General examination Flashcards
How long should the middle steps in handwashing take?
At least 15 seconds
What does poverty of expression suggest`?
Parkinonism
What does a startled expression suggest>
Hyperthyrodisim
What does apathy with poverty of expression and poor eye contact suggest?
Hypothyroidism
What does agitated expression suggest?
Anxiety, hyperthyroidism, hypomania
What can a warm temperature be due to`?
Vasodialtion from elevated arterial CO2 levels
Hyperthyroidism
What can cold hands suggest?
Vasoconstriction
Can occur in HF
What are different things that can be seen on nails?
Beau's lines Clubbing Leuconychia Lindsays nails Kolonychia Muehrcke's lines Nail fold telangictasia Onychomycosis Pitting Onchylosis Splinter haemorrhage Yellow nail
What does beau’s lines look like and a differential diagnosis?
Transerse grooves
Severe illnesss that affects growth of the nail matrix
What does clubbing look like and a differential diagnosis?
Loss of angle between nail fold and nail plate
Serious cardiac, respiratory or GI disease
What does leuconychia look like and a differential diagnosis?
White spots, ridges or complete discoloration of nail
Duet o trauma, infection, poisoning chemo and vit deficiency
What does Lindsay nails look like and a differential diagnosis?
White/btown half and half nails
CKD
What does koilonychoia look like and a differential diagnosis?
Spoon shaped depression of nail plate
Iron deficiency anaemia, lichen planus, repeated exposure to detergents
What does Muehrcke’s lines look like and a differential diagnosis?
Narrow, white transverse lines
Decreasedd protein synthesos or protein loss
What does nail fold telangiectasia look like and a differential diagnosis?
Dilated capillaries and erythema t nail fold
Connective tissue disorder, including systemic sclerosis, systemic lupus erythmatous, dermatoymotisis
What does ONYCHOLYSIs look like and a differential diagnosis?
Nail seperate from nail bed
Psoriasis, fungal infection traumam, thyrotoxicosis, tetracyclines
What does onchomyocis look like and a differential diagnosis?
Thickened of nail plate with white, yellow or brown discolouration
Fungal infection
What does pitting look like and a differential diagnosis?
Fine or coarse pits in nail
Psoriasis, eczema, alopecia areta, lichen planus
What does splinter haemorrhage look like and a differential diagnosis?
Small red streaks the lie longintudinally in nail plate
Trauma, IE
What does yellow nails look like and a differential diagnosis?
Yellow discoloration ad thickened
Yellow nail syndrome
What are some causes of clubbing?
Thoracic- Lung cancer, chronic suppurative conditions” Pulmonary TB, bronchiectasis, lung abscess, empyema and CF, mesothelioma, fibroma, PF
Cardiovascular: Cyanotic congenital heath disease, IE, arteriovenous shunts and aneurys,
GI: Cirrhosis, IBD, Coelcac
Others” Thyrotoxicosis, primary hypertrophic osteoarthropathy
Google the examination for clubbing
Ok smelly
When is clubbing likely?
If the interphalangeal depth ratio is more than 1
If the nail fold angle is more than 190 degrees
If the Schamroth’s window sign is absent
When does depigmentation occur?
Vitiligo
What can cause hyperpigmentation?
Excess of ACTH
What is haemochromatosis
Inherited condition of excesive iron absorption results in skin hyperpigmentation due to iron deposits and increased melanin prooduction
What is haemosiderin?
Product of haemoglobin breakdwon is deposted in the skin of the lower legs following subcutaneous extravastion of blood due to venous insufficiency
What can easy brusing be due to?
Reflection of skin and connective tissue fragility due to advancing age or glucocorticoid usage
What is hypercarotenemia?
Occurs due to excessive ingestion of cerotene containing vegetables or in situations of impaired metabolism such as hypothyroidism or anaorexia nervosa
Yellowish discoloration of face, palms and soles bur not sclera
What can skin discolouration be due to?
