان وجدت علق على االت

→ 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



1. Anatomical وهو ذكر العضو المتاثر وشكل تاثرهtral e.g ,Double mi


3. Functional من الناحة الوظفة

a. Compensation :-



b. Complications اي مضاعفات نتجت عن هذا المرضذكر


1- Personal history


2- Complaint ا اىي خبثل اىغزشف اى..؟؟؟؟؟

3- Present H.

ه ىيزشخض ثزحيو شن اىشغ ز ثذاخ شػ اىحبى حز ز اىيحظخ حبىخ اىط





Symptoms of ↑ ICT و حذس )طذاع قئ ا صغييخ ( الصبح ف قذ

Cranial N.s

ا اخجبس اىش 1

و رش ثقغ عداء ا غ –ظشك ارغش ف حبخخ 2

خفل عقؾ –احىذ – 2ثزشف اىحبخخ حبخز 6, 4, 3

(motor).... ثزؼغ مظ ا فنل ارؼج (sensory)خل ث اى ا شنشنخ 5

ثزشو –امو ثزدغ ساء خذك –ثزقفو ػل مظ 7

خبىل دخخ ا داس –ثزغغ مظ 8

ثزجيغ ثززني مظ 12, 9

و شنيخ ف سفغ مزفل ا حشمخ ساعل ىيدبج 11

Motor Affection

power → onset .. ػذب ثذأد اىشن مذ رؼب حب ح ا عجقب اسرطب

→ Degree ػذك شيو ال دشد ػؼف ف اىؼؼالد

→Distribution ا ..؟؟ ذك ا سخيل ..االمثش ربثشا االؽشاف ا اىنزف اىفخز

→TIA.s قجو رىل مب أرل ثبد بثيخ ىفزشاد خضح

Tone لو ػؼالرل خشجخ ال عبجخ

Muscle state ػؼالرل خغذ ال رخذ ال فش رغش

Abnormal movements


Trophic changes

Cerebellum → رؼشف رقف ص اذ غغ ...ثزبمو مظ ثبىيؼقخ

Sensory Affection

Superficial رو ( ا ثبىزحذذ –شنشنخ –و رغش ف االحغبط )اى

Deep ػؼالرل رؤىل ..؟؟ اذ غغ ثزقغ ؟؟ مأل اقف ػو اعفح .؟؟

Cortical ؟؟رؼشف رفشق ث اىفزبذ اىد اىؼذ ثذاخو خجل..

Autonomic (Sphincteric troubles) ف شبمو ف اىزجه ا اىزجشص ا اىدبع ...؟؟




عؤاه.....از اخش شح مذ فب عي ..؟؟االعزبع ىيشغ خذا اه



4- Past H






5- Family H


ا.......طيخ قشاثخ ثب اثب




5- Temperature

6- Res. (rate &rhythm)

7- Bl. P (palp & ausc)



Wall condition


Special characters

ثالثة عن



7- Decubitus عدلته ف السرر

5- color

6- hirsutism

7- texture

-الترتب االت:نقاط حسب 7ثم فحص باق الجسم ف


4- The head






5- mouth & throat



5- Neck

























at hernia orifices


10- Neurological

ثالثة في الرأس

Mental function → Consciousness, Orientation, Mood & behavior,

Memory , Intelligence .

Speech → (Aphasia , Dysarthria)

Cranial Nerves Ex.

1st Olfactory → شممه بن قهوة وهو مغمض uni or bil. Anosmia or normal

2nd Optic N. → Acuity , field , color , Ophthamoscope

3rd 4th 6th Ocular N.s

Ptosis → حجم البؤبؤ + حزئ وال كل

Pupils → 3 reflexes (Accommodation ,light , ciliospinal)

Extra-Ocular muscles

Nystagmus


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 ......خله قول ااه ه ه وبص على ال

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

muscle Tone الدكتور

االطراف االربعة والمنكبن والبطن → Muscle power المريض

Reflexes الشاكوش

Deep R. → (reinforcement) نعمله على الجانبن واذا لم ظهر نعمل

Upper L. e.g. Biceps , triceps , Brachioradialis ………

Lower L. e.g. Knee , Ankle , Planter

Clonus ....ال تنسى ال

Superficial R. → من فوق لتحت

Corneal , palatal , Pharyngeal

Abdominal

Cremasteric , Anal , Gluteal

Planter …….(Babinski ( اشهر طرقة لعمله


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 والعنن مغمضتن

(Tactile localization ,tactile discrimination)

(Perceptual rivalery)

(Stereognosis , graphothesia)

Examination of the Coordination

من فوق لتحت

Examination of the Cranium الشكل والحجم

Examination of the Neck →for meningeal irritation signs

Examination of the Back & Spine

Examination of the Gait لو قدر قف على رجله()


1. Anatomical وهو ذكر العضو المتاثر وشكل تاثرهepato spleno megallye.g ,H


3. Pathological مظهر المشكلةfocal , systemic , disseminated


a) Compensation :-





1- Personal history


2- Complaint ؟؟؟؟ ا اىي خبثل اىغزشف اى..؟

3- Present H.

حبىخ اىطه ىيزشخض ثزحيو شن اىشغ ز ثذاخ شػ اىحبى حز ز اىيحظخ





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)






ئخ قظخ (مزبثخ اىزبسخ اىشػ ثزشرت ص ظ )ػي


4- Past H






Raynauds phenomenon

Psoriasis ….in psoriatic arthritis

5- Family H






1. Temperature

2. Res. (rate &rhythm)



rhythm, rate ,volume

wall condition

equality on both sides

special characters

-ثالثة عن


2- Body built عضله 3- Decubitus عدلته ف السرر

1. color

2. hirsutism

3. texture



4- The head


+/- dry eye → Sjogrns Ś





5- mouth & throat



5- Neck

























at hernia orifices





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


Palpation ابحث عن االت من برة لجوة المفصل

Tenderness & Hotness

S.C. nodules

Thick Synovial membrane

Effusion

Range of movement & Joint Stability


1. Anatomical وهو ذكر العضو المتاثر وشكل تاثرهRT knee Effusione.g ,



a) Compensation :-




clinical examination simplified(hanzal)

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