CLINICAL SKILLS UNIT

EDUCATIONAL LOOPS

BY

CHSE

CSP 020401

GENERAL EXAMINATION

FIRST IMPRESSIONSFIRST IMPRESSIONS

How sick does the patient appear ?

- lying in bed

- sitting up in bed

- walking around

Hair distribution

Body habitus

Posture

HYDRATIONHYDRATION

• approximate estimation

• mild, moderate, severe

Signs: -skin turgor (supraclavicular / back of the hand)

- mucous membranes

- sunken orbits

- collapsed veins

- dry cracked lips

VITAL SIGNSVITAL SIGNS

• Blood pressure

• Pulse

• Respiratory rate

• Temperature

FACIESFACIES

• AcromegalyAcromegaly

• Cushing’sCushing’s

• Down syndromeDown syndrome

• Marfan’sMarfan’s

• Mitral faciesMitral facies

• Turner’sTurner’s

• ThyrotoxicThyrotoxic

Etc. etc. etcEtc. etc. etc

Acromegaly

Cushing’s

Thyroid stare

HANDS & NAILS

• abnormalities

• muscle wasting

• temperature

• sweating

• shape

• infection

Splinter haemorrhages

Koilonychia

Clubbing

Leuconychia

HEAD and NECKHEAD and NECK

1.1. EYESEYES

arcus senilusarcus senilus

xanthelasmaxanthelasma

jaundice jaundice (serum bilirubin > 2x upper limit normal; elastin)(serum bilirubin > 2x upper limit normal; elastin)

pallor pallor (anaemia)(anaemia)

cataractscataracts

drooping eyelidsdrooping eyelids

xanthelasma

HEAD and NECK

2. MOUTH2. MOUTH

central cyanosis

pallor (mucous membranes; frenulum)

angular cheilitis (Fe deficiency)

smell: sweet breath – liver failure

acetone - DKA

cigarettes

Deoxygenated Hb

> 50g/L bluish tinge

NECK

1.1. LYMPH NODESLYMPH NODES

1 sub-mental

2 sub-mandibular

3 cervical (jugular chain)

4 supra-clavicular

5 posterior triangle

6 post-auricular

7 pre-auricular

8 occipital

NECK

1.1. THYROIDTHYROID

Inspection: scars, swelling, mass

Palpation: enlarged / mass swelling

NECK

AXILLARY NODESAXILLARY NODES

A – central / apical

B – lateral / brachial

C – medial / pectoral

D – infraclavicular

E – subscapular / posterior

LYMPH DRAINAGE OF GROIN REGION

1. Horizontal or inguinal group

inguinal ligament

2. Femoral or vertical group

femoral vessels

The lower limb.

From buttocks and back, Lower abdomen, umbilical region, penis, perineum, lower vagina and anus

EDUCATIONAL LOOPS

BY

CHSE