GENERAL INSpection of patient

1. PROPEDEUTIC OF INTERNAL MEDICINE
LECTURE:
GENERAL
ISPECTION OF THE
PATIENT

2. PLAN OF THE LECTURE
 1. ROLE OF INSPECTION IN DIAGNOSTIC PROCESS
 2. GENERAL INSPECTION OF THE BODY
 2.1. Rules of inspection
 2.2. Maine parameters of inspection
 3. INSPECTION OF SEPARATE PART OF THE BODY
 3.1. The head 3.2. The skin
 3.3. The face 3.4. The neck
 3.5. The chest 3.6. The abdomen
 3.7. The hands 3.8. The legs

3. ROLE OF INSPECTION IN DIAGNOSTICROLE OF INSPECTION IN DIAGNOSTIC
PROCESSPROCESS
Overview of
the patient
allows to
choose tactic
further
treatment.
Overview of theOverview of the
patient allows topatient allows to
estimate the acuteestimate the acute
problem of theproblem of the
patient.patient.
Effectiveness ofEffectiveness of
reviewreview
determined bydetermined by
doctor erudition.doctor erudition.
You can only seeYou can only see
what you know.what you know.
Inspection isInspection is
carried out incarried out in
daylight in warmdaylight in warm
roomroom
The physicalThe physical
examination startsexamination starts
as soon as you seeas soon as you see
the patient.the patient.
Often your generalOften your general
observations point toobservations point to
a specific diagnosisa specific diagnosis
or to the systemor to the system
causing problems.causing problems.

4. GENERAL CONDITION
Satisfactory
Moderate
Severe
Very severe
The general condition of the patient includes the
following indicators: state of consciousness,
position in bed, motor activity. Depending on these
parameters is determined by the priority of the
diagnostic and therapeutic manipulations.
Incorrect evaluation
of the general
condition is not only
professional but
also a legal problem

5. State of consciousness
Clear consciousness: the patient is
oriented in time, space and person
Stupor: partial loss of consciousness
with preservation of verbal contact.
Moderate sleepiness, slowed commands
are executed
Sopor: loss of consciousness and lack
of verbal contact. Saved response to
pain

6. State of consciousness
Coma: loss of consciousness with total
loss of perception of the environment
and himself. With severe systemic and
neurological disorders
Delirium: severe disturbance of
consciousness with disorientation in the
environment and the person. There is
alcoholism, diabetic coma, as well as
metastatic tumors in the brain.

7. State of consciousness
Twilight disorders of consciousness it
appears disorientation, appearance
horrific hallucinations, anger, fear,
agitation with aggression. Occurs in
patients with schizophrenia

8. Talking of the patient
Changed talking most often occurs when
palsy.
In multiple sclerosis conversation
becomes a chopped up into individual
words or parts of words
Hoarseness indicates recurrent nerve
paresis. The resulting inflammation or
cancer of the mediastinum, aortic
aneurysm, myxedema

9. Gait (walking) of the patient
Unsteadiness of gait - lesions of the
cerebellum, significant hypertension,
aortic defect, severe anemia, fever
 Slow, tired gait when the patient barely
pulls his legs, and head and shoulders
lowered, indicating physical fatigue
Duck Walk indicate congenital
dislocation of the hip

10. Gait of the patient
 Hemiplegia - the patient drags up or assigns it
to the side, describing a semicircle on the
ground. After brain stroke.
 Posture proud man - with ascites
Posture of the
petitioner - when
the disease
Byehtyeryeva

11. Gait of the patient
Posture
clodhopper at
arthritis

12. Provisions in bed.
 Active.
 Passive.
 Involuntary: active
and passive
Attack of dispnea
Paine in right hypochondria

13. Type figure. Constitutional
type
ASTENIC
NORMOSTENIC
HYPERSTENICThin man,
epigastric
angle less
than 90
A man of
average
build,
epigastric
90
A man with a
broad chest,
epigastric angle
of more than 90

14. Type figure. Constitutional type
Rfdcvghnnn n m,mhjm
v mk
Definition of
epigastric
angle

15. Pathological forms of chest
a - emphysematous;
b - paralytic;
c - rachitic;
d - funnel;
e - scaphoid;
f - kyphoscoliosis.
a b
c
d
e
f

16. Leonardo da Vinci. The ideal human body

17. The skin
Wrinkled and dry skin occurs in severe
chronic diseases of the cardiovascular
system, respiratory, endocrine diseases.
Pale skin is often observed in diseases of
the cardiovascular system, kidney
disease, anemia. Cyanosis - bluish, gray-
blue, dark blue or blue-red color of the
skin and mucous membranes due to
enrichment of reduced hemoglobin levels.

