Physical examination 1 Flashcards
- Physical examination-> stages
- General survey
- Vital signs
- Mental status
- Skin
- HEENT
- Neck
- Thorax
- Extremities and peripheral vascular system
- Abdomen
- Musculoskeletal system
- Nervous system
- Additional examinations
1) rectal
2) genital
General survey
- Overall impression
- Grooming
- Physical qualities
General survey -> overall impression
- Apparent condition (stan ogólny)
1) good or moderate or bad - Level of consciousness
- > Glasgow coma scale - Signs of distress
- Obvious lesions
- Acute or chronic disease
Glasgow coma scale categories
- Eye opening
- Best motor response
- Best verbal response
Min. 3 points
Max 15 points
-> 3-8 -> coma
Glasgow coma scale eye opening
- None
- To pain
- To speech
- Spontaneous
Glasgow coma scale motor response
- No motor response
- Extension to pain (decerebrate)
- Flexion to pain (decorticate)
- Withdraw from pain
- Localizes pain
- Obeys commands
Glasgow coma scale verbal response
- None
- Incomprehensible (moans/ groans, no speech)
- Inappropriate (intelligible, no sustained sentences)
- Confused, disoriented
- Oriented
Signs of distress
1) Cardiac or respiratory
1. Clutching of the chest
2. Diaphoresis (excessive sweating)
3. Labored breathing
4. Wheezing
5. Coughing
2) Pain
3) Anxiety or depression of CNS
Obvious lesions
- Pallor
- Cyanosis
- Jaundice
- Rashes
- Bruises
- Skin lesions
General survey -> grooming
- Dress
- Personal hygiene
- Odors of the body or breath
- Facial expression
- Mood
- Attitude to other people and environment
General survey -> physical qualities
- Posture
- Motor activity
- Heigh
- Weight
- BMI
(6. Waist circumference) - Sexual development (voice)
Vital signs
- BP - blood pressure
- HR - heart rate
- RR - respiratory rate
- Temperature
HEENT
- Head
- Eyes
- Ears
- Nose and sinuses
- Thorax and mouth
Head examination steps
- Hair
- Scalp
- Skull
- Face
- Skin
Hair examination
- Quantity
- Distribution
- Texture and patterns of loss
- Evidence of dandruff (Łupież), nits
The scalp examination
- Lesions ->
1) scaling
2) redness
3) lumps
4) nevi
Skull examination
- General size and contour
- Lesions:
1) deformities
2) depressions
3) lumps
4) tenderness - Look for irregularities
- Palpate
- Percussion
The face
- Facial expressions
- Contours
- Lesions
1) masses
2) involuntary movements
3) asymmetry
Eye examination
- General look - elements of the eye
- Visual fields
- Extraocular movements
- Test for convergence
- Endocrine reflexes
- Visual acuity
- Fundus -> with ophthalmoscope
Eye examination - General look - elements of the eye
1) External
1. Eyebrows
2. Eyelids
3. Lacrimal apparatus
4. Conjunctivas
5. Sclera and cornea
2) Internal
1. Iris
2. Pupils
3. Lens
Eye examination - pupils
- Size
- Shape
- Symmetry of both
- The light reaction
1) in the same eye
2) in the opposite eye
3) light reflexion in corneas - Accommodation
Eye examination reflexes
- Graeffe’s sign (lid lag sign) -> lagging of the upper eyelid on downward rotation of the eye -> visible upper part of sclera
- Kocher’s sign -> convulsive retraction of the eyelid in fixation on a fast upwards movements-> visible lower part of the sclera
- Möbius sign -> inability to maintain convergence
- Stellwag’s sign -> infrequent or incomplete blinking
- Dalrymple’s sign -> wider eyelid opening (spasm) -> abnormal wideness of palpebral fissure
- Joffroy’s sign -> inability to wrinkle the forehead when the patient looks up
-> all in Graves orbitopathy
Eye examination - fundus
- Optic disc and cup
- Retina
- Retinal vessels
- Macula
Ear examination
- The external ear
- Otoscope -> tympanic membrane + middle ear
- Hearing
Ear examination - the external ear
- Auricle
2. Ear canal
Ear examination - otoscope
- Ear canal
1) Cerumen -> quantity, color
2) Lesions -> redness, discharge, swelling, foreign bodies - Tympanic membrane
1) color
2) contour and margins
3) pars flaccida (up)
4) cone of light
5) lesions -> perforations - Middle ear
1) Malleus -> umbo, handle, short process
2) (Incus) -> sometimes can be visible
Ear examination - hearing
- Ask patient about hearing
- Whisper Voice test
- Conductive Versus Neurosensory hearing Loss tests
1) Weber test -> test for lateralization
2) Rinne test -> Air versus Bone conduction test
Nose and sinuses examination
- General
- Pressure on the tip of the nose -> check swelling or tenderness
- Ask patient about rrhinorrhoea
- Test nasal obstruction
- Inspect the inside of the nares -> otoscope
1) mucosa
2) septum
3) lesions
4) exudate - Sinuses -> pallets for tenderness
1) frontal
2) maxillary
Mouth and throat examination
- External
- Vestibule of mouth and teeth
- Posterior part of mouth and pharynx
- Tongue and floor of the mouth
Mouth and throat examination - external
- The lips
1) color
2) moisture
3) lesions - Corners of mouth
1) inflammation
2) symmetry - Mandible -> protrusion -> prognathism
Mouth and throat examination - vestibule and teeth
- Teeth
1) missing
2) discolored
3) abnormalities - The gums
1) color
2) margins and papillae
3) abnormalities - Buccal mucosa
- Openings of the parotid ducts
- Saliva (Xerostomia)
Mouth and throat examination - posterior mouth and pharynx
- The roof of the mouth
1) hard palate
2) soft palate - Uvula
1) color
2) deviation
3) rise when eee - Pillars
- Tonsils
- Posterior pharynx