physical examination (3).ppt ppt of physical exami

physical examination general

1. Lectures on General Physical
Examination
Abraham Tesfaye(MD)
SPMMC
From Department of
Internal Medicine,Feb
2019

2. Physical Examination is the systematic
assessment of human body which involves the
use of one’s senses to determine the general
physical and mental conditions of the body
Physical assessment is the systematic
collection of objective information that is
directly observed or elicited through
examinations techniques

3. Indication of P/E
.on admission
.on discharge
.on follow up
.health camps
.before and after diagnostic and therapeutic
procedure

17. DOCTORS SHOULD BE OBSERVANT,LIKE A DETECTIVE.

Look at the patients general appearance…at the face ,hands
and body
Each examining system can be described using four elements;
- looking/inspection
- feeling/palpation
- tapping/percussion
- listening/auscultation

18. First impressions…..
Decide how sick is your patient?
Is she well,sitting up and talking?
Or ill totally not aware of her surroundings?

19. VITAL SIGNS
PULSE
BLOOD PRESSURE
TEMPERATURE
RESPIRATORY RATE
Oxygen saturation
Should be assessed immediately once you
discover that your patients unwell.
They provide important basic physiological
information.

20. Weight,body habitus and posture
Obesity,BMI >30.
Any wasting of muscles?
Tall?short?
Always observe when the patient walks into
the examination room.

21. FACIES
Specific diagnosis can be made by just
looking at a patient’s face.
Some facial characteristics are so typical of
certain diseases that they immediately
suggest the diagnosis….so called diagnostic
facies……

22. Important diagnostic facies
Acromegaly
Cushingnoid
Down syndrome
Marfanoid
Thyrotoxic
parkinsonism

23. acromegaly

24. Acromegaly hands

25. Downs syndrome

26. Cushing’s syndrome

29. JAUNDICE
It is the yellowish discolouration of a patient’s
skin and sclerae that results from
hyperbilirubinemia.
It happens when the serum bilirubin level
rises twice above the normal upper limit.
It is deposited in the tissues of the body that
contains elastin.

30. jaundice

31. CYANOSIS
Blue discolouration of the skin and mucous membranes;it is
due to the presence of deoxygenated haemoglobin in the
superficial blood vessels.
Types-central and peripheral
Central cyanosis- abnormal amount of deoxygenated
haemoglobin in the arteries and that a blue discolouration is
present in parts of the body with good circulation.eg;tongue.
Peripheral cyanosis-occurs when blood supply to a particular
part of body is reduced,eg;lips in cold weather becomes blue
but the tongue is spared.

32. cyanosis

33. PALLOR
Deficiency of haemoglobin can produce
pallor of the skin.
Should be noticeable especially in the
mucous membranes of the sclerae if the
anaemia is severe- Hb of less than 7g/L.
Facial pallor can also be seen in patients
with shock,due to the reduction of cardiac
output. These patients usually appear cold
and clammssy and significantly hypotensive.

34. Alopecia totalis

35. Oral cavity
The teeth and breath
Check the oral cavity looking for
MOUTH ULCERS
-Aphtous,drugs and trauma
-gastrointestinal disease;inflammatory bowel disease
-rheumatological;Behcets syndrome
-infections;herpes zoster,simplex

36. Behcets ulcers

37. Gum hypertrophy
Phenytoin
Pregnancy
Scurvy(vitamin C deficiency;gums become
swollen,spongy,red and bleeds easily)
Gingivitis;smoking
leukemia

39. NECK;lymphadenopathy,goitre
During palpation of lymph nodes the
following features should be considered;
SITE
-Localised or generalised?
-palpable lymph node areas are;
Epitrochlear,axillary,cervical and
occipital,supraclavicular,para-aortic,inguinal
and popliteal.

40.  SIZE
CONSISTENCY
-hard are suggestive of carcinoma
-soft may be normal
-rubbery may be due to lymphoma
.TENDERNESS
-Acute infection of inflammation
FIXATION
-If fixed to the underlying structures its most likely malignant

43. Cervical lymphadenopathy

44. NAILS
CLUBBING
-Increase in the soft tissue of the distal part of the fingers or toes.

45. clubbing

46. Four common steps of P/E:
.INSPECTION
.PALPATION
.PERCUSSION
.AUSCULTATION

47. INSPECTION

70. Thank you.