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BLOCK 2 > CLIN SKILLS PART 2: GENERAL PHYSICAL EXAMINATION > Flashcards

CLIN SKILLS PART 2: GENERAL PHYSICAL EXAMINATION Flashcards

1
Q

3 Parts of general examination

A
  • General Inspection (appearance)
    Look at the patients gait, habitus, face, hands and body
  • Vital signs (HR, RR, BP, Temp, Pulse Oximetry)
  • General examination (JACCOLD_
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2
Q

What’s the significance of general examination?

A
  • Gives you first clues to what the diagnoses may be
  • Or to what systemic examination you need to pay more attention to
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3
Q

Things to look at with general inspection

A
  1. Is the patient well or ill?
  2. What is the patients’ mental state (alert,
    confused, somnolent, comatose etc.)?
  3. Is the patient in respiratory distress?
  4. Gait (pattern of walk) – normal; what kind of abnormal gait?
  5. Body Habitus (short, tall & thin, obese)- The physique or body built
  6. Dysmorphic features (patient faces)
  7. Paraphernalia on or around the patient (O2
    mask, pack of cigarettes, walking aid etc.)- Is about looking at the patient’s surroundings
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4
Q

Looking at patient body habitus is about_____

A

Looking for any form of muscle wasting

*Cachetic- severe loss of weight and muscle wasting

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5
Q

Helpful acronym for GENERAL EXAMINATION

A
  • J: Jaundice
  • A: Anemia
  • C: Cyanosis
  • C: Clubbing
  • O: Oodema
  • L: Lymphodenophathy
  • D: Dehydration
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6
Q

The condition is seen with hyperbilirubinemia (bilirubin be rising twice above normal levels) with deposition of bilirubin to various body tissues

A

Jaundice

*Yellow eyes, skin

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7
Q

Prehepatic jaundice

A

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.
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8
Q

Two causes of jaundice

A
  • 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.
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9
Q

Exrahepatic jaundice

A

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

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10
Q

Intrahepatic jaundice

A

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

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11
Q

Causes of intrahepatic jaundice

A
  • Viral hepatitis
  • Alchoholic hepatitis
  • Drugs
  • Pregnancy
  • Some congenital disorders
  • Infitration (unintentional leakage or seepage of fluid into surrounding tissues)
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12
Q

Causes of extrahepatic jaundice

A
  • 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
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13
Q

The most thing we looking for with ANEMIA

A
  • Clinical signs of PALLOR

*paleness

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14
Q

Can produce pallor of the skin

A

ANEMIA

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15
Q

Noticeable in mucous membrane of the conjunctiva if anemia is severe

  • Hameglobin < 7 g/DL (for sever anemia)
A

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

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16
Q

4 Places to screen for pallor

A
  • 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)
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17
Q

Blue discolouration of the tongue and mucous membranes of the patient

A

Cyanosis

  • Occurs when there is more
    than 5 mg/dL of
    deoxygenated haemoglobin (not bound to oxygen) in the
    capillary blood.
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18
Q

Two types of cyanosis

A

-central cyanosis
- peripheral cyanosis

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19
Q

Cyanosis that is due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs.

A

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

20
Q

Cyanosis that is a sever sign of hypoxemia (Oxygen levels in the blood are lower than normal)

A

central cyanosis

21
Q

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

A
  • Peripheral cyanosis

*usually seen in the finger, toes, nose or lips

22
Q

What factors cause of peripheral cyanosis?

A
  • Reduced cardiac output
  • Arterial obstruction
  • Venous obstruction (due to deep vein thrombosis)
  • Exposure to cold

*Also caused by factors causing central cyanosis

23
Q

Is an increase in the soft tissue of the distal part of the fingers or toes

A

Clubbing

24
Q

The sign used to confirm clubbing on the patient nails or toes

A

Schamroth’s sign

25
Q

How is scamroth’s sign used in confirming patient diagnosis with clubbing

A

The disappearance of the
diamond shaped space,
that is formed when the
nails of two similar
fingers are held facing
each other, tells us tht the patient has clubbing