Abnormal pigments such as the sallow yellow brownish tinge in CKD
Bluish tinge is due to abnormal haemoglobns such as sulphaemoglibin or methaemoglobin or by drugs such as dapspne
What drugs cause abnormla skin colouration and what colour?
Mepacrine (yellow)
Amiodarone (bluish grey)
Phenothiazines (slate grey)
When is jaundice normally detectable?
Above 50 micro mol/l
What is pallor?
Pallor can result from anaemia in which there is a reduction in circulating oxy haemoglobin in the dermal and subconjunctival capillaries or from vasoconstriction due to cold exposure or sympathetic activation
What causes facial flushing?
Fever Exercise Heat exposure Emotional Mneopause Androgen deficiency Carcinoid syndrome Medullary thyroid cancer Serotonin syndrome Food/alcohol ingestion Neurological Rosacea Mastocytoses
What BMI is underweight in non asian and asian
Under 18.15
What BMI is normal in non asian and asian
- 5-24.9
18. 5-22.9
What BMI is overweight in non asian and asian
25-29.2
23-24.9
What BMI is obese t in non asian and asian
30-39.9
25-29.9
What BMI is mrobidly obese in non asian and asian
More than 40
more than 30
What are some causes of oedema?
Venous
Lymphatic
Inflammatory
Allergic
What are features to note in any lump or swelling?
Size Position Attachments- Fixed or mobile Consistency- Soft to stony hard Edge- Delineated or ill defined, regular or irregular, sharp or rounded Surface and shape Pulsation, thrills and bruits Infalmmation- Redness, tenderness warmth Transillumination- Pen torcch. Cystic swelling will light up
What can cause a bruit?
If blood flow through a lump is increased, a systolic murmur may be heard
With sufficient flow a thrill may be palpable
What is the examination sequence?
Inspect the lump, noting any change in the colour or texture of the overlying skin
Define the sit and shape of lump
Measure its size and record the findings diagrammatically
Gently palpate for tenderness of change in skin temperature
Feel the lump on one side, see and feel if a bulge occurs on the opposite side. Confirm the flucttion in two planes. Fluctation usually indicates that the lump contains fluid, although some soft lipomas can feel fluctuant
Auscultate for vascular brutis
Transilluminate
What size are normal nodes?
Less than 0.5cm in diamater
What do normal nodes feel like?
Soft
What do abnormal nodes fee; like?
Hodgkins lymphoma is rubbery
TB may be matted
Metastiatic cancer they feel hard
What are the facial features of hypothyrodism
Sparese, coarse hair and eyebrows, periorbital puffiness, dry, waxy skin, apathetic expression, macroglossia
What are the facial features of graves disease
Staring appearance due to lid retraction, proptosis, evidence of weight loss
What are the facial features of hypopituitarism
Pale, often unwrinckled skin with loss of hair
What are the facial features of acromegalu
Thickened, coarse skin with enlarged nose and frontal bones, prognathism, widely spcaed teeth, macroglossia
What are the facial features of cushings syndrome
Moon shaped plethroci facries
What are the facial features of osteogenesis imperfecta
Blue sclera
What are the facial features of herediatry haemorrhagic telangiectasia
Telangiectasia on and around lips
What are the facial features of systemic sclerosis
Tight skin constricting mouth, beaking of nose, loss of nasolabial folds
What are the facial features of myotonic dystrophy
Frontal balding, paucity of expression, bilateral ptsosis
What are the facial features of down;’s sdynreome
Flat facial profile, upslanting palpebral fissures, snall, low set ears, macroglossia, brushfield spots in iris
What are the facial features of SLE
Butterfly erythematosu rash on cheeks
What does turner’s syndrome look lije?
Due to loss of X
Delyaed puberty in girls
Short stature, webbing of neck, small chin, low set ears, low hairline, short fourth finger, increased carrying angle at the elbows and widely spaced nipples
