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Clinical Exam

This document provides an overview of procedures for clinical examination, including inspection, palpation, percussion, and auscultation of vital signs, pulses, blood pressure, temperature, and respiratory rate. It then describes examination of specific body systems like chest, heart, abdomen, nervous system, carotids, and jugular veins. The goal is to evaluate patients in a standardized way and check for any abnormalities.

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muchalaith
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137 views

Clinical Exam

This document provides an overview of procedures for clinical examination, including inspection, palpation, percussion, and auscultation of vital signs, pulses, blood pressure, temperature, and respiratory rate. It then describes examination of specific body systems like chest, heart, abdomen, nervous system, carotids, and jugular veins. The goal is to evaluate patients in a standardized way and check for any abnormalities.

Uploaded by

muchalaith
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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The Basic Procedures Of

CLINICAL EXAMINATION

1-Inspection
2-Palpation
3-Percussion
4-Auscultation

VITAL SIGNS
1-Pulse
2-Blood Pressure
3-Temperature
4-Respiratory Rate

RADIAL PULSE
Rate: 60-100/min(Tachycardia,Bradycardia)
Rhythm: Regular: (Irregular)
Volume:Good:(Small volume,Large olume,Collapsing)
Character: Normal:( Pulsus Bisfiriense)
State of Vessel Wall:Just Palpable (Thickened)
Radio-Femoral Delay: No Delay (Delay)

RADIAL PULSE

BLOOD PRESSURE
1-Palpatory Method
# 2-Auscultatorey Method
Normal Adult:120/80 mm of Hg
Hypotension<90/60

Hypertension>140/85

Palpatory Method

Auscultatorey Method

TEMPERATURE
*Use The Mercurial Thermometer
1-Oral : 36.6-37.2C
2-Axillary: + C
3-Rectal: - C
> 37.2 C = FEVER
< 36.6 C = HYPOTHERMIA

RESPIRATORY RATE
ESTIMATE THE RR in ONE MINUTE
NORMAL 14-18 cycle/min
>18 =Tachypnea
Causes:
1-General
2-Cardiac
3-Respiratory
4-Metabolic

RESPIRATORY RATE ABNORMALITIES

General Physical Examination


General Appearance:
1-consciousness
2-Position
3-Apparent age and weight
4-Facies
5-Mood
6-Behaviour

General Physical Examination


Head and Neck:
1-Look of the Face
2-Hair
3-Eyes
4-Mouth
5-Cervical Lymph Nodes
6-Thyroid Gland
7-Jugular Veins
8-Carotid Arteries

General Physical Examination


Upper Limbs:
1-Hands
2-Radial Pulse
3-Nails
4-Skin:Rash and Bleeding Spots
5-Joints
6-Axillary Lymph Nodes

General Physical Examination


Skin of Chest, Abdomen and Back:
1-Rash
2-Bleeding Spots
3-Breast Examination
4-Striae
5-Sacral Oedema
6-Other Abnormalities

General Physical Examination


Lower Limbs:
1-Skin:Rash and Bleeding Spots
2-Oedema
3-Hair
4-Nails
5-Joints
6-Peripheral Pulses
7-Inguinal Lymph Nodes

Emaciation

Smooth Tounge

Cervical Lymph Nodes

Goitre & Exophthalmos

Carcinoma of The Tongue

Ginvivitis

Angular Stomatitis

Acromegaly

Cushinoid Face

Cushing Disease

Myxoedema

Ptosis

Urticaria & Angio-oedema

Acne Vulgaris

Variola & Varicella

Systemic Lupus Erythematosus

Alopecia

Gum Hypertrophy

Central Cyanosis

Aphthos Ulcer

Anemia & Bleeding Spots

Hemorrhagic Blisters and Tonsillar


Enlargement

Anemia

Jaundice

Exophthalmos

Webb Neck

Goitre

Lymphadenopathy

Rhematoid Arthritis

Palmar Erythema and Clubbing

Koilonychia

Ulcers

Diabetic Dermopathy

Erythema Nodosum

Purpura

Examination of The Chest


1-Inspection:

chest expansion.
respiratory rate.
chest deformity.
Visible pulsation.
scars.
Gynecomastia.
dilated veins.
use of accessory muscles of respiration

Examination of The Chest


2-Palpation:

chest expansion.
apex beat.
vocal fremitus.
trachea.
breast.
axillary lymph nodes.

Examination of The Chest


3-Percussion:
We compare both sides of the chest regarding
intensity and equality of percussion note:
Normal and equal
Hyper-resonant
Tympanitic
Dull
Stony dull

Examination of The Chest


4-Auscultation:
We compare both sides of the chest for intensity and type
of breath sounds,added sounds,vocal resonanse

Types of breath sounds: vesicular,


bronchial, vesicular with prolonged
expiration.
Added sounds:ronchi,crepitations,pleural
rub.
Vocal Resonanse:increased or decreased

Examination of The Chest


Vesicular

Bronchial
Vesicular with prolonged expiration

Examination of The Heart(Precordium)

Inspection:
*visible pulsation in the neck.
*visible apex beat.
*respiratory distress.
*scars of previous operations.

