Physical examination- inspection Internal Medicine 3rd year. Dr. Székely Hajnal

Transcription

1 Physical examination- inspection Internal Medicine 3rd year Dr. Székely Hajnal

2 Inspection The book recommends examining the patient from the patient s right side Often you will need to examine the supine patient rolling. Goal: is to visualize one area of the body at a time. This preserves the patient s modesty but also helps you to focus on the area being examined

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6 Build - obesity

7 The head The Hair - note its quantity, distribution, texture, and pattern of loss, if any. Fine hair in hyperthyroidism; coarse hair in hypothyroidism

8 The scalp look for scaliness, lumps, nevi, or other lesions

9 The skull size contour Note any deformities, depressions lumps Enlarged: hydrocephalus, Paget s disease of bone. Tenderness after trauma.

10 The face Note the patient s facial expression and contours. Observe for : asymmetry involuntary movements edema, masses

11 The face Acromegaly Myxoedema

12 The face Cushing sy. Parkinson s disease parotis gland enlargement

13 The skin Pigmentation Hair distribution Lesions. Acne

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15 The eyes Exo/enophtalmus Conjunctiva and sclera pupils extraocular movements, strabism (convergent, divergent)

16 Eyebrows: Note their quantity, distribution and any scaliness of the underlying skin. Scaliness in seborrheic dermatitis; lateral sparseness in hypothyroidism

17 The eyelids Note the position of the lids in relation to the eyeballs. Inspect: Width of the palpebral fissures Edema of the lids Color of the lids Lesions Condition and direction of the eyelashes Adequacy with which the eyelids close.

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19 Pupils Inspect:size, shape, and symmetry Miosis: constriction, mydriasis: dilation. Anisocoria Reactions: ask the patient to look into the distance, shine a bright light obliquely into each pupil. The direct reaction (pupillary constriction in the same eye) The consensual reaction (pupillary constriction in the opposite eye

20 The ears Inspect each auricle and surrounding tissues for deformities, lumps, or skin lesions. Structure, symmetry, size, discharge tophus,rheumatoid nodules

21 The nose Inspect: anterior + inferior surfaces of the nose Shape, size, lesions, inflammation, deformity, edema. Epistaxis, discharge Pen light and nasal speculum

22 The mouth and pharynx The Lips. Observe: color (cherry-co poisoning pale:anaemia, cianotic: respiratory /cardiac diseases) Note: lumps, ulcers, cracking, or scaliness. Cheilitis angularis, Herpes simplex, Angiooedema, Peutz Jeghers sy., Hereditary haemorrhagic teleangiectasia

23 The Oral Mucosa color, ulcers, white patches, nodules The Gums and Teeth - note:color. Redness of gingivitis, black line of lead poisoning Inspect: gum margins and the interdental papillae

24 Oral cavity, tongue

25 The tongue Inspect for symmetry a test of the hypoglossal nerve (Cranial Nerve XII). Note: color and texture of the dorsum of the tongue.

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32 Inspection - thorax Shape Chest movement Simmetry Respiratory rate, rythm Breathing pattern

33 Asthenic chest Barrel chest

34 Pectus carinatum

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38 Examination of the abdomen Position the patient supine on an examining table or bed. The head and knees should be supported with small pillows + bended knees- for comfort and to relax the abdominal wall musculature arms should be at the sides and not folded behind the head, as this tenses the abdominal wall. Good lighting is essential.

39 Inspection of the abdomen Size, shape, level of the abdomen in relation to the level of the chest abdominal wall skin surgical scars correlation with the patient's recollection of previous operations striae, stretch marks enlarged veins bluish discoloration of the umbilicus (Cullen's sign) or flanks (Grey Turner's sign) umbilicus hernia sites

40 9 regions of the abdomen

41 Inspection of the abdomen

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43 Inspection of the abdomen

44 Inspection of the abdomen

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47 Abdominal masses inspected from several angles. differentiate abdominal wall from intra-abdominal masses abdominal wall mass - more prominent with tensing of the abdominal wall musculature, whereas an intraabdominal mass will become less prominent or disappear. Abdominal wall masses - most commonly hernias (umbilical, epigastric, incisional, or spigelian), neoplasms (benign and malignant), hematomas. mass examined for: movement with respiration or for pulsation with each heartbeat, for peristalsis, as it may well represent dilated bowel.

48 Inspection of the abdomen

49 Inspection of the abdomen the abdominal wall should be observed for motion with respiration. the abdominal wall moves posteriorly in a symmetrical fashion with inspiration. Peritonitis - localized or generalized rigidity of the abdominal wall so that this motion is absent.

50 Inspection of the abdomen

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52 Inspection- joints