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Transcript of 3-The Clinical Examination
8/14/2019 3-The Clinical Examination
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THE CLINICALTHE CLINICAL
EXAMINATIONEXAMINATION
KEEP THE BASIC PATTERN OFKEEP THE BASIC PATTERN OF
LOOKING,LOOKING,
FEELING,FEELING,TAPPING,TAPPING,
LISTENINGLISTENING
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GENERAL ASSESSMENTGENERAL ASSESSMENT
While talking to the pt. you can observe:While talking to the pt. you can observe:
– His face: fitness for age, in pain/comfortableHis face: fitness for age, in pain/comfortable
– His intellectual ability and intelligenceHis intellectual ability and intelligence
– His attitude to his disease, to you,His attitude to his disease, to you,
to treatmentto treatment
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GENERAL ASSESSMENTGENERAL ASSESSMENT
Your instructions:Your instructions:
– extremely simple if the pt. is unintelligentextremely simple if the pt. is unintelligent
– gentle if the pt. is shygentle if the pt. is shy
You can observe physical characteristics:You can observe physical characteristics:
– Posture, mobility, weight, color of skin, facialPosture, mobility, weight, color of skin, facialappearance and general body buildappearance and general body build
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GENERAL EXAMINATIONGENERAL EXAMINATION
Hold the pt’s hand and examine itHold the pt’s hand and examine it
– Count the pulse,Count the pulse,
– Temperature of the skinTemperature of the skin
– MoistureMoisture
– Color Color
– NailsNails
– CallositiesCallosities
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PULSEPULSE
RATERATE
RHYTHMRHYTHMVOLUMEVOLUME
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NAILSNAILS
SHAPESHAPE
– KOILONYCHIAS- ANEMIAKOILONYCHIAS- ANEMIA
– CLUBBING- COADCLUBBING- COAD
– BITTEN NAILS- ANXIETYBITTEN NAILS- ANXIETY
COLOURCOLOUR
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HANDSHANDS
TEMPERATURE: HOT, COLD, NORMALTEMPERATURE: HOT, COLD, NORMAL
MOISTUREMOISTURE
CALLOSITIES: OCCUPATIONCALLOSITIES: OCCUPATIONCOLOUR:COLOUR:
– BLUISH: CYANOSISBLUISH: CYANOSIS
– REDDISH-BLUE: POLYCYTHEMIAREDDISH-BLUE: POLYCYTHEMIA – PALOR: ANEMIAPALOR: ANEMIA
– NICOTINE-STAINED: HEAVY SMOKERNICOTINE-STAINED: HEAVY SMOKER
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PARONYCHIAPARONYCHIA
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NICOTINE STAINNICOTINE STAIN
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CLUBBINGCLUBBING
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CYANOSISCYANOSIS
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RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS
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ONICOMYCOSISONICOMYCOSIS
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EXAMINE THE HEAD AND NECKEXAMINE THE HEAD AND NECK
EYESEYES
–REACTION OF THE PUPILSREACTION OF THE PUPILS
– COLOUR OF THE SCLERACOLOUR OF THE SCLERA
– EXOPHTALMIAEXOPHTALMIA
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EXAMINE THE HEAD AND NECKEXAMINE THE HEAD AND NECK
EARS AND NOSEEARS AND NOSE
MOUTH, LIPS AND TONGUEMOUTH, LIPS AND TONGUE
NECK:NECK: – JUGULAR VEINSJUGULAR VEINS
– TRACHEATRACHEA
–THYROID GLANDTHYROID GLAND
– LYMPH NODESLYMPH NODES
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TRACHEATRACHEA
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LYMPH NODESLYMPH NODES
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LYMPH NODESLYMPH NODES
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NECK LUMPSNECK LUMPS
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NECK EXAMINATIONNECK EXAMINATION
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THYROID NODULETHYROID NODULE
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EXAMINE THE CHESTEXAMINE THE CHEST
INSPECTIONINSPECTION
– CYANOSISCYANOSIS
– RR AND RHYTHMRR AND RHYTHM
– CHEST EXPANSIONCHEST EXPANSION
– PARADOXICAL MOVEMENTPARADOXICAL MOVEMENT
– DEFORMITIESDEFORMITIES
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EXAMINE THE CHESTEXAMINE THE CHEST
PERCUSSIONPERCUSSION
– RESONANT SOUND- NORMALRESONANT SOUND- NORMAL
– HYPERRESONANCE- EXTRA AIRHYPERRESONANCE- EXTRA AIR
– DULNESS- PLEURAL FLUIDDULNESS- PLEURAL FLUID
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EXAMINE THE CHESTEXAMINE THE CHEST
AUSCULTATIONAUSCULTATION
– VESICULARVESICULAR
BREATHINGBREATHING
– WHEEZEWHEEZE – COARSE CRACKLESCOARSE CRACKLES
– FINE CRACKLESFINE CRACKLES
– PLEURAL RUBPLEURAL RUB
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PECTUS EXCAVATUSPECTUS EXCAVATUS
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KYPHOSISKYPHOSIS
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SCOLIOSISSCOLIOSIS
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CHEST EXPANSIONCHEST EXPANSION
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CHEST LANDMARKSCHEST LANDMARKS
OF THE LUNGSOF THE LUNGS
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CHEST ASCULTATIONCHEST ASCULTATION
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BREASTSBREASTS
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GYNECOMASTIAGYNECOMASTIA
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AXILLARY PALPATIONAXILLARY PALPATION
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LYMPHADENOPATHYLYMPHADENOPATHY
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EXAMINE THE HEART ANDEXAMINE THE HEART AND
CIRCULATIONCIRCULATION
MEASURE BPMEASURE BP
JUGULAR VEINSJUGULAR VEINSNECK ARTERIESNECK ARTERIES
TRACHEATRACHEA
HEARTHEART
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HEART LANDMARKSHEART LANDMARKS
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POINT OF MAXIMUM IMPULSEPOINT OF MAXIMUM IMPULSE
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HEART INSIGHTSHEART INSIGHTS
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EXAMINE THE ABDOMENEXAMINE THE ABDOMEN
POSITION OF THE PT.POSITION OF THE PT.