Examination of The Heart(Precordium)


Palpation:
*Apex Beat:location and quality.
*Left parasternal Heave.
*Thrills.
*Palpable Sounds.

Examination of The Heart(Precordium)


Percussion:
*useful only to determine increased
cardiac dulness in cases of pericardial
effusion.

Examination of The Heart(Precordium)


Auscultation:
*Timing with the carotid pulse or apex beat
to establish S1 and S2.
*Auscultatory Areas:
1-Main:Mitral,Left Lower Sternal
Boarder,Aortic,Pulmonary.
2-Accessory:Carotids,Left shoulder,Axilla.
*Normal Heart Sounds:
S1(M1+T1),S2(A2+P2)

Examination of The Heart(Precordium)

Examination of The
Heart(Precordium)
*S1 and S2:intensity and splitting.
*Murmurs:

Examination of The
Heart(Precordium)
*Added Sounds:
1-S3.
2-S4.
3-Opening snap.
4-Clicks.
5-Rub.

Examination of Abdomen
Inspection:
*Contour and Distension.
*Movement with respiration.
*Visible peristalsis and Pulsation.
*Scars.
*Striae.
*Dilated Veins.
*Umbilicus.
*Skin rash and Hair disribution.
*Hernial Orifices
*External Genitalia.

Ascites

Hepatosplenomegaly

Dilated Veins

Examination of Abdomen
Palpation:
*Superficial palpation:for rigidity and tenderness.
*Deep palpation for masses.
*Palpation for liver: size (liver span), tenderness,
surface, consistancy.
*Palpation for spleen: size,tenderness, surface,
cosistancy.
*Bimanual palpation for kidneys.We must
differentiate them fro liver and spleen.
*Palpation for para-aortic lymph nodes,urinary
bladder and pelvic organs.
*Palpation for inguinal lymph nodes.

Liver

Spleen

Kidney

Can palpate
upper Border

No

No

Yes

Moves with
respiration

Yes

Yes

Minimal

Bimanually
Palpable

No

No

Yes

Notch

No

Yes

No

Dullness on
Percussion

Yes

Yes

No

Examination of Abdomen
Percussion:
*Shifting Dullness: for ascites.
*Transmitted Thrill: for ascites.
*Percussion for Palpable Organs.

Examination of Abdomen
Auscultation:
*Bowel Sounds.
*Renal Bruit.
*Venous Hum.
*Friction Rub.

Examination of Abdomen
Additional:
*Per-Rectal Exam.
*Per-Vaginal Exam in Married Females.
Both in certain circumstances .

Examination of Nervous system


1-Mental State Assessment.
2-Cranial Nerve Examination.
3-Neurological Examination of Upper
Limbs.
4-Neurological Examination of Upper
Limbs.

Mental State Assessment


1-Consciousness.
2-Speech.
3-Behaviour.
4-Mood.
5-Thinking.
6-Insight.
7-Concentration.
8-Orientation.
9-Memory.
10-Judgment.
11-Psychiatric Phenomena:hallucinations,
delusions and illusions

Cranial Nerve Examination


1-Olfactory.
2-Optic.
3-Extraoccular movements
&Pupils:Occulomotor+Trochlear+Abducent
4-Trigeminal.
5-Facial.
6-Vestibulo-cochlear.
7-Glossopharyngeal.
8-Vagus.
9-Accessory.
10-Hypoglossal.

Abducent Nerve Palsy

Occulomotor Nerve palsy

Horner Syndrome

Fascial Palsy

Hypoglossal Palsy

Neurological Examination of
Upper Limbs
1-Inspection.
2-Tone.
3-Power.
4-Reflexes.
5-Co-ordination.
6-Sensation.

Grades of Muscle Weakness

Biceps reflex

Supinator Reflex

Triceps Reflex

Comparing upper and lower motor


neuron lesions

Finger/Nose Test

Neurological Examination of
Lower Limbs
1-Inspection.
2-Tone.
3-Power.
4-Reflexes.
5-Co-ordination.
6-Sensation.
7-Gait

Knee Reflex

Ankle Reflex

Plantar Reflex

Babiniski Sign

Heel/Shin Test

Examination of Carotids
1-Inspection
2-Palpation
3-Auscultation

Jugular Vein examination


1-Inspection.
2-Differentiate From carotid Pulsation.
3-Measure the JVP.
4-Identify the Waves.

Carotid

Jugular

Palpable

Yes

No

Changes with
body position

No

yes

Changes with
respiration

No

Yes

Disappears on No
pressure at the
root of the neck

Yes

Hepato-jugular
reflux

Yes

No

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