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