26
Q

Causes of clubbing

A
  • C: (Congenital Cyanotic Heart Disease, Cystic Fibrosis, Crohn’s Disease-affects the lining of the digestive tractcausing inflammation, Cholangiolitic Cirrhosis)
  • L: (Lung Abscess, Lipoid Pneumonia)
  • U: Ulcerative Colitis
  • B: (Bronchiectasis, Bronchogenic carcinoma)
  • B: Biliary Cirrhosis
  • I: (Infective Endocarditis, Idiopathic Pulmonary Fibrosis)
  • N: (Neoplasm of Lung, Liver, Oesophagus, Small and Large
    Bowel)
  • G: Graves Disease (thyroid acropachy)
27
Q

To diagnose patient with pitting oedema_____

A

Pit on the site with your finger for 15 seconds, and if the patient has pitting oedema the indentation will disappear after some time

28
Q

The two types of oedema are…

A

-Pitting oedema (indentation evident)
- Non-pitting oedema (indentation absent)

29
Q

Causes of non-pitting oedema

A
  • hypothyroidism (myxoedema)
  • Lymphoedema
30
Q

Enlargement of the lymph nodes

A

-Lymphodenopathy

*normal lymph node diameter is less than 1 cm, and is usually <0.5 cm in epitrochlear region

31
Q

Two types of lymphodenopathy

A
  • generalized lymphodenoppathy
  • localised lymphodenopathy
32
Q

Causes of generalised lymphodenopahty

A
  • Lymphoma
  • Leukemia
  • Infections:
    1. Viral- CMV/HIV
    2. Bacterial- TB/syphilis
    3. Protozoal- Toxoplasmosis
  • Connective tissue disorders
  • Infiltration (sarcoid)
  • Drugs (phenytoin)
33
Q

Causes of localised lymphodenophathy

A
  • Local acute/chronic infection
  • Metastasis from carcinoma or
    other solid tumour
  • Lymphoma esp. Hodgkin’s disease
34
Q

4 Basic areas where you can feel for enlarged lymph nodes

A
  • cervical region
  • axillary region
  • Inguinal region
  • Supraclavicular region
35
Q

Enlarged epitrochlear node is pathological and is caused by____

A
  • Local infection/
  • non-Hodgkin’s lymphoma
36
Q

Different types and locations of lymph nodes in human body

A
  • cervical lymph nodes
  • Axillary lymph nodes
  • Inguinal lymph nodes
  • Supraclavicular lymph nodes
37
Q

The two types of inguinal lymph nodes

A
  • Horizontal/inguinal group
  • Vertical/femoral group
38
Q

Where does the horizontal/inguinal group drain?

A

Drains lymph from From buttocks and back,
lower abdomen (below
umbilicus), umbilical
region, from skin of
penis, scrotum,
perineum, lower vagina,
vulva and anus

*Lower abdomen

39
Q

Where does the vertical/femoral group drains?

A

Drain lymphatic fluid from the lower extremities, including the feet, ankles, and lower legs, as well as from the external genitalia and lower abdominal wall

*Lower limbs

40
Q

Excessive loss of body water and electrolytes

A

dehydration

41
Q

sign of dehydration in infant

A

-sunken fontanel

42
Q

Signs of dehydration

A
  • reduced skin turgor
  • reduced urination
  • Low blood pressure
  • no tears when crying
  • Rapid heart rate and breathing
  • sleeplessness/tiredness
    -Unconciousness
  • sunken eyes
  • Dry skin, mouth or mucous membranes
43
Q

T/F: Cappillary refill should take 2 seconds after applying pressure to the nail or finger

A

True.

  • Delayed signifies dehydration, hypothermia, shock
44
Q

Step-By-Step practical general examination looking at the entire JACCOLD signs and presentations

Number one u examine____

A
  • HANDS
    -first u look for clubbing,
    -look for abnormal finding of the nails,
    -look at the nail beds,
    -and then the palms
    -U do capillary refill
    -skin tirgor
    -muscle wasting
45
Q

Step-By-Step practical general examination looking at the entire JACCOLD signs and presentations

Number two u examine____

A

The FACE & MOUTH (incl eyes)

46
Q

Step-By-Step practical general examination looking at the entire JACCOLD signs and presentations

Number three u examine____

A

lymphodenopathy and lower limbs for oedema

BLOCK 2 (56 decks)

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