Physical diagnosis:General Examination

Dr. Mohammad Shaikhani.mshaikhani_@hotmail.com

Introduce yourselfShake hands.Normal grip.Weak grip:Paralysis,Ill health,Depression.Slow relaxing grip:Myotonia Dystropfica.Comfortness:Comfortable. Mood.Distressed:Dyspniec.Orthopniec: dyspnea on lying down from pulm edem.Acidotic breath(deep sighing respiration or air hunger):Renal failure/Diabetic ketoacidosis/Lactic acidosis/Alcoholic ketoacidosis/Aspirin poisoning.Chynes sokes respiration(apnea-hyperpnea cycles):Head injury/Cerebral hemorrhage/Heart failure.

Body built:Normal.Obese.Cachectic:Cancer/Malnutrition/Malabsorbtion/Thyrotoxic/DM.Body habitus:Normal.Short:Familial/GH def/Celiac/Achondroplasis/Chronic disease /Turner.Gigant.Marfanoid.Signs of dehydration:Sunken eyes/Dry tongue/Loss of skin turgor.Personal hygiene.

Position in bed:NormalRestless:Renal,biliary & intestinal colic. In pain & can not move: peritonitis.Shocked: pale, cold extremities, oliguric,hypotension, dull sensoriumCan not move:Peritonitis/Arthritis/Paralysis.Head:Normal.Hydrocephalus.Microcephaly.Scalp:Rash (herpes zoster opthalmicus, psoriasis, seborrhea).Infection(tinea capitis & impetigo).Temporal resetion( sign of weight loss).Tender temporal artery(temporal artritis).Depressed fracture.Lipomas.

Eyes:Exopthalmus:Thyrotoxicosis.COPD.Alcoholism.Retrobulbar tumour.Enopthalmus:Horner syndrome.Periorbital oedema:Nephrotic.Real failure. Glomerulonephritis. Hypothyroid.Xanthomas.Artificial eye.Ptosis:Occulomotor palsy.Myasthenia gravis.Horner syndrome.Ears:Red & tender:Otitis externa.Relapsing polychondritis.Tophi(gout).Herpes zoster rash+ facial palsy(ramsi-hunts syndrome).

Conjunctiva:

Pallor:Anemia.Shock.Heart failure,hypopituitirism.Plethoric:Polycythemia.Superior vena caval obstruction.Hemorrhage:Trauma.Hypertension.Bleeding tendencies.Sclera:Yellow(jaundice).Blue(osteogenesis imperfecta).Cornea:Opacity.Lens: cataract.Lens dislocation.Marfan.Homocysteinrea.Ulcer: herpetic keratitis.Archus senilis or lipidicus.Kayser flesher ring(Wilson)

Facial features:Hypothyroid face.Thyrotoxic face/Acromegalic face.Hypopitutaric faceCushing face.Thalacemic face(mongoloid).Down face(mongoloid).Uremic face(earthy coloure):Anemia.Urochrome retention.Hemociderosis.Sclerodermic face.Sturg Weber (facial hemangioma).Cheeks:Malar flush(MS).Butter-fly rash( SLE).Coalasma(pregnancy).Nose:Rodent ulcer.Saddle-shaped(congenital syphilis).Parrot-peaked nose(scleroderma).Lips:Hare lip.Cyanosis.Talangiectasia or spiders.Pigmentation(Peutz-jagger syndrome).Herpes labialis, angular stomatitis( Vit def).