– SUPINE, SLIGHTLY FLEXED KNEES,SUPINE, SLIGHTLY FLEXED KNEES,
ARMS AT HIS SIDESARMS AT HIS SIDES
POSITION OF THE EXAMINERPOSITION OF THE EXAMINER
– AT RIGHT-HAND SIDE OF THE PT.AT RIGHT-HAND SIDE OF THE PT.
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EXAMINE THE ABDOMENEXAMINE THE ABDOMEN
PALPATIONPALPATION
– FLAT HAND FROM NON-TENDER AREAFLAT HAND FROM NON-TENDER AREA
– SUPERFICIALSUPERFICIAL
– DEEP TENDERNESSDEEP TENDERNESS
– NORMAL VISCERANORMAL VISCERA
– ABNORMAL MASSESABNORMAL MASSES
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EXAMINE THE ABDOMENEXAMINE THE ABDOMEN
INSPECTIONINSPECTION – SYMMETRYSYMMETRY
– MOBILITY WITH RESPIRATIONMOBILITY WITH RESPIRATION
– PAIN TO COUGHPAIN TO COUGH – DISTENSIONDISTENSION
– MASSESMASSES
– VISIBLE PERISTALSISVISIBLE PERISTALSIS – SKIN DISCOLORATIONSKIN DISCOLORATION
– SCARS, SINUSES, FISTULAS, STOMASSCARS, SINUSES, FISTULAS, STOMAS
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EXAMINE THE ABDOMENEXAMINE THE ABDOMEN
PERCUSSIONPERCUSSION
– LIVERLIVER
– SPLEENSPLEEN
– DISTENDED BOWEL- HYPERRESONANCEDISTENDED BOWEL- HYPERRESONANCE
– ASCITIS- SHIFTING DULLNESSASCITIS- SHIFTING DULLNESS
– STIMULATES VISIBLE PERISTALSISSTIMULATES VISIBLE PERISTALSIS
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EXAMINE THE ABDOMENEXAMINE THE ABDOMEN
AUSCULTATIONAUSCULTATION
– BOWEL SOUNDSBOWEL SOUNDS
– VASCULAR BRUITSVASCULAR BRUITS
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MANDATORYMANDATORY
PR EXAMINATIONPR EXAMINATION
PV EXAMINATIONPV EXAMINATION
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FOUR THINGS EASY TO FORGET:FOUR THINGS EASY TO FORGET:
– PALPATE SUPRACLAVICULAR NODESPALPATE SUPRACLAVICULAR NODES
– PALPATE HERNIA ORIFICESPALPATE HERNIA ORIFICES
– FEEL THE FEMORAL PULSESFEEL THE FEMORAL PULSES
– EXAMINE THE GENITALIAEXAMINE THE GENITALIA
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ASCITESASCITES
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CAPUT MEDUSACAPUT MEDUSA
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ABDOMEN DRAPINGABDOMEN DRAPING
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HEPATOMEGALYHEPATOMEGALY
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NORMAL ABDOMENNORMAL ABDOMEN
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NORMAL ABDOMENNORMAL ABDOMEN
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OBESITYOBESITY
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PALPATIONPALPATION
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ASSYMETRIC ABDOMENASSYMETRIC ABDOMEN
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UMBILICAL HERNIAUMBILICAL HERNIA
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PERCUSSIONPERCUSSION
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ABDOMINAL ASCULTATIONABDOMINAL ASCULTATION
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EXAMINE THE LIMBSEXAMINE THE LIMBS
BONES AND JOINTSBONES AND JOINTS
MUSCLES AND SOFT TISSUESMUSCLES AND SOFT TISSUES
ARTERIESARTERIES
VEINS AND NERVESVEINS AND NERVES
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EXAMINE THE LIMBSEXAMINE THE LIMBS
INSPECTIONINSPECTION
– COLOUR, SCARS, SWELLING,COLOUR, SCARS, SWELLING,
DEFORMITY, WASTING,DEFORMITY, WASTING,
PALPATIONPALPATION – TEMPERATURE, EDEMA, THICKENINGTEMPERATURE, EDEMA, THICKENING
MOVEMENTMOVEMENT
– ACTIVEACTIVE
– PASSIVEPASSIVE
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ARTERIESARTERIES
FEEL THE PULSESFEEL THE PULSES
LISTEN FOR BRUITSLISTEN FOR BRUITS
RECORD THE PULSES AND BRUITSRECORD THE PULSES AND BRUITS
ON A SIMPLE DIAGRAMON A SIMPLE DIAGRAM
