CLIN SKILLS PART 2: GENERAL PHYSICAL EXAMINATION Flashcards
3 Parts of general examination
- General Inspection (appearance)
Look at the patients gait, habitus, face, hands and body - Vital signs (HR, RR, BP, Temp, Pulse Oximetry)
- General examination (JACCOLD_
What’s the significance of general examination?
- Gives you first clues to what the diagnoses may be
- Or to what systemic examination you need to pay more attention to
Things to look at with general inspection
- Is the patient well or ill?
- What is the patients’ mental state (alert,
confused, somnolent, comatose etc.)? - Is the patient in respiratory distress?
- Gait (pattern of walk) – normal; what kind of abnormal gait?
- Body Habitus (short, tall & thin, obese)- The physique or body built
- Dysmorphic features (patient faces)
- Paraphernalia on or around the patient (O2
mask, pack of cigarettes, walking aid etc.)- Is about looking at the patient’s surroundings
Looking at patient body habitus is about_____
Looking for any form of muscle wasting
*Cachetic- severe loss of weight and muscle wasting
Helpful acronym for GENERAL EXAMINATION
- C: Clubbing
- A: Anemia
- J: Jaundice
- C: Cyanosis
- O: Oodema
- L: Lymphodenophathy
- D: Dehydration
The condition is seen with hyperbilirubinemia (bilirubin be rising twice above normal levels) with deposition of bilirubin to various body tissues
Jaundice
*Yellow eyes, skin
Prehepatic jaundice
Results from haemolysis of your RBC throughout the body, thus releasing haemoglobin, which is converted by certain enzymes in your body to bilirubin
- This leads to an excess of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells, which the liver cannot process efficiently.
Two causes of jaundice
- Intrahepatic causes (occurs when there is a problem with bilirubin processing within the liver
- Extrahepatic jaundice occurs when there is a blockage in the bile ducts outside the liver, preventing the flow of bile (and bilirubin) from the liver into the intestines.
Exrahepatic jaundice
Occurs when there is a blockage in the bile ducts outside the liver, preventing the flow of bile (and bilirubin) from the liver into the intestines.
*Due to gall stones or tumours in bile ducts or its narrowing
Intrahepatic jaundice
Occurs when there is a problem with bilirubin processing within the liver
*Leads to build up of bilirubin in the liver»>jaundice»>yellowing f the skin and eyes
Causes of intrahepatic jaundice
- Viral hepatitis
- Alchoholic hepatitis
- Drugs
- Pregnancy
- Some congenital disorders
- Infitration (unintentional leakage or seepage of fluid into surrounding tissues)
Causes of extrahepatic jaundice
- Duct stones
- Carcinoma
- Biliary stricture (narrowing or constriction of the bile ducts)
- Sclerosing cholangitis (chronic liver disease characterized by inflammation and scarring (fibrosis) of the bile ducts inside and outside the liver)
- pancreatic pseudocyst
The most thing we looking for with ANEMIA
- Clinical signs of PALLOR
*paleness
Can produce pallor of the skin
ANEMIA
Noticeable in mucous membrane of the conjunctiva if anemia is severe
- Hameglobin < 7 g/DL (for sever anemia)
Pallor
*For adult males, the normal range is typically between 13.8 to 17.2 grams per deciliter (g/dL).
*For adult females, the normal range is usually between 12.1 to 15.1 g/dL
4 Places to screen for pallor
- Look in the eyes (pooling the lower eyelid down)
- Frenulum (under the patient tongue)
- Face (pallor is due to shock from reduction of cardiac output)
- Hand and Nails (nails be looking pail with patient presenting with white coloured hands in comparison to pink physician’s hands)
Blue discolouration of the tongue and mucous membranes of the patient
Cyanosis
- Occurs when there is more
than 5 mg/dL of
deoxygenated haemoglobin (not bound to oxygen) in the
capillary blood.
Two types of cyanosis
-central cyanosis
- peripheral cyanosis
Cyanosis that is due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs.
Central cyanosis
*There is an abnormal amount of deoxygenated haemoglobin in the arteries; and a blue discolouration is present in parts of the body with good circulation
Cyanosis that is a sever sign of hypoxemia (Oxygen levels in the blood are lower than normal)
central cyanosis
Cyanosis that occurs when blood supply to a particular part of the body is reduced
and/or the tissues extract more oxygen than normal from the
circulating blood
- Peripheral cyanosis
*usually seen in the finger, toes, nose or lips
What factors cause of peripheral cyanosis?
