Surgery

Dr: Ebtisam
8-Oct-06 Lec: -2-

GENERAL EXAMINTION
Introduction

 Repetition is the secrete of learning.

 Looking for signs which will confirm the tentative diagnosis

 Learning from talking to the patient

 Hold the patient hand and examine it Pulse…Nails…Temp….Moisture…

ColorCallosities
 Vital signs

 Inspect the head and neck

 Cyanosis, Plethora, Dyspnoea, Xanthoma, Arcus senalis, Jugular venous pressure
 Eyes, Nose, Mouth, Trachea, Visible lumps
 Look for oedema
 Inspect the abdomen
 Inspect the limbs.

EXAMINATION OF A LUMP

 Position.
 Colour and texture of overlying skin
 Temperature
 Tenderness
 Shape
 Size
 Surface
 Edge.

Composition [solid. Cystic. Gas]

1. Consistency
2. Fluctuation
3. Fluid thrill
4. Translucency
5. Resonance [Dull. Resonant ]
6. Pulsatility.
7. Compressibility.
8. Bruits.

1
 9. Reducibility

 Relations to surrounding structures.

 State of regional lymph glands.

 State of local tissues.

 General examination.

EXAMINATION OF AN ULCER

 Position.
 Colour.
 Tenderness.
 Temperature.
 Shape.
 Size.
 Base.
 Floor.

 Edge.

1. Sloping edge [Inflamatory.Venous ]

2. Punched out edge [Syphilitic.Neuopathic.Diabetic.Leprosy ]
3. Rolled edge [B C C]
4. Undermined edge [ T.B ]
5. Everted edge [Ca.]

 Depth
 Discharge
 Relations.
 Local lymph glands.
 State of local tissues.
 General examination.

2
EXAMINATION OF HEAD AND NECK

Inspection and palpation

a-The Colour

*pallor (anemia)

*cyanosis ( central ,peripheral)

*polycythemia

*jaundice

*others ;

1-brown pigmentation; ..addisons disease.. pregnancy.. café au lait patch.. melanoma.

2-vitiligo

b-General appearance

1-normal body build (wasted, overweight)

2-disease affecting facial appearance
• Bells palsy
• parkinsonism disease
• Scleroderma
• others

c-Jugular venous pressure.

d-Look for thyroid enlargement

e-Look for lymph node enlargement

f-Look for any abnormal lump

3
g-Examine the eye;

1-arcus senilis
2-xanthelasma (xanthoma)
3-exophthalmus
4-subconjunctival hemorrhage
5-periorbital hemorrhage
6-Horners syndrome
7-others; reaction of the pupils to light… accommodation… eye movement…corneal
or lens opacities …visual acuity …visual field…the fundi….

h-Examination of the nose;

1-saddle nose
2-rhinophyma.

i-Examination of the ear;

1- bat ears
2-cauliflower ears
3-keloid nodules
4-accessory auricle

• NB/don't forget to examine the external auditory canal and the ear drum.

j-Shape of the skull;

1-hydrocephalus (congenital, acquired)

2-multiple sebaceous cysts (cocks peculiar tumor)

k-Examine of the salivary gland;

*submandibular salivary gland;

submandibular calculi.
*parotid gland;
- mumps (epidemic viral parotitis)
-pleomorphic adenoma( mixed parotid tumour)
-carcinoma of parotid gland

4
l-Examine the mouth;

Introduction/
• retract the lips to see the buccal mucosa.
• push the check outside to see the buccal side of the gum.
• Look for floor of the mouth.
• Look for posterior third of the tongue.
• Depress the tongue to see the fauces , tonsils , and pharynx.

• NB/always palpate the structures in the mouth bimanually—using gloves.

Congenital abnormalities of the lips and palates;

• cleft lip and palate.

The lips , buccal mucosa , and tongue;

* mucus retention cyst /extravasations.
* stomatits; local trauma.. , local infection.. , general condition.., vitamin
deficiency.. ,blood disease .., immunosuppression, drugs , debility.
* syphilis
* chronic superficial glossitis.

* carcinoma of the lip; premalignant condition.., symptoms.. , lymphatic drainage..., The

distribution of carcinoma of the lips.

*carcinoma of the tongue; premalignant condition.., symptoms.., lymphatic drainage.

* the tonsil; acute tonsillitis.., carcinoma of the tonsil.., lymphosarcoma of the tonsil..,
Peritonsillar abscess (Quincy)

* the floor of the mouth;

Ranula.., sublingual dermoid cyst.., stone in Wharton's duct.

m-The neck;
• enlarged lymph gland (infection , secondary tumour deposits)
• branchial fistula or sinus
• carotids body tumour
• cystic hygromata
• pharyngeal pouch.
• sternomastoid tumour
• thyroglossal cyst
• the thyroid gland

5
Written By:
Rand Aras Najeeb