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The Upper and Lower Extremities
Department of Internal Medicine Faculty of Medicine
Muhammadiyah University Yogyakarta
Nicotine Staining
Onychomycosis: Fungal Infection of the Nail
Onycholysis: Separation of Nail from Underlying Bed, often due to onychomycosis
Paronychia: Infection of skin adjacent to nail of middle finger
Peripheral Vascular Disease, Hand Tissue death (i.e. gangrene) of the fingers secondary to severe peripheral
vascular disease
Joint deformities secondary to rheumatoid arthritis
Clubbing associated with conditions that cause chronic hypoxemia
Cyanosis
Pitting edema Note divit left (pitting) after application of pressure.
Right upper extremity DVT. Note diffuse swelling
Lymph Nodes of the Upper Extremity
Palpation of Epitrochlear Lymph Nodes
Palpation of the Axilla
Left Axillary Adenopathy
The Femoral Region
The femoral pulse
Vascular Anatomy
The Popliteal Region
Below The Knee
Acute Arterial Insufficiency: Note Mottled Appearance of Skin
Chronic Arterial Insufficienc with Ulcers
Gangrene of Toes
Venous Insufficiency
Cellulitis
Assymetric Leg, Swelling secondary to Deep Venous Thrombosis in
Right Leg
Onychomycosis
Venous Stasis Ulcer
Neuropathic Ulcer in Patient with Diabetic Neuropathy
Clinical Osteomyelitis
Edema of Right Foot. Note Loss of Distinct Edges of Malleolous and Extensor Tendons
on Top of Foot
Massive edema. Note: Remaining imprint of fingers.
Lymphedema, Left Leg
Paronychia: Infection of the skin medial and inferior to nail of great
toe. Image on the right is post I&D
Location of Dorsalis Pedis Artery
Location of Dorsalis Pedis Artery
Palpating Dorsalis Pedis Artery
Location of Posterior Tibial Artery
Location of Posterior Tibial Artery
Palpating Posterior Tibial Artery
Using Doppler Device to Identify Posterior Tibial Artery
The learning pyramid
(www.arl.org)
10% of what they read 20% of what they hear 30% of what they see 50% of what they see and hear 70% of what they talk over with others 80% of what they use and do in real life 95% of what they teach someone else to do