Physical diagnosis: General Examination

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Physical diagnosisGeneral Examination

• Dr. Mohammad Shaikhani.
• mshaikhani__at_hotmail.com

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Introduce yourself

• Shake hands.
• Normal grip.
• Weak gripParalysis,Ill health,Depression.
• Slow relaxing gripMyotonia Dystropfica.
• Comfortness
• Comfortable.
• Mood.
• Distressed
• Dyspniec.
• Orthopniec dyspnea on lying down from pulm edem.
• Acidotic breath(deep sighing respiration or air
  hunger)
• Renal failure/Diabetic ketoacidosis/Lactic
  acidosis/Alcoholic ketoacidosis/Aspirin
  poisoning.
• Chynes sokes respiration(apnea-hyperpnea cycles)
• Head injury/Cerebral hemorrhage/Heart failure.

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Body built

• Normal.
• Obese.
• CachecticCancer/Malnutrition/Malabsorbtion/Thyrot
  oxic/DM.
• Body habitus
• Normal.
• ShortFamilial/GH def/Celiac/Achondroplasis/Chroni
  c disease /Turner.
• Gigant.
• Marfanoid.
• Signs of dehydrationSunken eyes/Dry tongue/Loss
  of skin turgor.
• Personal hygiene.

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Position in bed

• Normal
• RestlessRenal,biliary intestinal colic.
• In pain can not move peritonitis.
• Shocked pale, cold extremities,
  oliguric,hypotension, dull sensorium
• Can not movePeritonitis/Arthritis/Paralysis.
• Head
• Normal.
• Hydrocephalus.
• Microcephaly.
• Scalp
• Rash (herpes zoster opthalmicus, psoriasis,
  seborrhea).
• Infection(tinea capitis impetigo).
• Temporal resetion( sign of weight loss).
• Tender temporal artery(temporal artritis).
• Depressed fracture.
• Lipomas.

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Eyes

• ExopthalmusThyrotoxicosis.COPD.Alcoholism.Retrobu
  lbar tumour.
• EnopthalmusHorner syndrome.
• Periorbital oedemaNephrotic.Real failure.
  Glomerulonephritis. Hypothyroid.
• Xanthomas.
• Artificial eye.
• PtosisOcculomotor palsy.Myasthenia gravis.Horner
  syndrome.
• Ears
• Red tenderOtitis externa.Relapsing
  polychondritis.Tophi(gout).
• Herpes zoster rash facial palsy(ramsi-hunts
  syndrome).

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Conjunctiva

• PallorAnemia.Shock.Heart failure,hypopituitirism.
  
• PlethoricPolycythemia.Superior vena caval
  obstruction.
• HemorrhageTrauma.Hypertension.Bleeding
  tendencies.
• Sclera
• Yellow(jaundice).
• Blue(osteogenesis imperfecta).
• CorneaOpacity.
• Lens cataract.
• Lens dislocation.Marfan.Homocysteinrea.
• Ulcer herpetic keratitis.
• Archus senilis or lipidicus.
• Kayser flesher ring(Wilson)

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Facial features

• Hypothyroid face.Thyrotoxic face/Acromegalic
  face.Hypopitutaric face
• Cushing face.Thalacemic face(mongoloid).Down
  face(mongoloid).
• Uremic face(earthy coloure)
• Anemia.Urochrome retention.Hemociderosis.
• Sclerodermic face.
• Sturg Weber (facial hemangioma).
• CheeksMalar flush(MS).Butter-fly rash(
  SLE).Coalasma(pregnancy).
• Nose
• Rodent ulcer.
• Saddle-shaped(congenital syphilis).
• Parrot-peaked nose(scleroderma).
• Lips
• Hare lip.Cyanosis.Talangiectasia or
  spiders.Pigmentation(Peutz-jagger
  syndrome).Herpes labialis, angular stomatitis(
  Vit def).

