Clinical examination

Equipment required for a full

examination
Stethoscope
Pen torch
Measuring tape
Opthalmoscope
Otoscope
Sphygmomanometer
Tendon hammer tuning fork
Cotton wool

wooden spatula
thermometer
magnifying glass
disposable gloves

Clinical examination
General examination
Systemic examination

Inspection
Palpation
Percussion
auscultation

A personal system for performing a physical examination

Handsake and introduce
Note general appearances while talking
Does the patient look well
Any immediate or obvious clues egobesity,plethora,breathelessness
Complexion

Face
Mouth and ears
Neck
Thorax,abdomen

Information from a handshake

Features

Cold,sweaty hands

Cold ,dry hands

Hot ,sweaty hands

Large ,fleshy,sweaty hands

Dry coarse skin

Deformed hands/fingers

Diagnosis

Raynauds phenomenon

Hyperthyroidism

Anxiety

Acromegaly

Manaul occupation ,hypothyroidism

Trauma,rheumatoid arthritis

Abnormal facial expression

Features

Diagnosis

Parkinsonism

Poverty of expression

Apathy with poverty of expression and poor eye contact

Apathy with pale and puffy skin

Agitated expression

Depression

Hypothyroidism

Anxiety ,hyperthyroidism,hypomania

Clothing
Clothing gives clues about personality,state of mind and
social circumstances
Young people wearing dirty clothes may have problems
with alcohol or drug addiction
Elderly pts with faecal or urinary soiling may be unable
to look after themselves because of physical
disease,immobility,dementia and other mental disease

General examination:
Anaemia/pallor
Defination
Common causes
Best seen in mucus membrane of conjunctivae,lips
,tongue and in nail beds
Angular stomatitis and koilonychias are the features of
iron deficiency anaemia

Cyanosis
Cyanosis is a bluish discoloration of the skin and mucus
membranes that occurs when absolute concentration of
deoxygenated haemoglobin is increased.
Types:central and peripheral
Central
Seen in lips and tongue
Causes:cardiac and pulmonary diseases

Peripheral cyanosis
Seen in hands ,feet or ear lobule
In cold condition

Jaundice/icterus
Yellowish discoloration of skin and mucus membrane
due to increase in bilirubin level
Upper sclera,mucus membrane and skin
Hypercarotenaemia
It occurs in patients who eat large amount of raw
carrots and tomatoes and in hypothyroidism
Seen in face palm and sole but not the sclera

Examination of hands
Deformity
In long standing rheumatoid arthritis swan neck
deformity and ulnar deviation of metacarpophalangeal
joint
Long thin fingers are typical of marfans syndrome
Trauma is the most common cause of hand deformity
Colour
Look for cyanosis in the nail bed and tobacco staining of
fingers

Clubbing
Clubbing is a painless soft tissue swelling of the terminal
phalanges
Causes of clubbing
Thoracic:lung cancer,bronchiectasis,lung
abscess,empyema,cystic fibrosis
Cardiovascular:cyanotis congenital herat
disease,infective endocarditis
Gastrointestinal:cirrhosis,inflammatory bowel
disease,coeliac disease

Examination
Look across the nail bed from the side of each finger
Observe distal phalanges,nail and nail bed
Place the nails of corresponding fingersback to back and
look for a visible gap between the nail beds-schamroths
window
Fluctuation test

Features to note in any lump or

swelling
Size
Position
Attachments
Consistency
Edge
Surface and shape
Signs of inflammation-redness,tenderness,warmth

lymph node
Normal nodes in adults are <0.5cm
Normal consistency is soft

Dehydration

Weight and height

Body mass index:weight/height2(wt in kg/m2)
Normal BMI:18.5-22.9(Asian),18.5-24.9(non-Asian)

Odema
Oedema is tissue swelling due to increase in interstitial
fluid .
Mechanism of oedema:

Decreased oncotic pressure

Increased hydrostatic pressure
Increased capillary permeability
Lymphatic obstruction

Vitals
Measuring blood pressure
Pulse
Respiratory rate
Temperature