Physical diagnosis:
General Examination
Dr. Mohammad Shaikhani.
mshaikhani_@hotmail.com
Introduce yourself
Shake hands.
Normal grip.
Weak grip:Paralysis,Ill health,Depression.
Slow relaxing grip:Myotonia Dystropfica.
Comfortness:
Comfortable.
 Mood.
Distressed:
Dyspniec.
Orthopniec: dyspnea on lying down from pulm edem.
Acidotic breath(deep sighing respiration or air hunger):
Renal failure/Diabetic ketoacidosis/Lactic acidosis/Alcoholic
ketoacidosis/Aspirin poisoning.
Chynes sokes respiration(apnea-hyperpnea cycles):
Head injury/Cerebral hemorrhage/Heart failure.
Body built:
Normal.
Obese.
Cachectic:Cancer/Malnutrition/Malabsorbtion/Thyrotoxic/DM.
Body habitus:
Normal.
Short:Familial/GH def/Celiac/Achondroplasis/Chronic disease
/Turner.
Gigant.
Marfanoid.
Signs of dehydration:Sunken eyes/Dry tongue/Loss of skin turgor.
Personal hygiene.
Position in bed:
Normal
Restless:Renal,biliary & intestinal colic.
 In pain & can not move: peritonitis.
Shocked: pale, cold extremities, oliguric,hypotension, dull sensorium
Can not move:Peritonitis/Arthritis/Paralysis.
Head:
Normal.
Hydrocephalus.
Microcephaly.
Scalp:
Rash (herpes zoster opthalmicus, psoriasis, seborrhea).
Infection(tinea capitis & impetigo).
Temporal resetion( sign of weight loss).
Tender temporal artery(temporal artritis).
Depressed fracture.
Lipomas.
Eyes:
Exopthalmus:Thyrotoxicosis.COPD.Alcoholism.Retrobulbar
tumour.
Enopthalmus:Horner syndrome.
Periorbital oedema:Nephrotic.Real failure. Glomerulonephritis.
Hypothyroid.
Xanthomas.
Artificial eye.
Ptosis:Occulomotor palsy.Myasthenia gravis.Horner syndrome.
Ears:
Red & tender:Otitis externa.Relapsing polychondritis.Tophi(gout).
Herpes zoster rash+ facial palsy(ramsi-hunts syndrome).
Conjunctiva:
Pallor:Anemia.Shock.Heart failure,hypopituitirism.
Plethoric:Polycythemia.Superior vena caval obstruction.
Hemorrhage:Trauma.Hypertension.Bleeding tendencies.
Sclera:
Yellow(jaundice).
Blue(osteogenesis imperfecta).
Cornea:Opacity.
Lens: cataract.
Lens dislocation.Marfan.Homocysteinrea.
Ulcer: herpetic keratitis.
Archus senilis or lipidicus.
Kayser flesher ring(Wilson)
Facial features:
Hypothyroid face.Thyrotoxic face/Acromegalic face.Hypopitutaric face
Cushing face.Thalacemic face(mongoloid).Down face(mongoloid).
Uremic face(earthy coloure):
Anemia.Urochrome retention.Hemociderosis.
Sclerodermic face.
Sturg Weber (facial hemangioma).
Cheeks:Malar flush(MS).Butter-fly rash( SLE).Coalasma(pregnancy).
Nose:
Rodent ulcer.
Saddle-shaped(congenital syphilis).
Parrot-peaked nose(scleroderma).
Lips:
Hare lip.Cyanosis.Talangiectasia or spiders.Pigmentation(Peutz-jagger
syndrome).Herpes labialis, angular stomatitis( Vit def).
Facial features:
Facial features:
Facial features:
Mouth & tongue:
Puckered mouth(scleroderma).
Tongue cyanosis.
Frenulum pallor or yallowness.
Gum hypertrophy:Myelogenous leukemia.Epilepsy.Nifedipine.
Tongue fasciculations(motor neuron disease).
Smooth tongue (iron & vitamins dificiencies).
Painless ulcers (SLE, sero negative arthritis).
Painful aphthus ulcer(idiopathic or Behcet disease).
Petichae or echemosis.
Monilia infection of tongue.
