clinical examination
TRANSCRIPT
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CMMUNITY BASED MEDICAL
COLLEGE,BANGLADESH
DEPARTMENT OF MEDICINE
DR.TOFAYEL UDDIN AHMED
REGISTRAR MU-2
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CASE HISTORY PARTICULARIS OF THE PATIENT HISTORY PHYSICAL EXAMINATION
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A . PARTICULARIS OF THE PATIENT NAME AGE SEX RELIGION OCCUPATION MARITAL STATUS ADDRESS DATE OF ADMISSION DATE OF EXAMINATION
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B. HISTORY PRESENTING COMPLAINTS HISTORY OF PRESENT ILLNESS HISTORY OF PAST ILLNESS TREATMENT HISTORY DRUG AND TRANSFUSION HISTORY FAMILY HISTORY SOCIOECONOMIC HISTORY / INCLUDING OCCUPATION PERSONAL HISTORY/ habit, hobby, diet, sleep, bowel,
bladder etc HISTORY OF TRVELLING HISTORY OF IMMUNIZATION
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C. PHYSICAL EXAMINATION GENERAL EXAMINATION SYSTEMIC EXAMINATION
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GENERAL EXAMINATION
APPEARANCE DECUBITUS Posture of patient in bed INTELLIGENCEEducational and occupational history COOPERATION BODY BUILDHeavy/average/small NUTRITIONHEIGHT WEIGHT
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GENERAL EXAMINATION ANAEMIA – type/site/eg
JUNDICE CYANOSIS OEDEMA CLUBBING KOILONYCHIA SKIN AND BODY HAIR NECK VEINE LYMPHNODES PULSE BP TEMP DEHYDRATION
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SYSTEMIC EXAMINATION CARDIOVASCULAR SYSTEM RESPIRATORY SYSTEM GASTROINTESTINAL SYSTEM NERVOUS SYSTEM
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CARDIOVASCULAR SYSTEM PULSE
- RATETachycardia >100bpm-
fever,anaemia,thyrotoxicosisCCF,shock,drug-sulbitamol
bradycardia<50/bpm-in.MI,myxoedema,hypothermia,obstructive jundice,drug-beta-blockers,amioderon,vrapamil
- RHYTHM
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- VOLUME- SYMMETRY- CHARACTER- CONDITION OF VESSEL WALL- RADIO-FEMORAL DELAY
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CARDIOVASCULAR SYSTEM BP NECK VEINE OTHER PULSATION
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INSPECTION
SHAPE
CARDIAC IMPULSE
OTHER VISIBLE PULSATION
ANY SWELLING OR SCAR MARK
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PALPATION
APEX BEAT
THRILLS
LEFT PARASTERNAL LIFT/HEAVE
PALPABLE HEART SOUND
OTHER PALPATION
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PERCUSSION
AREA OF SUPERFICIAL CARDIAC DULLNESS
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AUSCULTATION
- HEART SOUND
- MURMUR
- pericardil rub
- other sound
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RESPIRATORY SYSTEM
- SHAPE OF THE CHEST- MOVEMENT OF THE CHEST- SINGS OF RESPIRATORY DISTRESS- VISIBLE PULSATION- ANY SCAR MARK- RATE AND RHYTHM OF RESPIRATION
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PALPATION
- POSATION OF TRACHEA- POSATION OF APEX BEAT- EXPANTION OF THE CHEST WALL- VOCAL FREMITUS- LOCALISED TENDERNESS
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PERCUSSION
- POSATION OF TRACHEA- POSATION OF APEX BEAT- EXPANSION OF THE CHEST WALL- VOCAL FREMITUS- LOCALISED TENDERNESS
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PERCUSSION
PERCUSSION NOTE ON
- MID CLAICULAR LINE
- MID AXILLARY LINE
- INFACSCAPULAR LINE
LIMITS OF CARDIAC DULLNESS
UPPER BORDER OF LIVER DULLNESS
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AUSCULTATION BREATH SOUND
- INTENSITY
- CHARACTER
VOCAL RESONANCE
ADDED SOUNDS
- RHONCHI
- CREPITATION
- PLEURAL RUB
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GASTROINTESTINAL SYSTEMMOUTH AND PHARYNXABDOMAN PROPER- INSPECTION - SIZE AND SHAPE - MOVEMENT - SKIN- SCAR,PROMINENT VEINE,SPIDER NAEVIA - POSATION AND SHAPE OF UMBILICUS - VISIBLE MASS - VISIBLE PERISTALSIS - EPIGASTRIC PULSATION - PUBIC HAIRS,GROIN,GENITALIA - HERNIAL ORIFICES : IMPULSE ON COUGHING
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PALPATION SUPERFICIAL START IN THE LEFT ILIAC REGION AND THEN
GO ANTICLOCKWISE- TENDERNESS- RIGIDITY- HYPERASETHESIA- RIGIDITY- FLUID THRILL DEEP
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PALPATION DEEP- LEFT KIDENY- SPLEEN- RIGHT KIDENY- LIVER- URINARY BLADDER- AORTA AND PARA-AORTIC GLAND AND COMMON
FEMORAL VESSELS- INGUINAL LYMPH GLANDS- GENITALIA : PEINS/SCROTUMA/SPERMATIC
CORD/VULVA- PER RECTAL EXAMINATION
