CLINICAL SKILLS UNIT
EDUCATIONAL LOOPS
BY
CHSE
CSP 020401
GENERAL EXAMINATION
FIRST IMPRESSIONSFIRST IMPRESSIONS
How sick does the patient appear ?
- lying in bed
- sitting up in bed
- walking around
Hair distribution
Body habitus
Posture
HYDRATIONHYDRATION
• approximate estimation
• mild, moderate, severe
Signs: -skin turgor (supraclavicular / back of the hand)
- mucous membranes
- sunken orbits
- collapsed veins
- dry cracked lips
VITAL SIGNSVITAL SIGNS
• Blood pressure
• Pulse
• Respiratory rate
• Temperature
FACIESFACIES
• AcromegalyAcromegaly
• Cushing’sCushing’s
• Down syndromeDown syndrome
• Marfan’sMarfan’s
• Mitral faciesMitral facies
• Turner’sTurner’s
• ThyrotoxicThyrotoxic
Etc. etc. etcEtc. etc. etc
Acromegaly
Cushing’s
Thyroid stare
HANDS & NAILS
• abnormalities
• muscle wasting
• temperature
• sweating
• shape
• infection
Splinter haemorrhages
Koilonychia
Clubbing
Leuconychia
HEAD and NECKHEAD and NECK
1.1. EYESEYES
arcus senilusarcus senilus
xanthelasmaxanthelasma
jaundice jaundice (serum bilirubin > 2x upper limit normal; elastin)(serum bilirubin > 2x upper limit normal; elastin)
pallor pallor (anaemia)(anaemia)
cataractscataracts
drooping eyelidsdrooping eyelids
xanthelasma
HEAD and NECK
2. MOUTH2. MOUTH
central cyanosis
pallor (mucous membranes; frenulum)
angular cheilitis (Fe deficiency)
smell: sweet breath – liver failure
acetone - DKA
cigarettes
Deoxygenated Hb
> 50g/L bluish tinge
NECK
1.1. LYMPH NODESLYMPH NODES
1 sub-mental
2 sub-mandibular
3 cervical (jugular chain)
4 supra-clavicular
5 posterior triangle
6 post-auricular
7 pre-auricular
8 occipital
NECK
1.1. THYROIDTHYROID
Inspection: scars, swelling, mass
Palpation: enlarged / mass swelling
NECK
AXILLARY NODESAXILLARY NODES
A – central / apical
B – lateral / brachial
C – medial / pectoral
D – infraclavicular
E – subscapular / posterior
LYMPH DRAINAGE OF GROIN REGION
1. Horizontal or inguinal group
inguinal ligament
2. Femoral or vertical group
femoral vessels
The lower limb.
From buttocks and back, Lower abdomen, umbilical region, penis, perineum, lower vagina and anus
EDUCATIONAL LOOPS
BY
CHSE