- Reduced cardiac output
- Arterial obstruction
- Venous obstruction (due to deep vein thrombosis)
- Exposure to cold
*Also caused by factors causing central cyanosis
Is an increase in the soft tissue of the distal part of the fingers or toes
Clubbing
The sign used to confirm clubbing on the patient nails or toes
Schamroth’s sign
How is scamroth’s sign used in confirming patient diagnosis with clubbing
The disappearance of the
diamond shaped space,
that is formed when the
nails of two similar
fingers are held facing
each other, tells us tht the patient has clubbing
Causes of clubbing
- C: (Congenital Cyanotic Heart Disease, Cystic Fibrosis, Crohn’s Disease-affects the lining of the digestive tractcausing inflammation, Cholangiolitic Cirrhosis)
- L: (Lung Abscess, Lipoid Pneumonia)
- U: Ulcerative Colitis
- B: (Bronchiectasis, Bronchogenic carcinoma)
- B: Biliary Cirrhosis
- I: (Infective Endocarditis, Idiopathic Pulmonary Fibrosis)
- N: (Neoplasm of Lung, Liver, Oesophagus, Small and Large
Bowel) - G: Graves Disease (thyroid acropachy)
To diagnose patient with pitting oedema_____
Pit on the site with your finger for 15 seconds, and if the patient has pitting oedema the indentation will disappear after some time
The two types of oedema are…
-Pitting oedema (indentation evident)
- Non-pitting oedema (indentation absent)
Causes of non-pitting oedema
- hypothyroidism (myxoedema)
- Lymphoedema
Enlargement of the lymph nodes
-Lymphodenopathy
*normal lymph node diameter is less than 1 cm, and is usually <0.5 cm in epitrochlear region
Two types of lymphodenopathy
- generalized lymphodenoppathy
- localised lymphodenopathy
Causes of generalised lymphodenopahty
- Lymphoma
- Leukemia
- Infections:
1. Viral- CMV/HIV
2. Bacterial- TB/syphilis
3. Protozoal- Toxoplasmosis - Connective tissue disorders
- Infiltration (sarcoid)
- Drugs (phenytoin)
Causes of localised lymphodenophathy
- Local acute/chronic infection
- Metastasis from carcinoma or
other solid tumour - Lymphoma esp. Hodgkin’s disease
4 Basic areas where you can feel for enlarged lymph nodes
- cervical region
- axillary region
- Inguinal region
- Supraclavicular region
Enlarged epitrochlear node is pathological and is caused by____
- Local infection/
- non-Hodgkin’s lymphoma
Different types and locations of lymph nodes in human body
- cervical lymph nodes
- Axillary lymph nodes
- Inguinal lymph nodes
- Supraclavicular lymph nodes
The two types of inguinal lymph nodes
- Horizontal/inguinal group
- Vertical/femoral group
Where does the horizontal/inguinal group drain?
Drains lymph from From buttocks and back,
lower abdomen (below
umbilicus), umbilical
region, from skin of
penis, scrotum,
perineum, lower vagina,
vulva and anus
*Lower abdomen
Where does the vertical/femoral group drains?
Drain lymphatic fluid from the lower extremities, including the feet, ankles, and lower legs, as well as from the external genitalia and lower abdominal wall
*Lower limbs
Excessive loss of body water and electrolytes
dehydration
sign of dehydration in infant
-sunken fontanel
Signs of dehydration
- reduced skin turgor
- reduced urination
- Low blood pressure
- no tears when crying
- Rapid heart rate and breathing
- sleeplessness/tiredness
-Unconciousness - sunken eyes
- Dry skin, mouth or mucous membranes
T/F: Cappillary refill should take 2 seconds after applying pressure to the nail or finger
True.
- Delayed signifies dehydration, hypothermia, shock
Step-By-Step practical general examination looking at the entire JACCOLD signs and presentations
Number one u examine____
- HANDS
-first u look for clubbing,
-look for abnormal finding of the nails,
-look at the nail beds,
-and then the palms
-U do capillary refill
-skin tirgor
-muscle wasting
Step-By-Step practical general examination looking at the entire JACCOLD signs and presentations
Number two u examine____
The FACE & MOUTH (incl eyes)
Step-By-Step practical general examination looking at the entire JACCOLD signs and presentations
Number three u examine____
lymphodenopathy and lower limbs for oedema
