General Examination Flashcards
First 4 steps of general examination
Washing of hands
Introduction - your name, your level , your school, and why you are here
Patient introduction - name ,age, date of birth
Consent
Position of doctor during examination
Right hand side of patient
Position of bed
Semirecumbent - 45 degrees
General observation to make
Patient look well ? Ill? Mildly ill? Severely ill ?
Posture , gait , posture in bed
Speech ,interaction
Nutritional state - Cachexia, slim, plump, obese ( general, central)
Wasting ( temporalis, ribs prominence), cracked skin, loss of scalp and body hair , poor wound healing
Edema
Temperature ( 35.8-37 is normal )
Position of patient indicating LVHF
Pain when lying horizontally due to orthopnea
Position of patient indicating peritonitis
Patients prefers lying supine and shallow breathing to reduce pain with legs sometime drawn up. Very minimal movement
Position of patient indicating renal colic
Patient restless , rolling around to find position free of pain
Position of patient indicating acute inflammatory or infective joint disease
Affected limbs lie motionless
Position of patient in severe meningitis
Neck may bend backwards and appear to burrow into pillow
Hand exam
Tremors
Dupuytrens contracture
Clubbing of fingers
Oslers nodes
Splinter hemorrhages
Koilonychia
Leuconychia
Tremors type in hand
Tremors
fine tremors ( thyrotoxicosis, beta agonists)
Pill rolling tremor (Parkinson’s)
Coarse jerky tremor ( hepatic or uremic failure )
Type of odors to pay attention to
Alcohol on breath
Acetone smell in DKA
Fetor hepaticus
Halitosis in suppurative lung dx, gingivitis
What does inflammation of overlying Skin of lymph node with pain indicate
An infective origin
What does non tender lymph node indicate
Malignant lymphadenopathy
What to note when palpating lymph node
Site
Size
Position
Shape
Consistency
Mobility
Tenderness
Isolated or not
