CLIN SKILLS PART 2: GENERAL PHYSICAL EXAMINATION Flashcards
3 Parts of general examination
- General Inspection (appearance)
Look at the patients gait, habitus, face, hands and body - Vital signs (HR, RR, BP, Temp, Pulse Oximetry)
- General examination (JACCOLD_
What’s the significance of general examination?
- Gives you first clues to what the diagnoses may be
- Or to what systemic examination you need to pay more attention to
Things to look at with general inspection
- Is the patient well or ill?
- What is the patients’ mental state (alert,
confused, somnolent, comatose etc.)? - Is the patient in respiratory distress?
- Gait (pattern of walk) – normal; what kind of abnormal gait?
- Body Habitus (short, tall & thin, obese)- The physique or body built
- Dysmorphic features (patient faces)
- Paraphernalia on or around the patient (O2
mask, pack of cigarettes, walking aid etc.)- Is about looking at the patient’s surroundings
Looking at patient body habitus is about_____
Looking for any form of muscle wasting
*Cachetic- severe loss of weight and muscle wasting
Helpful acronym for GENERAL EXAMINATION
- C: Clubbing
- A: Anemia
- J: Jaundice
- C: Cyanosis
- O: Oodema
- L: Lymphodenophathy
- D: Dehydration
The condition is seen with hyperbilirubinemia (bilirubin be rising twice above normal levels) with deposition of bilirubin to various body tissues
Jaundice
*Yellow eyes, skin
Prehepatic jaundice
Results from haemolysis of your RBC throughout the body, thus releasing haemoglobin, which is converted by certain enzymes in your body to bilirubin
- This leads to an excess of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells, which the liver cannot process efficiently.
Two causes of jaundice
- Intrahepatic causes (occurs when there is a problem with bilirubin processing within the liver
- Extrahepatic jaundice occurs when there is a blockage in the bile ducts outside the liver, preventing the flow of bile (and bilirubin) from the liver into the intestines.
Exrahepatic jaundice
Occurs when there is a blockage in the bile ducts outside the liver, preventing the flow of bile (and bilirubin) from the liver into the intestines.
*Due to gall stones or tumours in bile ducts or its narrowing
Intrahepatic jaundice
Occurs when there is a problem with bilirubin processing within the liver
*Leads to build up of bilirubin in the liver»>jaundice»>yellowing f the skin and eyes
Causes of intrahepatic jaundice
- Viral hepatitis
- Alchoholic hepatitis
- Drugs
- Pregnancy
- Some congenital disorders
- Infitration (unintentional leakage or seepage of fluid into surrounding tissues)
Causes of extrahepatic jaundice
- Duct stones
- Carcinoma
- Biliary stricture (narrowing or constriction of the bile ducts)
- Sclerosing cholangitis (chronic liver disease characterized by inflammation and scarring (fibrosis) of the bile ducts inside and outside the liver)
- pancreatic pseudocyst
The most thing we looking for with ANEMIA
- Clinical signs of PALLOR
*paleness
Can produce pallor of the skin
ANEMIA
Noticeable in mucous membrane of the conjunctiva if anemia is severe
- Hameglobin < 7 g/DL (for sever anemia)
Pallor
*For adult males, the normal range is typically between 13.8 to 17.2 grams per deciliter (g/dL).
*For adult females, the normal range is usually between 12.1 to 15.1 g/dL
4 Places to screen for pallor
- Look in the eyes (pooling the lower eyelid down)
- Frenulum (under the patient tongue)
- Face (pallor is due to shock from reduction of cardiac output)
- Hand and Nails (nails be looking pail with patient presenting with white coloured hands in comparison to pink physician’s hands)
Blue discolouration of the tongue and mucous membranes of the patient
Cyanosis
- Occurs when there is more
than 5 mg/dL of
deoxygenated haemoglobin (not bound to oxygen) in the
capillary blood.
Two types of cyanosis
-central cyanosis
- peripheral cyanosis
Cyanosis that is due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs.
Central cyanosis
*There is an abnormal amount of deoxygenated haemoglobin in the arteries; and a blue discolouration is present in parts of the body with good circulation
Cyanosis that is a sever sign of hypoxemia (Oxygen levels in the blood are lower than normal)
central cyanosis
Cyanosis that occurs when blood supply to a particular part of the body is reduced
and/or the tissues extract more oxygen than normal from the
circulating blood
- Peripheral cyanosis
*usually seen in the finger, toes, nose or lips
What factors cause of peripheral cyanosis?
- Reduced cardiac output
- Arterial obstruction
- Venous obstruction (due to deep vein thrombosis)
- Exposure to cold
*Also caused by factors causing central cyanosis
Is an increase in the soft tissue of the distal part of the fingers or toes
Clubbing
The sign used to confirm clubbing on the patient nails or toes
Schamroth’s sign
