Hello students, hope you will find this post useful. The purpose of this post is to acquaint young medical graduates about General physical examination which is the step one of their learning process during their study of MBBS.
You should first saw this video and read the following material. I will also post more material and videos for examination purpose.
To start with General physical Examination, first look at the built and stature of patient. General physical examination should start from the time when patient enters into Doctor cabin.
See whether the patient is tall stature or having short stature. Whether patient well built or moderate built or poorly built and nourished. The height of a person is usually equal to arm span in normal condition.
Look at the colour of hairs and note whether there is any premature greying of hair or not, or any patches of baldness. Have a look at the skin of patient, any abnormal pigmentation or petechial spots.
Now look for following signs.
- Anaemia: This is the first thing you have to note down. For this check the pallor of skin and mucous membrane. Pallor is checked over the lower Palpebral conjuctiva and also note the colour of palmer creases on hands. The skin will become pale once the patient has anaemia.
- Cyanosis: Cyanosis is the bluish discoluration of nails and it is due to presence of increased amount of reduced Hb in blood. Cyanosis can be Central or peripheral or it can be mixed also.
Central cyanosis is noticed on skin and mucous membrane like tongue, lips, cheeks etc. and is due to diminished arterial oxygen saturation. The temperature of the limbs remains warm and it may be associated with clubbing. Cyanosis remains if we provide local heat to the body part. Breathing of pure oxygen helps to decrease central cyanosis.
While peripheral cyanosis is due to decreased flow of blood to some local part of body. It is seen on skin of peripheral parts. the temperature of extremity remains low and it is not associated with clubbing. Providing local heat to the body part helps to abolish the cyanosis while it remains even with inhalation of 100% oxygen.
Your examiner may ask following questions to you regarding cyanosis.
What is the difference between central and peripheral cyanosis?
What are the causes of central or peripheral cyanosis?
Where you look for central or peripheral cyanosis?
What is Differential cyanosis?
So all students should prepare answers for these questions regarding cyanosis.
3. Clubbing: In clubbing, there occurs bulbous enlargement of terminal phalanges and it occurs due to dilatation of arterioles and capillaries along with interstitial edema.
Grading: There are 4 grades of Clubbing.
Grade 1– Characterized by softening of nail bed.
Grade 2- It is characterized by obliteration of angle of nail bed.
Grade 3- Characterized by Drumstick or parrot beak appearance due to swelling of subcutaneous tissue.
Grade 4- All around swelling of fingers tips with redness and pain also called as Hypertrophic pulmonary osteoarthropathy.
Question : What are causes of clubbing?
Cardiac: Cyanotic CHD, Infective endocarditis
Pulmonary: Lung carcinoma, Bronchiectasis, Lung abscess, Empyema,
GIT Causes: Crohn disease. Ulcerative colitis, Biliary cirrhosis
Endocrine : Myxedema, Acromegaly
Other causes include- Idiopathic, hereditary, gout etc.
Question : What is Schamroth sign?
Ans: A diamond shape space is seen at level of proximal mail folds when two fingers are kept together with nails facing each other. This space is lost in case of clubbing and this is known as Schamroth sign.
4. Jaundice: Jaundice is the yellowish discoluration of body and tissue fluids due to increased amount of bile pigments in body. The scleral tissue in the eyes and Basal ganglia in the brain have high affinity for bile pigments.
Students should check the icterus or yellowish tinge in the sclera. In newborn babies and infants , skin colour, hands etc. are also seen for presence of jaundice.
There are three types of jaundice.
a) Hepatocellular jaundice : Due to damage to liver because of Viral hepatitis, drugs , Hepatocelluar carcinoma, cirrhosis.Bilrubin is raised, ALP raised, rise in SGOT, SGPT levels in this type of jaundice.
b) Obstructive jaundice: Due to obstruction in biliary pathway. Characterized by pain and tenderness in right hypochondrium, weight loss and pruritis.
c) Hemolytic jaundice: Due to increased destruction of RBCs in the blood . Causes include parasitic infection like Malaria, drugs, mismatched blood transfusion etc.