Leukoplakia.
Tonsils:Normal.Enlarged.Infected.
Mouth odor: alcohol, uremic fetor,hepatic fetor
Neck:
Goiter.Lymph nodes & other lymph node groups.
Vascular pulsation.
Short with webs(Turner syndrome).
Breasts:
Female breasts:Normal.Mass or thickenings or nodularity.
Male breasts: Normal.Mass.
Gynecomastia:Liver cirrhosis.Drugs as spirinolactone,oestrogen.
Puberty.Old age.Hypogonadism.Thyrotoxicosis. Tumours
(testicular,adrenals,lung)
Chest:
Obvious chest deformities & scars.
Dialated veins or arteries.
Abdomen:
Distended or not.
Rashes & discolorations.
Abnormal pulsations.
Dilated veins.
Pancreatitis:Cullen & turner signs.
Hands:
Tremor:Rest(parkinsonism).Action(anxiety,thyrotoxic or familial)
Flapping(transient laps in maintained posture):organ failure.
Chorea:Rheumatic.Huntington.SLE.Pregnancy.Oral
contraceptive.Drugs as phenothiazines.Polycythemia.
Cerebral pulsy(chorioathetosis).
Wasting.
Wrist drop(radial nerve pulsy).
Claw hand(ulnar nerve pulsy).
Duptryn contracture:Liver cirrhosis.Occupational.Idiopathic.RA
Rheumatoid hand:Swan neck.Boutonniere.
Heberdon nodes(distal IP joints in osteoarthritis).
Tophi in gout.
Osler nodes(SBE).
Warm hands.Wet hands.Cold hands.
Tendons & palmar xanthomas.
Raynauld phenpmena.Pale creases(anemia)
Hands:
Nails:
Nails clubbing(lung,liver,cyanotic heart,intestinal &inflammatory
bowel diseases).
what degree?
1.increased base flactuation.
2.loss of nail angle.
3.increased curvature.
4.drum stick.
Confirm clubbing by Shamruth sign:
Absence of rectangular space on coinsiding corresponding nails of
both hands).
Cholenychia or spoon nails(flat or concave in iron dificiency).
Splinter sunangual hemorrhage(SBE,trauma,valculitis,trichinliasis).
White nails:Hypoalbuminemia.Severe chronic illness.
Nail pitting in psoriasis.
Transverse depression in nails(Beaus lines):Acute severe illness.
Onycolysis(elevation of nail end):Thyrotoxicosis.Chronic nail
Hands:
Scleroderma hand.
Acromegaly.
Short metacarpals(hypoparathyroid)
Tetany:Hypocalcemia.Hyperventilation.
Legs:
Wasting
Pseudohypertrophy(Hereditary Dushein muscular dystroohy).
Swolen&tender(DVT).
Ulcers.
Erythema nodosum(tender red painful nodules):
TB.Streptococcal infections.Sarcoidosis.IBD.Behcet disease.
Varicose veins.
Coldness in ischemia(compare with other side).
Ankle edema:
Pitting:
Heart failure.Renal failure.Nephrotic syndrome.Liver
cirrhosis.Malnutrition.
Non-pitting:Lyphedema.
Legs:
Rashes:Petichae or echemosis, vasculitic rash.
Hair changes.
Feet:
Edema.Swelling.Flat foot.Pes cavus(friedricks ataxia).
Rheumatoid foot.
Swollen big toe(gout).
Ulcers.
Gangrene.
Achilis tendonitis(sero –ve arthritis).
Cold in ischemia(compare with other side).
Diabetic foot ulcers or gangrene.
Clubbing of toe nails.
Legs:
Joints:
Small &large joints.Swelling.Deformity.Tenderness.Hotness.Restricted
movements.
Skin:
Scratching marks( pruritis,obstructive jaundice)Rashes.
Talangiectasia & spider nevi.
Petichae & echemosis.
Neurofibromas.
Vitiligo patches.
Allopacia areata or totalis.
Hemangiomas.
Herpes zoster.
Xeroderma.
Rose spots(typhoid).Xanthomas.Albinisim.
Vital signs: PR,BP,RR,Temp
Temperature:Oral .Axillary.Rectal.