Inspection as a Clinical Skill Flashcards
____________ meaning
the judging of one’s nature, is the art of judging
character from the features of the face
Physiognomy, from the Greek physiognomonia,
Thickening of the subcutaneous
tissues may be seen in ____, ______ and ____
chronic alcoholism, acromegaly
and myxoedema
The enlarged characteristic face is due to a large supraorbital ridge that causes frontal bossing, a broad nose and a prominent broad and square lower jaw.
Other
features include an enlarged tongue and soft tissue
swelling of the nose, lips and ears
Acromegalic
Due to mouth breathing in children: a narrow nose/
nares, a high-arched palate (the ‘Gothic’ palate),
prominent incisor teeth, undershot jaw with a
perpetually open mouth and ‘stupid’ expression
Adenoidal
plethoric face, thickened ‘greasy’ skin, telangiectasia, suffused conjunctivae and rosacea.
Alcoholic (due to chronic use)
Other features may include rhinophyma,
parotid swelling and characteristic changes to the lips
and corners of the mouth
Alcoholic (due to chronic use)
The bird-like features—beaking of the nose,
limitation of mouth opening, puckering or furrowing
of the lips and a fixed facial expression—are due to
binding down of facial skin
Bird-like (systemic sclerosis: CREST
syndrome)
Other features of CREST include
_______ and ____
telangiectasia on the face and hands
There is bossing of the skull, hypertrophy of the
maxillae (which tends to expose the upper teeth),
prominent malar eminences and depression of the bridge of the nose
Chipmunk (thalassaemia major)
The major haemoglobinopathies
cause _______ of the skull and facial bones because
of an increase in the bone marrow cavity.
hyperplasia
The patient with _______ has a pale face with cold
clammy skin, sunken eyes, hollow cheeks and a
forlorn, apathetic look (similar to the Hippocratic
facies
cholera
The face has a typical ‘moon shape’, plethora, hirsutism
(more obvious in women), acne
Cushingoid
This describes the deathly, mask-like features of advanced
peritonitis—sunken eyes; ‘gaunt’ face; ‘collapsed’
temples; dry, crusty lips; and clammy forehead
Hippocratic
The typical tall stature, arachnodactyly and chest
deformities, combined with the facial features of a
subluxation of the lens of the eye and high-arched
palate, help to pinpoint the diagnosis
Marfanoid (Marfan syndrome)
This is typically shown in flushed or rosy cheeks with
a bluish tinge due to dilatation of the malar capillaries.
It is associated with pulmonary hypertension.
Mitral (mitral valve disease, especially
mitral stenosis)
The facial features include a flat profile, with crowded
features, a round head, dysplastic lowset ears,
protruding tongue, mongoloid slant of the eyes with
epicanthic folds, mouth hanging open
Mongoloid (Down syndrome)
peripheral silver iris spots in pts with DS
Brushfield’s spots
Facial characteristics include an expressionless,
‘tired’-looking face with bilateral ptosis.
Myopathic (myopathy/myasthenia gravis)
Typical features include frontal baldness,
expressionless triangular facies, partial ptosis,
cataracts and temporal muscle atrophy
Myotonic (dystrophia myotonia)
The face usually has an apathetic look and is ‘puffy’
with possible periorbital oedema
Myxoedemic (hypothyroidism)
In pts with Myxedema coma:
The skin (not the sclera)
may appear yellow (due to ______) and is
generally dry and coarse
hypercarotenaemia
Type of speech in pts with myxedema coma:
The tongue is usually
enlarged and the patient speaks with a ‘thickened’,
croaking, slow speech
The main feature is skull enlargement, notably of the
frontal and parietal areas (the head circumference is
usually greater than 55 cm, which is abnormal)—the ‘hat
doesn’t fit any more’ hallmark.
Pagetic (Paget disease)
Other features of Paget:
Other features include
increased bony warmth and deafness
Characteristic is the mask-like facies with lack of
facial expression and fixed unblinking stare. There is
immobility of the facial muscles
Parkinsonian
Pigmented macules (1–5 mm in diameter) occur on lips, buccal mucosa and fingers.
Peutz–Jegher’s
A face older than the years with premature gross
wrinkling of the skin, stained teeth, deep raspy voice,
‘loose’ cough, smell of tobacco.
