15.2 Clinical examination of the clothed patient Flashcards
What is the difference between a sign and symptom?
- A sign is an objective observable phenomenon that can be identified by another person.
- A symptom is a subjective experience which cannot be observed by another person.
What features may you notice regarding a patient’s facial appearance or expression?
- Facial appearance (facies): certain disorders present with characteristic facial appearances e.g. Down syndrome, acromegaly (thick lips, mandible protrusion), Parkinson’s (diminished facial expressivity)
- Facial expression: may show emotion/anxiety, could show facial palsy.
What can a patient’s complexion tell you?
- Yellow: juandice
- Pallor: anaemia
- Cyanosis: cardiac or respiratory disease
- Erythema: polycythaemia
- Hyperpigmentation: Addison’s
What may a patient’s gait and posture tell you?
- Intoxication
- Hemiparesis: swinging one leg, may be caused by a stroke
- Shuffling: Parkinson’s
- Broad based ataxic gait, clumsy, staggering: cerebellar deficit
What unusual movements may you notice in a patient?
- Tremor
- Rigidity
- Fasciculation (involuntary muscle twitches)
- Orofacial dyskinesia (involuntary repetitive movements of the mouth and face)
What might you be able to tell about a patient from their eyes?
- Exophthalmos: hyperthyroidism
- Yellow sclerae: juandice
- Pale conjunctivae: anaemia
- Dry eyes: xerosotmia
What might you be able to tell about a patient from their smell?
- Halitosis
- Pear smelling breath: diabetes, ketoacidosis
- Hepatic fetor: bad breath due to liver failure
- Smell of infection or general bad smell: sign of neglect in children and vulnerable adults
What might you be able to tell about a patient from their speech?
- Dysarthria: difficulty speaking due to localised oropharyngeal muscle pathology
- Dysphonia: abnormal voice due to upper or lower respiratory pathology
- Dysphasia: abnormalities in content of speech due to brain pathology
What might you be able to tell about a patient from their hands?
- Tremor
- Nicotine stains
- Cyanosed hands
- Abnormally large hands
- Palmar erythema (red palms could indicate rheumatoid arthritis or liver cirrhosis)
- Dupuytren’s contracture
- Muscle wastage
What might you be able to tell about a patient from their fingers?
- Painful swelling: sign of sickle cell anaemia
- Presence of nodules: could indicate musculoskeletal condition e.g. osteoarthritis
- Clubbing: lung cancer, heart disease, infective endocarditis
What might you be able to tell about a patient from their nails?
- Kolionychia: spoon shaped nails due to iron deficiency
- Splinter haemorrhages
- Reynaud phenomenon: associated with connective tissue disease
- Nail biting: anxiety
What 6 vital signs may you need to record in a medical emergency?
- Pulse rate
- Respiratory rate
- Temperature
- Systolic blood pressure
- Oxygen saturation
- Level of consciousness
What acronym is used to assess level of consciousness?
AVPU
- Alert
- Voice
- Pain
- Unresponsive
What should a patient’s oxygen saturation be?
96% in a healthy pt.
May be lower in pts with COPD or other conditions but this is normal for them.
What is a healthy BP?
120/80
- Hypertension = 140/90 and higher
- Hypotension = 90/60 and lower