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NERVESNERVES
MOTORMOTOR
SENSORYSENSORY
REFLEXESREFLEXES
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CELLULITISCELLULITIS
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DVTDVT
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EDEMAEDEMA
INGUINO CRURALINGUINO CRURAL
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INGUINO- CRURALINGUINO- CRURAL
LYMPH NODESLYMPH NODES
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FEMORAL ARTERY PALPATIONFEMORAL ARTERY PALPATION
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DORSALIS PEDIS ARTERYDORSALIS PEDIS ARTERY
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DORSALIS PEDIS ARTERYDORSALIS PEDIS ARTERY
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POSTERIAL TIBIAL ARTERYPOSTERIAL TIBIAL ARTERY
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POPLITEAL ARTERYPOPLITEAL ARTERY
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NEUROPATHIC ULCERNEUROPATHIC ULCER
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GANGRENEGANGRENE
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VENOUS ULCERVENOUS ULCER
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KNEE EFFUSSIONKNEE EFFUSSION
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INGUINAL HERNIAINGUINAL HERNIA
OC
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HYDROCELEHYDROCELE
PR EXAMINATION
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PR EXAMINATIONPR EXAMINATION
TESTICULAR EXAMINATION
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TESTICULAR EXAMINATIONTESTICULAR EXAMINATION
REMEMBER
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REMEMBERREMEMBER
MEASURE THE BP YOURSELFMEASURE THE BP YOURSELF
DO A RECTAL EXAMINATIONDO A RECTAL EXAMINATION
EXAMINE THE FEMALE BREASTSEXAMINE THE FEMALE BREASTS
CHECK WEAK POINTS OF THECHECK WEAK POINTS OF THE
ABDOMEN FOR SMALL HERNIASABDOMEN FOR SMALL HERNIAS
ADVISES TO MEDICAL STUDENTSADVISES TO MEDICAL STUDENTS
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ABOUT GOOD HEALTHABOUT GOOD HEALTH
TO DOTO DO
– GET HELP WHEN YOU NEED IT, BEGET HELP WHEN YOU NEED IT, BE
HONEST, AVOID WRONG INFORMATIONHONEST, AVOID WRONG INFORMATION
– DO LAB. TESTS FOR HEPATITIS B,CDO LAB. TESTS FOR HEPATITIS B,C
– REGULAR MEALS AND MODERATEREGULAR MEALS AND MODERATE
ALCOHOL INTAKEALCOHOL INTAKE
– DO PHYSICAL ACTIVITIES, AVOIDDO PHYSICAL ACTIVITIES, AVOIDSTAYING IN FRONT OF YOUR LAPTOPSTAYING IN FRONT OF YOUR LAPTOP
FOR AGESFOR AGES
ADVISES TO MEDICAL STUDENTSADVISES TO MEDICAL STUDENTS
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ABOUT GOOD HEALTHABOUT GOOD HEALTH
TO DOTO DO
– DO PHYSICAL ACTIVITIES, AVOIDDO PHYSICAL ACTIVITIES, AVOID
STAYING IN FRONT OF YOUR LAPTOPSTAYING IN FRONT OF YOUR LAPTOPFOR AGESFOR AGES
– BE INTERESTED NOT INTERESTING ANDBE INTERESTED NOT INTERESTING AND
USE YOUR SENSE OF HUMOURUSE YOUR SENSE OF HUMOUR
– ENGAGE IN SOCIAL ACTIVITIES WITHENGAGE IN SOCIAL ACTIVITIES WITH
YOUR FAMILY, FRIENDS AND COMUNITYYOUR FAMILY, FRIENDS AND COMUNITY
ADVISES TO MEDICAL STUDENTSADVISES TO MEDICAL STUDENTS
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ADVISES TO MEDICAL STUDENTSADVISES TO MEDICAL STUDENTS
ABOUT GOOD HEALTHABOUT GOOD HEALTH
NOT TO DONOT TO DO
– SMOKESMOKE
– USE NOT PRESCRIBED DRUGSUSE NOT PRESCRIBED DRUGS
– IGNORE YOUR FAMILY AND FRIENDSIGNORE YOUR FAMILY AND FRIENDS
WHILE SERVING OTHERS OR MEETINGWHILE SERVING OTHERS OR MEETING
THEIR DEMANDSTHEIR DEMANDS – IGNORE YOUR OWN NEEDS FORIGNORE YOUR OWN NEEDS FOR
PERSONAL AND INTELLECTUAL GROWTHPERSONAL AND INTELLECTUAL GROWTH