Adult General Physical Examination

Dr. Seyed Morteza Mahmoudi, MBBS

Gulf Medical University, Ajman2013

Making use of all our senses, Except?

Initial Steps

1- Greet

Initial Steps

2- Introduce yourself

Initial Steps

3- Make sure you have the right patient

Initial Steps

4- Explain

Initial Steps

5- Make sure the environment is appropriate

Initial Steps

6- Consent

Initial Steps

7- Wash hands, safety precautions

Initial Steps

8- Drape and adequately expose

Initial Steps

9- If necessary get a chaperon

Initial Steps

10- Ask about pain

Steps 1- Greet

2- Introduce yourself

3- Make sure you have the right patient

4- Explain

5- Make sure the environment is appropriate

6- Consent

7- Wash hands, safety precautions

8- Drape and adequately expose

9- Chaperon

10- Pain consideration

Start your physical examination as soon as

you see the patient

Physical Examination Hand shakeBody built Face ClothingComplexionSoundsOdorsPosture and gaitMovementsSpot diagnosis

Useful Pneumonic PallorEdemaNail changes/clubbingCyanosisIcterus Lymph nodesSkin changes

SCHAMROTH’S WINDOW TEST

CAUSES OF CLUBBINGcyanotic congenital heart diseaseSub acute bacterial endocarditislung carcinoma bronchiectasisEmphysemalung abscesslung fibrosis Pulmonary TuberculosiscirrhosisIBDCeliac disease Thyrotoxicosis Familial

CAUSESCENTRAL CYANOSISAbnormal hemoglobin

levels Congenital heart

diseaseHypoventilationAsthmaMethmoglobinemia Valvular heart diseaseCOPD

Pulmonary embolismArterial obstructionHeart failureRight to left venous

arterial shuntsHigh altitudesPolycythemia

PERIPHERAL CYANOSISExposure to cold

Reduced cardiac output

Arterial or venous obstruction

Skin ChangesDry & inelasticMoistThickened and greasy Atrophied ColourDupuytren's contractureRashesSwellingsHemorrhagesHair

Nail Changes

KoilonychiasOnycholysis Pitting Splinter hemorrhages

Lymph node ExaminationCervical

Sub mental -Submandibular – Tonsillar (Jugulodigastric)- PreauricularPostauricular Occipital Superficial (Anterior) Cervical Posterior cervicalSupraclavicular

AxillaryInguinal

Massive lymphadenopathy

Tuberculosis Lymphadenopathy