Smoker’s
The prominent eyes (sclera may not be covered by
the lower eyelid) and conjunctivitis are features of the
_____
thyrotoxic patient
The facial characteristics include ptosis—‘fishlike’
mouth, small chin (micrognathia), low-set ears and
deafness.
Turner syndrome
Cardio lesions in Turner syndrome
Cardiac lesions include coarctation of the
aorta and pulmonary stenosis
Classic sign of Turner syndrome
Webbing of the neck is
the classic sign
A sallow ‘muddy’ complexion with uraemic fetor—an
ammoniacal halitosis
Uraemic
Ddx for malar rash
SLE, Rosacea, • Erysipelas • Seborrhoeic dermatitis • Photosensitivity eruptions
Erythema, scaling with a discrete red advancing
edge on the cheeks and bridge of the nose; the
sharp border, lack of pustules and adherent scale
make it differ from rosacea
• SLE
Papules, pustules and telangiectasia on an
erythematous background on cheeks, forehead
and chin
• Rosacea
Painful, erythematous, indurated skin infection
with a well-defined raised edge
• Erysipelas
Red and scaly rash involving eyebrows, eyelids,
nasolabial folds
• Seborrhoeic dermatitis
Erythematous on areas that are exposed to the sun
• Photosensitivity eruptions
Increased browning pigmentation, usually confined
to symmetrical areas of the cheeks
Chloasma/melasma
Drugs causing melasma:
- combined oral contraceptive pill
- hydroxychloroquine (Plaquenil)
- diphenylhydrazine
Causes of Malar flush
- Mitral stenosis
- Pulmonary stenosis
- Rosacea
- SLE
- Mesenteric adenitis
Causes of Spider naevi
- Pregnancy
- Liver disease
- Vitamin B deficiency in normal people
Causes of enlarged tongue
- Acromegaly
- Hypothyroidism
- Amyloidosis
- Down syndrome
Causes of cataracts
- Senility
- Corticosteroid therapy
- Diabetes
- Hypoparathyroidism
- Dystrophia myotonia
- Trauma
- Ocular disease (e.g. glaucoma
Causes of telengiactesia
Systemic sclerosis
• CREST syndrome
• Liver disease (e.g. alcoholism
_____ is a bluish discolouration of the skin and
mucous membranes due to deoxygenated haemoglobin
concentrated in the superficial blood vessel
Cyanosis
02 treshold for cyanosis
The
arterial oxygen saturation is 80–85% before it is clinically
apparent.
Types of Cyanosis
It is classified as central or peripheral.
Type of cyanosis:
Cyanosis is present in parts of the body with good
circulation, such as the lips and tongue
Central
Causes of central cyanosis
The main causes are pulmonary disease,
pulmonary oedema, cyanotic congenital heart
disease (right to left shunt), respiratory depression,
polycythaemia
Cyanosis is in the extremities, such as the outer surface
of the lips, nose and ears
Peripheral
Causes of peripheral cyanosis
The main
causes are peripheral vascular disease, cardiac failure,
‘shock’, exposure to cold, left ventricular failure and
all causes of central cyanosis .
Characteristics of clubbing
• Loss of usual angle between base of nail and nail fold • Curvature in two planes • Increased sponginess in base of nail • Increased convexity of nail
Usual etiology of clubbing:
respiratory diseases
Common causes of inc pigmentation:
Increased melanocyte-stimulating
hormone (MSH)
Addison disease (see CHAPTER 23)
• Cushing syndrome
• Ectopic ACTH syndrome
Common causes of inc pigmentation:
Metabolic
- Hyperthyroidism
- Haemochromatosis
- Cirrhosis of the liver
- Porphyria
- Chronic kidney failure
- Malnutrition/malabsorption
- Pregnancy
Drugs causing inc pigmentation:
- Amiodarone
- Antibiotics (busulphan, bleomycin, minocycline)
- Antimalarials (chloroquine/hydroxychloroquine)
- Arsenic, gold, silver
- Chemotherapy
- Dapsone
- Oral contraceptive pill (OCP)
- Phenothiazines
- Photochemotherapy (PUVA)
- Psoralens
- Thiazides
Tumors causing inc pigmentation:
- Lymphomas
- Acanthosis nigricans
- Metastatic melanoma
