This document provides guidance on performing a physical examination, including assessing various body systems and signs. Key areas covered include: examining grip strength, breathing patterns, body size/shape, hydration, position in bed, the head/scalp, eyes/ears/mouth, neck, chest/abdomen, hands/nails, legs/feet, joints, and skin. Vital signs including temperature, pulse, blood pressure, and respiration are also mentioned. The exam involves methodically observing the patient's appearance, movements, and any abnormalities across their whole body.
18. 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)
27. 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 disorders.
28. Hands: Scleroderma hand. Acromegaly. Short metacarpals(hypoparathyroid) Tetany:Hypocalcemia.Hyperventilation.
29. 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.
30. 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.