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Clinical Practical Cont - Assessment 2
Clinical Practical Cont - Assessment 2
General overview:
Conscious level
Appearance
Body built
Colours (complexion)
Decubitus
Facial expressions
Vital signs:
Pulse BPTR
Blood pressure
Respiratory rate
Temperature
Systemic overview:
Head & neck
Upper limbs (hands)
Lower limbs (feet)
1- Conscious level:
Alertness, orientation (time, place & person), mood (= emotional state,
depression, euphoria), memory (near & far events), intelligence (IQ test, the
patient & the doctor can understand each other) and behaviour.
Normally: The patient is fully conscious, oriented to time, place & persons,
cooperative and of average mood, memory & intelligence.
Conscious level is impaired (disturbed) → confusion/ coma in neurological
disorders (cerebrovascular stroke, meningitis, Alzheimer disease) and major
organ failure (liver, kidney, respiratory failure)
2- Appearance:
Normally: looks well
Abnormally: looks ill
Ill & toxic: in chronic infection (tuberculosis, infective endocarditis,
thyrotoxicosis)
Ill & cachectic: malignancy
Body height:
Height: the distance between the occiput to the heels in the standing upright
position
Span: the distance between the tips of the fingers in the outstretched hands
Normally: the body height is nearly equal to the span (proportionate)
Upper body segment: the distance from the occiput till the symphysis pubis
Lower body segment: the distance from the symphysis pubis till the floor
Normally the upper body segment equals the lower body segment
Short stature (dwarfism) causes: pituitary gland hypofunction,
hypothyroidism in children (cretinism)
Tall stature: as in pituitary gland hyperfunction in children ((gigantism)
4- Complexion (Colours):
Pallor
Jaundice PPJC
Cyanosis
Pigmentation
Pallor: decreased visibility of oxyhemoglobin in blood vessels
Sites of examination:
Inner aspect of lips.
Tongue
Skin of the face.
Nails.
Inferior fornix of the conjunctiva
Palmar creases
Causes of pallor:
Anemia.
Shock
Toxemia e.g. infective endocarditis.
Edema of the face e.g. nephrotic syndrome, myxedema
Hyperpigmentation
4- Decubitus:
It is the position of the patient in bed
Normally, the patient lies flat & comfortable in bed without dyspnea or pain
Abnormal positions:
Orthopnea:- Semi setting position, due to left-side heart failure,
COPD, massive ascites, morbid obesity
Squatting position: In Fallot's tetralogy (cyanotic congenital heart
disease)
The prayer’s position: pericardial effusion, pancreatitis
Lateral Position in chest diseases: pleurisy, lung abscess
Dorsal position (flexed knees & hips) with abdominal rigidity:
peritonitis, appendicitis
Squatting position Prayer position
Malar rash
General Examination – Part III
6- Vital Signs:
A- Pulse:
Pulse Rhythm: you should know it first before counting the rate. It is either
regular or irregular
Plateau pulse:
Definition: slow ascending and slow descending with low amplitude.
Causes: Aortic stenosis, left ventricular failure (LVF)
Pulsus paradoxus:
Definition: exaggerated drop of the systolic blood pressure during
inspiration (more than 10 mm Hg)
Causes: pericardial tamponade, COPD, congestive heart failure
Detection: Measure B.P. during inspiration & during expiration.
Pulsus deficit:
Definition: Pulse rate at the apex of the heart is more than the rate of
the radial pulse
Mechanism: Contraction of an empty ventricle (so some weak beats
are unable to reach the radial artery).
Causes: A.F >10 bpm, multiple extrasystoles < 10 bpm.
- Abnormal finding in which the pulse of the femoral artery is weaker &
delayed in comparison to the radial artery when they are felt simultaneously.
- Caused by Coarctation of aorta
The patient’s pulse is 75 beat/min., regular, average volume, equal on both sides,
no special character, the blood vessel walls are normal and not felt with palpable
pulsations of dorsalis pedis artery
B- Temperature:
Measurement: Using a mercury thermometer
Oral temperature:
Insert the thermometer under the tongue with closed lips for 3
minutes.
Normal oral temperature= 36.5 – 37.2 °C.
Rectal temperature:
Insert the thermometer in the rectum through the anal canal for 2
minutes (subtract 0.5 o C of the reading).
Indicated in infants, comatosed patients, painful oral lesions.
Axillary temperature:
Insert the thermometer in axilla for 3 minutes (add 0.5o C to the
reading).
Abnormal body temperature:
Fever: body temperature > 37.2 °C.
Hypothermia: body temperature ≤ 35 °C.
Hyperthermia: body temperature > 41 °C.