Physical Examination

More documents

Recommendations

Info

• Pallor: o Pheumatic activity. o Infective endocarditis. o Low cardiac output. o Shock. o Anaemia. • Cyanosis: Cyanosis in heart disease (reduced Hb >5g/dl to be clinically overt). Central cyanosis: detected in lips and tongue occurs in : o Congenital cyanotic heart disease. o Acute pulmonary edema. o Pulmonary arteriovenous fistula. o Hypoxic cor‐pulmonale. Peripheral cyanosis detected only in the hands and feet: o Heart failure. • Jaundice. 4 II. TEXTURE III. ERUPTION B.MUCOUS MEMBRANE: Conjunctiva, mouth and tongue Comment on color, signs of vitamin deficiency. C. HAIR: - Somatic - Sexual - Comment on presence, thickness, luster D. NAILS: Clubbing, dystrophies, brittleness, color, spooning, spider angiomata and Capillary pulsation. CLUBBING: Due to proliferation of the soft tissue at the nail bed, occurs in: - Congenital cyanotic heart disease. - Infective endocarditis. - Hypoxic cor pulmonale. - Unilateral clubbing in thoracic inlet syndrome and Aortic aneurysm. Normally angle of nail is 160‐165 degree (obtuse angle), clubbing has four grades: - First degree → Obliteration of the angle at the nail bed. - Second degree → increased convexity longitudinally and side by side. - Third degree → drum stick appearance due to thickening and increase diameter of terminal phalanx. - Fourth degree → pulmonary osteoarthropathy where there is thickening of the synovial membrane of the hands and feet. 7. SUBCUTANEOUS TISSUE: Masses, Nodules, and Oedema
SYSTEMATIC EXAMINATION: 5 Head <strong>Examination</strong>: Size and Shape Face: Expression and Symmetry Eyes: Lids, Eye balls, Conjunctiva , Sclera (color), Cornea, Pupils, Lens, Eye brow and eye lashes. Nose: Nasal bridge, Discharge Ears: Setting, Discharge Cheeks: Malar flush as in mitral stenosis. Mouth: Lips, Teeth, Gums, Tongue, Tonsils NECK: NECK VEINS: The jugular venous pressure is perhaps the single most important hemodynamic measurement to ascertain volume status at the bedside. The external (EJV) or internal (IJV) jugular veins may be used, although the IJV is preferred because the EJV is valved and not directly in line with the superior vena cava (SVC) and right atrium (RA). The EJV is easier to visualize when distended, and its appearance has been used to discriminate between a low and high central venous pressure. Distinguishing the Jugular Venous Pulse from the Carotid Pulse Feature Internal Jugular Vein Carotid Artery Appearance of pulse Undulating two troughs and two peaks for every cardiac cycle (biphasic) Single brisk upstroke (monophasic) Response to inspiration Height of column falls and troughs become more prominent No respiratory change to contour Palpability Generally not palpable (except in severe TR) Palpable Effect of Pressure Can be obliterated with gentle pressure at base of vein/clavicle Cannot be obliterated The venous pressure Jugular venous pressure should be initially estimated with the patient lying with upper trunk elevated at 30 0 . In this position, at normal jugular venous pressure, no pulsations are visible. This correlates roughly to a jugular venous pressure less than 6‐10 cm. When the jugular venous pulsations are visible, the venous pressure is measured as the vertical distance between the top of the venous pulsations and the sternal angle (angle of Louis).
Page 1 and 2: General examination 1 Learning obje
Page 3: 3 Abnormal Characters of arterial p
Page 7 and 8: 7 The abdominojugular reflux: is pe

Physical Examination

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?