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Facial features
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Facial features
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Facial features
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Mouth tongue

• Puckered mouth(scleroderma).
• Tongue cyanosis.
• Frenulum pallor or yallowness.
• Gum hypertrophyMyelogenous leukemia.Epilepsy.Nife
  dipine.
• Tongue fasciculations(motor neuron disease).
• Smooth tongue (iron vitamins dificiencies).
• Painless ulcers (SLE, sero negative arthritis).
• Painful aphthus ulcer(idiopathic or Behcet
  disease).
• Petichae or echemosis.
• Monilia infection of tongue.
• Leukoplakia.
• TonsilsNormal.Enlarged.Infected.
• Mouth odor alcohol, uremic fetor,hepatic fetor

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Neck

• Goiter.Lymph nodes other lymph node groups.
• Vascular pulsation.
• Short with webs(Turner syndrome).
• Breasts
• Female breastsNormal.Mass or thickenings or
  nodularity.
• Male breasts Normal.Mass.
• GynecomastiaLiver cirrhosis.Drugs as
  spirinolactone,oestrogen. Puberty.Old
  age.Hypogonadism.Thyrotoxicosis. Tumours
  (testicular,adrenals,lung)

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Chest

• Obvious chest deformities scars.
• Dialated veins or arteries.

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Abdomen

• Distended or not.
• Rashes discolorations.
• Abnormal pulsations.
• Dilated veins.

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PancreatitisCullen turner signs.
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Hands

• TremorRest(parkinsonism).Action(anxiety,thyrotoxi
  c or familial)
• Flapping(transient laps in maintained
  posture)organ failure.
• ChoreaRheumatic.Huntington.SLE.Pregnancy.Oral
  contraceptive.Drugs as phenothiazines.Polycythemia
  .
• Cerebral pulsy(chorioathetosis).
• Wasting.
• Wrist drop(radial nerve pulsy).
• Claw hand(ulnar nerve pulsy).
• Duptryn contractureLiver cirrhosis.Occupational.I
  diopathic.RA
• Rheumatoid handSwan neck.Boutonniere.
• Heberdon nodes(distal IP joints in
  osteoarthritis).
• Tophi in gout.
• Osler nodes(SBE).
• Warm hands.Wet hands.Cold hands.
• Tendons palmar xanthomas.
• Raynauld phenpmena.Pale creases(anemia)

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Hands
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Nails

• Nails clubbing(lung,liver,cyanotic
  heart,intestinal inflammatory bowel diseases).
• what degree?
• 1.increased base flactuation.
• 2.loss of nail angle.
• 3.increased curvature.
• 4.drum stick.
• Confirm clubbing by Shamruth sign
• Absence of rectangular space on coinsiding
  corresponding nails of both hands).
• Cholenychia or spoon nails(flat or concave in
  iron dificiency).
• Splinter sunangual hemorrhage(SBE,trauma,valculiti
  s,trichinliasis).
• White nailsHypoalbuminemia.Severe chronic
  illness.
• Nail pitting in psoriasis.
• Transverse depression in nails(Beaus lines)Acute
  severe illness.
• Onycolysis(elevation of nail end)Thyrotoxicosis.C
  hronic nail disorders.

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Hands

• Scleroderma hand.
• Acromegaly.
• Short metacarpals(hypoparathyroid)
• TetanyHypocalcemia.Hyperventilation.

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Legs

• Wasting
• Pseudohypertrophy(Hereditary Dushein muscular
  dystroohy).
• Swolentender(DVT).
• Ulcers.
• Erythema nodosum(tender red painful nodules)
• TB.Streptococcal infections.Sarcoidosis.IBD.Behcet
  disease.
• Varicose veins.
• Coldness in ischemia(compare with other side).
• Ankle edema
• Pitting
• Heart failure.Renal failure.Nephrotic
  syndrome.Liver cirrhosis.Malnutrition.
• Non-pittingLyphedema.

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Legs

• RashesPetichae or echemosis, vasculitic rash.
• Hair changes.
• Feet
• Edema.Swelling.Flat foot.Pes cavus(friedricks
  ataxia).
• Rheumatoid foot.
• Swollen big toe(gout).
• Ulcers.
• Gangrene.
• Achilis tendonitis(sero ve arthritis).
• Cold in ischemia(compare with other side).
• Diabetic foot ulcers or gangrene.
• Clubbing of toe nails.

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Legs
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Joints

• Small large joints.Swelling.Deformity.Tenderness.
  Hotness.Restricted movements.
• Skin
• Scratching marks( pruritis,obstructive
  jaundice)Rashes.
• Talangiectasia spider nevi.
• Petichae echemosis.
• Neurofibromas.
• Vitiligo patches.
• Allopacia areata or totalis.
• Hemangiomas.
• Herpes zoster.
• Xeroderma.
• Rose spots(typhoid).Xanthomas.Albinisim.
• Vital signs PR,BP,RR,Temp
• TemperatureOral .Axillary.Rectal.