Hyperthyroidism
Hyperthyroidism
Category: The Art of Physical Examination
Where you get to the fundamentals of Medicine by relearning the clinical examination
Cushing’s Syndrome
CUSHING's SYNDROME
Acromegaly
Acromegaly
Acromegaly has become a relatively rare case, we hereby have sought after cases with significant clinical findings to have a systematized discussion.
Examination of the Endocrine System
Examination of the Endocrine System
The Endocrinology is not just restricted to thyroid disorders and diabetes alone. It is way more extensive and it’s clinical examination is a crucial aspect.
Abdominal examination
Abdominal Examination
The Abdominal examination is not just restricted to the Gastrointestinal system, rather it covers all the quadrants of abdomen. Learn the secrets to score higher in this system.
Enter
Greet the Examiner
Sanitize your hands
Introduce yourself to the examiner
Inspect around for any clues
Expose
Approach from the right side and adequately expose the patient take patients permission and adequately expose the patient, up to knees and abdomen, if male possibly bare above the waist
Hands
Check for asterixis, clubbing, nail changes, nicotine staining, Dupuytren’s contracture, check for scars, radial artery scars, arts line, run your hands to check for av fistula, if you find a fistula do not forget to palpate and auscultate, you are supposed to comment whether it is being used or not so look for puncture marks. Also check for any tattoo marks. Check the pulse, offer for blood pressure.
Neck
Inspect for JVP it can be seen to know about cardiac cirrhosis, restrictive cardiomyopathy associated with liver conditions, volume status in renal failure, also check for puncture marks in neck for any previous central line insertion, also do not forget to check for lymph nodes
Eyes
Check for pallor, icterus
Mouth
Check oral cavity, denture, oral hygiene, tongue, ulcers, gum hypertrophy
Chest
Check for any gynecomastia, if it is there then examine for it asking permission from the examiners and the patient,
Abdomen Examination proper
Always start with the inspection Adequately expose the abdomen and inspect all quadrants, check if they are moving symmetrically, notice any distended veins, scars, scars of peritoneal dialysis, check if there is any pyoderma gangrenosum, scars of splenectomy, liver transplant, hernioplasty, check for visible pulsation, distended veins,
Superficial Palpation
Palpate gently and look at the patients face for any grimace to notice any tenderness
Deep Palpation
Liver: start from right lower quadrant just beyond umbilicus and palpate towards right costal margin advancing with each deep inspiration. Identify where the liver edge is felt, note any tenderness, texture, nodularity etc.
Lif -palpate deep for any masses, transplant kidney
Rif- palpate deep for any masses, transplant kidney
Epigastrium - palpate deep for any masses, gentle if pulsatile
Hypogastrium - palpate for any swellings from pelvis incl bladder
Rt flank; lt flank - check for ballotable swellings
Percuss liver
Percuss for shifting dullness (do not do that in case of very gross ascites, where you can do fluid thrill by asking either patient or examiner to keep ahand)While in the same position palpate for the spleen and percuss it.
Percuss over enlarged Kidneys
Right iliac fossa for bowel sounds, just on either side of midline halfway between umbilicus and xiphisternum for renal bruit. Also, on all masses felt auscultate for vascularity as evidenced by bruit especially liver.
BACK: Then sit the patient up Check for spider angioma in the back of upper trunk, gynecomastia, sacral edema.
LEGS: Finally, both legs for pedal edema.
Concluding: Thank the patient, offering to help dress him up, wash hands and turn to the examiner. Present by saying that you would finish the examination by further checking for hernial orifices, per rectal examination.
Examination of Respiratory System
Examination Of Respiratory System
Lungs being the only organ to float on water, its extensive peculiarity lies when to learn to pick up different lung sounds and associate them to the clinical condition…
Enter
Greet the Examiner
Sanitize your hands
Introduce yourself to the examiner
Check If The Patient Is Short Of Breath At Rest, See For Usage Of Any Accessory Muscles, Pursed Lip Breathing, Intercostal Indrawing, Scar Marks, Any Audible Noises, Ask The Patient To Cough
Inspect around for any clues
LOOK AROUND, ANY INHALERS, OXYGEN DELIVERY DEVICES, CPAP DEVICES, NEBULISERS, SPUTUM POT (IF YOU SEE A SPUTUM POT YOU ARE EXPECTED TO OPEN IT UP AND CHECK)
Expose
Note Any Deformities Of The Chest WallPectus ExcavatumPectus CarinatumKyposcholiosisBarrel Shaped Chest
Look For Any Cushingoid Appearance
Hands
Begin Examination Asking The Patient To Raise His Hands With Wrists Extended. Asterixis Checked, Look, On Dorsal Aspect, For Clubbing, Cyanosis(Peripheral), Splinter Hemorrhages, Leukonychia Or Koilonychia, Onycholysis, Nail Pitting, Nicotine Staining (Not To Mention In Abdomen Station), Then Ask The Patient To Turn The Hands Over To Examine The Palmar Aspect For – Radial Artery Scar, Dupuytren’s Contracture, Thenar & Hypothenar Wasting, Check The Pulse. No Need To Check Both Sides, Or For Collapse
Neck
Inspect The Jvp, Also Part Of Resp Exam, Talks About Corpulmonale
Mouth
Look For High Arch Palate, Dental Hygiene, And Tongue (Undersurface Of Tongue Cyanosis, Gingival Hyperplasia (Nifedipine, Cyclosporine Toxicity)
Always start with the inspection Adequately expose the Chest and inspect, check if the chest wall movements are bilaterally symmetrically, notice any distended veins, scars, scars over chest wall. Any surgical or ICD scar, Note Any Deformities Of The Chest WallPectus ExcavatumPectus CarinatumKyposcholiosisBarrel Shaped Chest.
Trachea
Palpate For The Tracheal Position, Check Which Side It Is Deviated Mostly It’s The Pathological Side Unless You Are Dealing With A Massive Pleural Effusion, Also Check Cricosternal Notch Distance Which Will Be Reduced In Copd.
Go Backkkkk! Respiratory System The Money Is On The Back. Don’t Waste Your Time Once You Determined The Tracheal Position
Neck
Palpate for lymph nodes
Back
Palpate For Breath Movements, Check For Sacral Edema
Leg
Check For Pedal Edema
Percuss anterior chest wall
FRONT: Auscultate all the lung fields Vocal resonance is important
BACK: Auscultate all the lung fields Vocal resonance is important
Concluding: Thank the patient, offering to help dress him up, wash hands and turn to the examiner.
General Examination
A detailed head-to-toe analysis of the patient along with the essential clinical findings that would be the cornerstone for finding a disease condition would be covered in this section.
Art of Physical Examination
Art of Clinical Examination
Yet many more clinical videos in the category to detail the system involved and lead towards diagnosis.