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PERCUSSION SHIF TING DULLNESS PERCUSSION OVER ENLARGED
ORGAN AND OTHER MASSES UPPER BORDER OF THE LIVER
DULLNESS
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AUSCULTATION BOWEL SOUND BRUITS
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NERVOUS SYSTEM MENTAL FUNCTION CRANIAL NERVES MOTOR FUNCTION SENSORY FUNCTION
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MENTAL FUNCTION APPEARANCE , BEHAVIOUR AND
COMMUNICATION EMOTIONAL STATE ORINTATION IN PLACE AND TIME MEMORY SPEECH AND LANGUAGE SLEEP HALLUCINATION/DELUSION INTELLIGENCE
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CRANIAL NERVES
OLFECTORY OPTIC OCLOMOTOR, TROCHLEAR AND ABDUCENT TRIGEMINAL FACIAL NERVE VESTIBULOCOCHLERA GLOSSOPHARYNGEAL AND VAGUS ACCESSORY HYPOGLOSSAL
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1 OLFECTORY TEATING OF SMELL EG. EFFECT
– ANOSMIA
- PAROSMIA
- OLFACTORY HALLUCINATION
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2 OPTIC VISUAL ACUITY – SNELLEN,S CHART
IS USED – DISTANT VISION,NEAR VISION
FIELD OF VISION – CONFRONTATION TEST
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2 OPTIC COLOR VISION OPTHALMOSCOPIC EXAMINATION PUPILLARY REFLEXES
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3,4,6 OCLOMOTOR, TROCHLEAR AND ABDUCENT
Ocular movement Pupil
- size
- shape
- light reflex
- accommodation reflex
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5 TRIGEMINAL Sensory function
- pain, touch, temp
- Corneal reflex Motor function
- muscle of mastication- clench
Teeth, open mouth aginst pres.
- jaw jerk
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7 FACIALMOTOR Wrinkling of forehead – frontal belly of occipito –
frontalis Close eye , don`t let me open – orbicularis occuli Ask to whistle – orbicularis oris Puff your cheek out – buccinator Show me your teeth and a smile
-levator anguli oris and risorius
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7 FACIAL
SENSORY TEST
- ANTERIOR 2/3 OF TOUNG
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8 VESTIBULOCOCHLERA
VESTIBULAR –
VERTIGO,DIZZINESS
COCHLEAR DIVISON –
RUB FINGER
RINNE`S TEST
WEBER`S TEST
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9,10 GLOSSOPHARYNGEAL AND VAGUS
OPEN MOUTH AND SAY AAA…. ASK THE PATIENT TO COUGH SEE THE PALATAL REFLEX SENSATION IN THE POSTERIOR 1/3 OF
TOUNG
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11 ACCESSORY
SHRUG YOUR SHOULDER AGAINST REGISTANCE
TURN YOUR HEAD TO OTHER SIDE AGAINST RESISTANCE
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12 HYPOGLOSSAL
LOOK AT THE TOUNG
- WASTING
- FASICULATION
WAGGLE YOUR TOUNG FROM SIDE TO SIDE
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MOTOR FUNCTION BULK OF MUSCLE TONE OF MUSCLE STRENGTH OF MUSCLES REFLEXS COORDINATION OF MOVEMENT INVOLUNTARY MOVEMENTS GAIT
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EXAMINATION OF REFLEXES TENDON/DEEP REFLEX SUPERFICIAL REFLEXES
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TENDON/DEEP REFLEXES KNEE JERK- L3,4 ANKLE JERK-S1,2 BICEPS JERK-C5,6 TRICEPS JERK-C6,7 SUPINATOR JERK-C5,6 JAW JERK- CLONUS :PATELLAR/ANKLE
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CLONUS PATELLAR CLONUS – SHARPLY PUSH
THE PATELLA TOWARDS THE FOOT ANKLE CLONUS – SUPPORT THE
FLEXED KNEE WITH ONE HAND IN POPLITEAL FOSSA
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SUPERFICIAL REFLEXES ABDOMINAL REFLEX CORNEAL REFLEX ANAL REFLEX PALATAL REFLEX CREMASTERIC REFLEX
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COORDINATION OF MOVEMENT
TEST FOR COORDINATION OF UPPER LIMB
- FINGER NOSE TEST- RAPID ALTERNATING MOVEMENT
TEST FOR COORDINATION OF LOWER LIMB
- HEAL SHIN TEST
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INVOLUNTARY MOVEMENTABSENT IN NORMAL INDIVIDUALS- - TREMOR - – CHOREA- – ATHETOSIS - – DYSTONIA - – MYOCLONUS - – TICS – DYSKINESIA – HEMIBALLISMUS – EPILEPSY – TETANY - CRAMP
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GAITmanner of walking
Spastic gait Stamping gait Drunken gait Wadding gait High steping gait Fastinate gait Scissor gait Dancing gait Hemiplegic gait
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SENSORY FUNCTION TACTILE SENSATION: LIGHT
TOUCH,PRESSURE,TACTILE LOCALIZATION AND TACTILE DISCRIMINATION
P0SITION SENSE RECOGNITION OF SIZE,SHAPE,WEIGHT
AND FORM OF OBJECT APPRECIATION OF VIBRATION PAIN TEMPERATURE