Facial features:

Facial features:

Facial features:

Mouth & tongue:

Puckered mouth(scleroderma).Tongue cyanosis.Frenulum pallor or yallowness.Gum hypertrophy:Myelogenous leukemia.Epilepsy.Nifedipine.Tongue fasciculations(motor neuron disease).Smooth tongue (iron & vitamins dificiencies).Painless ulcers (SLE, sero negative arthritis).Painful aphthus ulcer(idiopathic or Behcet disease).Petichae or echemosis.Monilia infection of tongue.Leukoplakia.Tonsils:Normal.Enlarged.Infected.Mouth odor: alcohol, uremic fetor,hepatic fetor

Neck:

Goiter.Lymph nodes & other lymph node groups.Vascular pulsation.Short with webs(Turner syndrome).Breasts:Female breasts:Normal.Mass or thickenings or nodularity.Male breasts: Normal.Mass.Gynecomastia:Liver cirrhosis.Drugs as spirinolactone,oestrogen. Puberty.Old age.Hypogonadism.Thyrotoxicosis. Tumours (testicular,adrenals,lung)

Chest:

Obvious chest deformities & scars.Dialated veins or arteries.

Abdomen:

Distended or not.Rashes & discolorations.Abnormal pulsations.Dilated veins.

Pancreatitis:Cullen & turner signs.

Hands:

Tremor:Rest(parkinsonism).Action(anxiety,thyrotoxic or familial)Flapping(transient laps in maintained posture):organ failure.Chorea:Rheumatic.Huntington.SLE.Pregnancy.Oral contraceptive.Drugs as phenothiazines.Polycythemia.Cerebral pulsy(chorioathetosis).Wasting.Wrist drop(radial nerve pulsy).Claw hand(ulnar nerve pulsy).Duptryn contracture:Liver cirrhosis.Occupational.Idiopathic.RARheumatoid hand:Swan neck.Boutonniere.Heberdon nodes(distal IP joints in osteoarthritis).Tophi in gout.Osler nodes(SBE).Warm hands.Wet hands.Cold hands.Tendons & palmar xanthomas.Raynauld phenpmena.Pale creases(anemia)

Hands:

Nails:

Nails clubbing(lung,liver,cyanotic heart,intestinal &inflammatory bowel diseases).what degree?1.increased base flactuation.2.loss of nail angle.3.increased curvature.4.drum stick.Confirm clubbing by Shamruth sign:Absence of rectangular space on coinsiding corresponding nails of both hands).Cholenychia or spoon nails(flat or concave in iron dificiency).Splinter sunangual hemorrhage(SBE,trauma,valculitis,trichinliasis).White nails:Hypoalbuminemia.Severe chronic illness.Nail pitting in psoriasis.Transverse depression in nails(Beaus lines):Acute severe illness.Onycolysis(elevation of nail end):Thyrotoxicosis.Chronic nail disorders.

Hands:

Scleroderma hand.Acromegaly.Short metacarpals(hypoparathyroid)Tetany:Hypocalcemia.Hyperventilation.

Legs:

WastingPseudohypertrophy(Hereditary Dushein muscular dystroohy).Swolen&tender(DVT).Ulcers.Erythema nodosum(tender red painful nodules):TB.Streptococcal infections.Sarcoidosis.IBD.Behcet disease.Varicose veins.Coldness in ischemia(compare with other side).Ankle edema:Pitting:Heart failure.Renal failure.Nephrotic syndrome.Liver cirrhosis.Malnutrition.Non-pitting:Lyphedema.

Legs:

Rashes:Petichae or echemosis, vasculitic rash.Hair changes.Feet:Edema.Swelling.Flat foot.Pes cavus(friedricks ataxia).Rheumatoid foot.Swollen big toe(gout).Ulcers.Gangrene.Achilis tendonitis(sero –ve arthritis).Cold in ischemia(compare with other side).Diabetic foot ulcers or gangrene.Clubbing of toe nails.

Legs:

Joints:

Small &large joints.Swelling.Deformity.Tenderness.Hotness.Restricted movements.Skin:Scratching marks( pruritis,obstructive jaundice)Rashes.Talangiectasia & spider nevi.Petichae & echemosis.Neurofibromas.Vitiligo patches.Allopacia areata or totalis.Hemangiomas.Herpes zoster.Xeroderma.Rose spots(typhoid).Xanthomas.Albinisim.Vital signs: PR,BP,RR,TempTemperature:Oral .Axillary.Rectal.