Professional Documents
Culture Documents
Physical Examination
Physical Examination
General Inspection
Nails
Palm of hands
- Muscle wasting (hypothenar & thenar), temperature (warm/ cold), nicotine stain,
callus, Osler node, Janeway lesion
Osler nodes are painful, on the finger tips. Janeway lesion is on the palm. They are
lesions of bacterial endocarditis
Radial pulse
- report pulse, rhythm, volume, compare the radial pulse on both hands and is there
any radio-radio delay
Brachial pulse
- If sphygmomanometer is provided, I will measure the BP. If not, the omit this part.
Eye
Mouth
- The height of JVP is _cm above the water level when patient is lying 45° pop up.
Carotid pulse (ask patient to turn to left and right) and palpate the pulse
- Any pigmentation
2) Palpation
Apex beat thrills- loud murmurs that can be felt by vibration (4 areas) left
parasternal heave (must ask the patient to hold his breath and continue breathing
after you have done) carotid pulse (ask patient to turn to the left and right- located
anteriorly and medially to the sternocleidomastoid muscle)
- Apex beat is felt at the 5th ICS left mid-clavicular line; there is no thrills, no
parasternal heave felt
3) Auscultation
Mitral stenosis (ask patient to lean towards his left side, auscultate with bell)
Aortic murmurs “Right” (ask patient to sit up and lean forward, hold his breath when
auscultate)
Carotid bruits (use bell to auscultate – patient should hold his breath)
Auscultate lung bases for any fluid retention in Acute Heart Failure and pulmonary
oedema
- No sacral edema
Leg
Pitting edema
General Inspection
Inspection of Leg
Any thin and shiny skin, any hair loss, scars of previous healed ulcer, varicose veins,
foot ulcers (mainly on dorsum, but check between and under toes), color of the leg-
pale or dusky red, gangrene
Nails
Buerger’s Test
Ask patient to lie in supine position for 5 to 10 minutes and lift the leg vertically up to
450 for 1-2 mins and observe colour of the foot.
- No colour change is observed (if foot become pale and veins form “gutters” -PVD)
Then, ask patient to sit up and hang the legs on the edge of the bed, observe for 2-3
mins. Color of the foot will become gradually red reactive hyperemia (note the time
taken to change the colour from pale to red)
Feel for temperature with the dorsum of your hand from foot up to leg and compare
with other side
- The temperature for both legs are warm and equal
Pulse
i) dorsalis pedis – on the dorsum of the foot, lateral to the extensor halluces longus
on the mid foot
iv) femoral – midpoint between the anterior superior iliac spine and pubic symphysis,
just below inguinal ligament
v) abdominal aorta – 2-3cm above the umbilicus, half way between umbilicus and
xiphisternum – use deep palpation technique to assess the width of vessel
Auscultation
General Inspection
Inspection of Leg
Any thin and shiny skin, any hair loss, scars of previous healed ulcer, varicose veins,
venous ulcer, swelling, foot ulcers (mainly on dorsum, but check between and under
toes), color of the leg- pale or dusky red, gangrene
Look for enlarged torturous veins along the course of superficial veins and at the
groin & knee
Normally BP in the arms and legs should be the same. If obstruction systolic
pressure in the limb reduced hard to listen by stethoscope use doppler
ultrasound to listen blood flow
Interpretation:
Normal > 0.9 ; Arterial disease 0.8-0.9 ; Severe arterial disease <0.5
General Inspection
Nails
Palm of hands
- Muscle wasting (hypothenar & thenar), temperature (warm/ cold), nicotine stain,
callus
Radial pulse
- report pulse, rhythm, volume, compare the radial pulse on both hands and is there
any radio-radio delay
Brachial pulse
- If sphygmomanometer is provided, I will measure the BP. If not, the omit this part.
Eye
Nose
Mouth
Neck
Trachea alignment
- There is no trachea deviation since the paratracheal space for both sides are equal.
- Any pigmentation
* Chest movement (at the end of the bed) – The chest rises up when patient is
breathing in and move down when breathing out. The chest movement for both sides
are equal and symmnetrical
2) Palpation
- Chest expansion – ask patient to breath in and out; clavicle, above and below
nipple
- Tactile fremitus – ask patient to say 99; apex of the lung, 2 areas above nipple, 1
below, and 2 on lateral sides
(The resonance is felt and equal on both sides)
3) Percussion
- apex of the lung clavicle 2 areas above nipple area below nipple 2 on
lateral sides
4) Auscultate
- apex of the lung clavicle 2 areas above nipple area below nipple 2 on
lateral sides
(Good air entry, vesicular breath sounds are heard, there is no additional sound)
General Inspection
Vital signs
∞ Type
-Pulse, respiratory rate and temperature ∞ Shape and margin
∞ Arrangement
Skin
∞ Distribution
i) Types
iii) Arrangement
- Group: annular, linear, herpetiform, zosteriform
iv) Distribution
Mucous membranes
-White striation (Lichen planus), hairy leukopenia (HIV), Koplik’s spot (measles)
Palpation (using the pulps of the fingers to palpate one side at each time)
Report: any tenderness felt, pain at which site and cervical lymph node
Palpation (using the pulps of the fingers to palpate one side at each time)
Report:
v) tenderness