General examination

This presentation is for undergraduate medical students to illustrate general examination with videos and photos

1. GENERAL PHYSICAL EXAMINATION Shaimaa Elkholy

2. Rule of 7 General appearance Vital signs Head examination Neck examination Upper limb examination Lower limb examination Lymph node examination + Breast Shaimaa Elkholy

3. 1. General appearance Consciousness & Orientation (GCS) Cooperation Mentality Memory Mood Decubitus Body built 7 Shaimaa Elkholy

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5. Orthopnea Shaimaa Elkholy

6. Platypnea Shaimaa Elkholy

7. Trepopnea Shaimaa Elkholy

8. Squatting Shaimaa Elkholy

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10. Body Mass Index (BMI) It is calculated by the formula weight/ height 2 (Kg/m 2 ) BMI Underweight <18.5 Normal 18.5-24.9 Overweight 25-29.9 Obese 30-39.9 Morbidly obese >40 Shaimaa Elkholy

11. Cachexia Shaimaa Elkholy

12. Obese Shaimaa Elkholy

13. 2. Vital signs Pulse Blood pressure Respiratory rate Temperature Shaimaa Elkholy

14. Pulse Shaimaa Elkholy

15. Pulse Shaimaa Elkholy

16. Pulse Rate Rhythm Volume Special character Equality on both sides Peripheral pulsations State of arterial wall 7 Shaimaa Elkholy

17. Pulse Rate = 60 -100 < 60 -----------> bradycardia > 100 ----- -----> tachycardia Shaimaa Elkholy

18. Pulse Rhythm Regular Irregular Shaimaa Elkholy

19. Pulse Irregular Regular irregularity Irregular irregularity Shaimaa Elkholy

20. Pulse Shaimaa Elkholy

21. Pulse Shaimaa Elkholy

22. Pulse Extra systoles AF Can count 4 Cannot count 4 Pulse deficit < 10 Pulse deficit > 10 Normal Rapid No Systolic expansion of neck veins Exercise - - - Exercise +++ Shaimaa Elkholy

23. Pulse Deficit Shaimaa Elkholy

24. Pulse Volume Small Big Big (hyper dynamic) Anemia AR A-V fistula Pregnancy PDA, VSD LCF Paget disease Thyrotoxicosis Shaimaa Elkholy

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26. Pulse Special character Pulses parvus et tardus (plateau pulse) Water hummer pulse (collapsing) Bisferiens Pulsus alternans Pulsus paradoxicus Shaimaa Elkholy

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29. Pulse Equality on both sides Shaimaa Elkholy

30. unequal pulse ??!! Shaimaa Elkholy

31. Out side Wall Inside Shaimaa Elkholy

32. Pulse Peripheral pulsations Shaimaa Elkholy

33. Brachial pulse Flex the patient’s elbow Medial to the biceps Shaimaa Elkholy

34. Carotid Arteries At the level of thyroid cartilage Shaimaa Elkholy

35. The dorsalis pedis artery Lateral to the extensor hallucis tendon Absent in 10% Shaimaa Elkholy

36. The posterior tibial pulse. Shaimaa Elkholy

37. Popliteal Artery Shaimaa Elkholy

38. Seconded Method Shaimaa Elkholy

39. Femoral pulse Shaimaa Elkholy

40. Blood pressure Shaimaa Elkholy

41. Blood pressure Shaimaa Elkholy

42. Respiratory rate Shaimaa Elkholy

43. Respiratory rate 16 -22 Shaimaa Elkholy

44. Temperature 36.5 – 37.2 Shaimaa Elkholy

45. Temperature Shaimaa Elkholy

46. Temperature Shaimaa Elkholy

47. Head Examination Shaimaa Elkholy

48. Head examination Facies Hair Eye Nose & cheeks Mouth Ear Parotid 7 Shaimaa Elkholy

49. Facies Shaimaa Elkholy

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57. Hair Shaimaa Elkholy

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62. Eye Shaimaa Elkholy

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64. Exophthalmos Enophthalmos Shaimaa Elkholy

65. Eye brow Shaimaa Elkholy

66. Eye lid Shaimaa Elkholy

67. Causes of puffiness of eye lids Oedema ( nephrotic & angioedema) Chronic cough Myxedema S.V.C obstruction ( mediastinal S) Cavernous sinus thrombosis Shaimaa Elkholy

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69. Xanthelasma Shaimaa Elkholy

70. Heliotrope rash Shaimaa Elkholy

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72. Cornea Shaimaa Elkholy

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75. Sclera Shaimaa Elkholy

76. Bitot spots .>>> Vit A def. Shaimaa Elkholy

77. Pre-hepatic Hepatic Post-hepatic Entero-hepatic Circulation Sterco - bilinogen indirect direct Shaimaa Elkholy

78. Types of jaundice Shaimaa Elkholy

79. Function test Pre-hepatic Jaundice Hepatic Jaundice Post-hepatic Jaundice T.Bil +++ +++ +++ D.BIL N +++ +++ inD.BIL +++ +++ N Urobilinogen N / + ++ -- / - ve Urine Color N Dark ( urobilinogen + direct bilirubin ) Dark (direct bilirubin ) Stool Color N N /Pale Pale ALPH,GGT N +++ Marked +++ AST, ALT N ++++ +++ Conj Bil . Urine Not Present Present Present Shaimaa Elkholy

