General Inspection and Vital Sign

The first step in every physical examination is the general inspection of the patient.

It include sex,age,mental status,vital signs,development and habitus,state of nutrition,consciousness,facial feature and expression,position and posture,gait,skin, distribution of lymph nodes.

Sex

It is not difficult to determine in normal people.

Secondary sex traits are specifically related to the effects of androgens and estrogens in female and androgens alone in the male.

Male: Testes,scrotum,axillary and pubic

hair,depth of the vioce Female: Nipple,breasts,vagina,ovaries

Premature development indicates premature stimulation by the hormones.

Age Age is closely related to the

occurrence and prognosis of the sickness.

Vital SignsTemperature:

Normal body temperature is kept within narrow limits.

Temperature regulation centre of the hpothalamus determines the set point.

Temperature taken: （ 1 ） Axillary temperature:36° ～ 37°c （ 2 ） Rectal temperature:36 ． 5 ～ 37 ． 5

°c. It is suitable for children and

unconscious patients. （ 3 ） Oral temperature:36 ． 3 ～ 37 ． 2°c

Pulse Palpating radial artery is convenient

for rate determination. The pulse is best counted for a full

minute. Noting the rate,rhythm,etc.

Respiration

Respiration rate is the number of inspiration per minute.

Blood Pressure

Development and habitus Thyroid hormone promotes linear

growth. Androgens accelerate growth and

muscular development.

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HabitusClinical adult habitus can be divide into three

types according to distributive symmetry of paired structures including skeleton muscle and fat.

Normal body habitus ： （ 1 ） asthenic type:tall height,longilineal

neck,thin muscle,narrow shoulders ； （ 2 ） sthenic type:converse expressions of

asthenic type ； （ 3 ） ortho-sthenic type:normal adult

habitus.

NutritionState of nutrition can be classified to well,poorly

and fairly. Overweight or obesity:due to excessive caloric

intake or endocrine disease. Underweight: A slender patient is not necessarily ill. Severe underweight is referred to as cachexia. Decreased caloric intake or because of various

wastiong disease ,such as pulmonary tuberculosis,malignance and hyperthyroidism, may result weight lose.

State of consciousness

Facial features

1.Acute facial feature:redness,excitement and conflicted

2.Chronic facial feature: malignancy,liver cirrhosis. 3 ． Hepatic facies: Chronic facial feature

with spider angioma. 4 ． Nephrotic facies:pale face and an

edema in the eyelids.

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5 ． Hyperthyroidism facies:widened palpebral fissures,being startled expression,alert and flushed facial feature.

6 ． Myxedema face: Dull expression,periorbital edema,sparse eyebrows and hair.

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7 ． Mitral facies:cynosis in facies and lip,seem in the condition of mitral stenosis of rheumatic heart disease.

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8 ． Acromegaly facis:prominent nose and jaw,enlarged skull etc.

9 ． Moon face:round like full moon and reddish skin

Indicating Cushing’s syndrome caused by adrenal cortical hyperfunction.

Often with buffalo shoulders.

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Position and posture

Patient’s position may revealsignificant information.certain position to relief from pain also maybe of diagnostic importance 。 Common positions are the following:

1 ． Active position:body movements are free.

2 ． Passive position:patients cannot modify the position of their own.

Position and posture

3 ． Compulsive position: relief from pain.

Orthopnea:decrease dyspnea Forced standing position:due to the

attack of angina pectoris.

Gait The manner in which a patient walks is

often diagnostic value. Typical abnormal gaits include: 1 ． Festinating gait:seen in parkinsonsim. Patient walks with his body held rigid and

whith his trunk and head bent forward. 2 ． Ataxic gait: Patients taggers or waddle. resembling alcoholi intoxication. Seen in

disease of brain and cerebellum tracts.

3.Scissors gait:walking with the thighs close together,because of the rigidity of the adductor muscles.

Seen in spastic paraplegia.

skin

Color 1.Pallor:the hemoglobin content of

the blood is decreased. In anemia and shock.

2. Redness: the amounts of oxygenated blood in the dermal vessels increased.in fever or sunburn.

3.Cyanosis:increases in deoxygenated blood hemoglobin.

seen in congestive heart failure pneumonia and congenital heart disease with right-to-left shunts.

4.Jaundice:increase in tissue bilirubin in the skin.or carotenemia.

5.Hyperpigmentation:seen in Addison’s hypoadrenocorticism,pregnancy,exposure to sunlight.

Skin eruption Skin eruption:it is often an evidence in a

diagnosing certain diseases. Noting its shape,time of

appearence,accompany pruritus. 1 ． Maculae:flat limited area of color

change in the skin. 2 ． Papules:is a solid elevation of the

skin. 3 ． Maculopapulae: either maculae and

papules,larger than 1cm in diameter. 4 ． Urticaria:

Subcutaneous bleeding Subcutaneous bleeding: 1 ． Petechia:bleeding sign of less

than 2 cm in diameter. 2 ． Purpura ： 3 ～ 5mm in diameter. 3 ． Ecchymosis: ＞ 5mm in diameter. 4 ． Hematoma:bleeding with

pronounced protrude of the skin.

Spider angioma and hepatic palmar erythema Spider angioma are highly branched

stellate arterial lesion which pulsate,blanch and disappear on pressure.they usually occur only on the upper half of the body.

Hepatic palmar erythema:indicates the redness of the thenar and hypothenar.

They are often seen in acute or chronic hepatitis and liver cirrhosis.

Lymph nodes

There are several nodes bearing regions which are easily examined.

Normal lymph node

Normal lymph nodes are: Small,soft,nonfixed. Use palmar surface of finger tips. Lymph nodes should be described as

to: Exact location,size presence or absence of

tenderness,consistency,inflammation,movable,

一、 Normal lymph node Sequence of palpation: （ 1 ） preauricular and postauricular （ 2 ） mastoid （ 3 ） suboccipital region （ 4 ） posteries cevical triangle （ 5 ） anterior cevical triangle （ 6 ） supraclavicular fossa （ 7 ） axillary fossa （ 8 ） groins

Axilla fossa including an apex and four walls:anterior,posterior,lateral and medial.

Character of lymphadenopathy

Inflammation:painful,soft Mallignant infiltration:very hard,stony Enlargment of a single lymph node in the

left supraclavicular fossa----lesion in the upper abdomen

Enlargment of a single lymph node in the right supraclavicular fossa----cancer in the lung.

notes Vital signs Normal body habitus Overweight or obesity,

Underweight(cachexia) Facial features Position and posture Gait

notes Skin color Skin eruption Subcutaneous bleeding Spider angioma and hepatic palmar

erythema Lymph nodes can be described as to----- Sequence of palpation on normal lymph

node Character of lymphadenopathy