80. Nose & cheeks Shaimaa Elkholy

81. Malar rash Shaimaa Elkholy

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83. Mouth Shaimaa Elkholy

84. Mouth Odor Lips Tongue Teeth Gums Oral cavity Palate Shaimaa Elkholy

85. Bad odor Alcohol Acetone: DKA Ammonia: CRF Fetor hepaticus : LCF Halitosis Dental caries SLS GIT obstructio : Pharyngeal pouch, Achalasia Shaimaa Elkholy

86. Lips 3 colors Angular stomatitis Ulcers Shaimaa Elkholy

87. Pallor Shaimaa Elkholy

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89. Cyanosis Shaimaa Elkholy

90. Central cyanosis Peripheral cyanosis Site All the body (tongue) Hands & feet Ears & nose Ext. lips Hands Warm cold Effect of warming ++ --- Effect of O2 Improve No effect Causes Cong., resp.failure , abnormal HB(met Hb ) Cold , Shock, Raynaud’s Shaimaa Elkholy

91. Pigmentation Shaimaa Elkholy

92. Angular stomatitis Oral ulcers Shaimaa Elkholy

93. Teeth & gums Shaimaa Elkholy

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95. Tongue Shaimaa Elkholy

96. Tongue Fiery red (B3) Pellagra Pale glazed Magenta (B2) Beefy (B12) Shaimaa Elkholy

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98. Oral cavity & Palate Shaimaa Elkholy

99. Ears Shaimaa Elkholy

100. Parotid Shaimaa Elkholy

101. Neck examination Shaimaa Elkholy

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103. Trachea Shaimaa Elkholy

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105. Trachea Central Tracheal length Tracheal tug (A.A, Cambell’s sign) Mobil or fixed Shaimaa Elkholy

106. Vessels (carotid A) Shaimaa Elkholy

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109. Neck veins Shaimaa Elkholy

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111. Neck veins Shaimaa Elkholy

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113. Carotid pulsation Medial to sternomastoid One peak Unaffected by posture Unaffected by respiration Better felt than seen JVP Lateral to sternomastoid Wavy pulsation Prominent on lying down Decrease by inspiration Seen and not palpable Shaimaa Elkholy

114. Thyroid gland Inspection Palpation Percussion Auscultation Shaimaa Elkholy

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116. Lymph nodes 1. Circular set: -Inner ring ( Waldyer’s ring) Retropharyngeal, tonsils, Eustacian tube -Outer ring: Sub mental Submandibular Pre-auricular Post-auricular Occipital Shaimaa Elkholy

117. 2. Vertical set: -Superficial group: Along body of sternomastoid -Deep group: Ant. cervical : infrahyoid , pre –laryngeal, pre-tracheal Post. Cervical : along border of trapezius DEEP CERVICAL : upper & lower groups : deep to the sternomastoid : along IJV Supra clavicular LNs Shaimaa Elkholy

118. Lymph nodes Shaimaa Elkholy

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120. Upper limb Shaimaa Elkholy

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122. Hand examination S (shape, sweating) T (tremors , temp.) N (nail, nodule) Palmer erythema Pallor Shaimaa Elkholy

123. Acromegaly Shaimaa Elkholy

124. Shaimaa Elkholy Polydactyly

125. Spade hands Shaimaa Elkholy

126. Palmer erythema Familial Pregnancy LCF R.A. T hyrotoxicosis Shaimaa Elkholy

127. Flapping tremors Shaimaa Elkholy

128. Fine tremors Shaimaa Elkholy

129. Koilonychia ( spooning) Shaimaa Elkholy

130. Leukonychia Shaimaa Elkholy

131. Paronychia Shaimaa Elkholy

132. Onycholysis Shaimaa Elkholy

133. Signs of infective endocarditis Splinter hemorrhages : multiple linear, reddish brown marks along the axis of fingernails and toe nails Shaimaa Elkholy

134. Nail pitting Shaimaa Elkholy

135. Half & half nail Shaimaa Elkholy

136. Cyanosis in the nails with Clubbing Shaimaa Elkholy

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141. Beau’s lines Shaimaa Elkholy

142. Nodules Janeway lesions:  painless, erythematous maculopapules on the palms and soles that do not blanche.  They are caused by thrombi in small vessels, without vasculitis Osler's nodules:  painful, red papulo -nodules with a pale center.  They are found on the fingertips, and last days to weeks.  Caused by microabscesses in the dermis, they may even contain gram-positive cocci .   Shaimaa Elkholy

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144. Heberden's and Bouchard's Nodes Shaimaa Elkholy

145. Skin Stria Scratch marks Scar Spider nevi Purpura Ecchymosis Thin or thick Shaimaa Elkholy

146. Stria alba Shaimaa Elkholy

147. Stria Rubra Shaimaa Elkholy

148. Scratch marks Shaimaa Elkholy

149. DONot BLAnch ( Purpiric eruption) Shaimaa Elkholy

150. Spider nevi Shaimaa Elkholy

151. Shaimaa Elkholy Multiple Spider nevi

152. Ecchymosis Shaimaa Elkholy

153. Tendon xanthoma Injection sites Epitrochlear LNs Axillary LNs. Shaimaa Elkholy

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156. Epi - trochlear lymph node Shaimaa Elkholy

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158. Lower Limb Oedema Dorsalis pedis Post. Tibial Lax calf muscles Varicosities Skin + ulcer Pretibial myxedema Erythema nodsum Shaimaa Elkholy

159. Pitting seen in the left limb Shaimaa Elkholy

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161. Erythema nodosum Shaimaa Elkholy

162. Erythema nodosum Shaimaa Elkholy

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