18. • Redness of the skin is observed in a significant increase
hemoglobin level and number of red blood cells
(polycythemia), but such phenomena are rare. Often
redness (hyperemia) of the skin is limited and temporary.
Redness of the face observed in fever, limited congestion
occurs in inflammatory processes (abscess, erysipelas,
dermatitis). One of the cutaneous manifestations of systemic
lupus is the appearance of red spots on the face that is
shaped like butterfly wings is placed on the cheeks, and
the body - the back of the nose
• Based jaundice color of skin and visible mucous
membranes (mouth, eye sclera) in clinical practice
diagnosed with jaundice. Jaundice - a symptom that occurs
in various diseases due to excessive accumulation of
bilirubin in the blood

19. • On examination, the patient's skin can
detect areas of hyperpigmentation or
depigmentation, commonly observed in
endocrine disorders
• On examination, the patient's skin can
detect scarring, the presence of which
indicates postponed surgery, trauma,
purulent skin and subcutaneous tissue,
which in some cases can help in the
diagnosis of internal diseases

20. Swelling
 Swelling called excessive accumulation of fluid in the
tissues, the extracellular space. Edema may be obvious,
detected by palpation or hidden. At the press of a finger in
the area of edema appears fossa, which then slowly turns.
Water retention in the body accompanied by an increase in
body weight of the patient, reducing the volume of daily
urine output. Swelling observed in severe diseases of the
heart and kidneys. The degree of severity varies - from
mild swelling under the eyes in the morning after waking
up to anasarca (swelling of the body). In severe cases fluid
accumulates in the pleural cavity (hydrothorax) in the
pericardial cavity (hydropericardium) and so on.

21. Swelling
 In severe debilitating diseases, protein deficiency,
malignant tumors arising swelling.
 Slight swelling in both legs appear when hormonal
fluctuations associated with the menstrual cycle,
pregnancy, treatment of sex hormones or hormones of
the adrenal cortex.
 It should also be remembered that after a long stay on
his feet in both feet or legs at the end of the day formed
static edema (mainly in people who are overweight).

22. The head
 - pay attention to its shape, facial expression of
the patient, his eyes, nose shape. Facial
expression is the mirror of the physical and
mental condition of the patient. For example,
suffering facial expression indicates the severity
of the disease. In agonizing patients and in
patients with inflammation of the peritoneum
(peritonitis) observed the so-called Hippocratic
face, characterized by pale skin, deep, sunken
eyes, sharp facial features. The skin of the
patient is cold with sticky sweat

23. The head
Cyanotic rosy cheeks, bluish color of the
mucous lips and nose, lehkozhovtushni
sclera stenosis of the left atrioventricular
opening (facies mitralis).

24. Abnormal facial expressions
Features Diagnosis
 Poverty of expression Parkinsonism
 Startled expression Hyperthyroidism
 Apathy, with poverty Depression
of expression and poor eye
contact
 Apathy, with pale and Hypothyroidism
puffy skin
 Lugubrious expression Myotonic dystrophy
with bilateral ptosis

25. The face
The face is the most revealing area of the body, showing
the features of its physical and psychological well-being
and disease. In no other part of the body can one find so
many signs of clinical disorders. Face-to-face contact is
often the first interaction with the patient and thus forms
an essential part of the clinical examination.
Abnormal facies
The face may show one or
more of the many
characteristic
features associated with
diseases

26. The face
acromegaly
Hypothyroidism:
Note a
noncommunicative
affect
Lipodystrophy:
prominent muscular
contours due to
deficient
subcutaneous fat
Cushing's syndrome
Moon face

27. The face and eyes
Upper lid retraction
Acropachy
Graves' disease=
Bazedow’s disease=
Hyperthyroidism Pretibial myxoedema

28. The face and eyes
Hypothyroidism: hair
lossClinical features of
hypothyroidism
The eyes are not
shining,
noncommunicative
affect
Hypothyroidism

29. The mouth
 It is possible to detect signs of inflammation of the mucosa
(stomatitis), rash - enantema that appears when measles,
hemorrhagic diathesis. Pale mucous membranes of the
mouth occurs with anemia and ochrodermia palate - with
jaundice. During the inspection of the oral cavity should
pay attention to the tongue of the patient, which can be
coated in feverish conditions, diseases of the digestive
tract. In some diseases can detect color changes and
atrophy of tongue papillae. For example, in scarlet fever
tongue is crimson, liver cirrhosis - red, looks like patent
leather, at vit. B-12 deficiency anemia is marked atrophy
of the mucosa with inflammatory hyperemia tip and edges
of the tongue (Hanter’s glossitis).

30. The neck
 On examination, the
patient's neck draw
attention to the
condition of the
thyroid gland, lymph
nodes, pulsation of
vessels. Increased
thyroid observed in
thyrotoxicosis,
endemic goitre.

31. The neck
Cervical lymph nodes may increase in
acute lymphadenitis, tuberculosis, syphilis,
infectious mononucleosis, measles,
lymphosarcoma, leukemia
At hypertension, aortic aneurysm, aortic
insufficiency, thyrotoxicosis even at rest
possible dancing cervical arteries. In
patients with right ventricular heart failure
can be detected swollen neck veins,
indicating congestion in the superior vena

32. The abdomen
Inspection of the abdomen performed in the
supine and standing positions of the
patient. You determine the shape of the
abdomen, the size, the mobility of the
abdominal wall, the presence of abnormal
protrusion. Normally, the stomach
symmetrical, flat, depending on the
constitution may be slightly protruding in
hyperstenic and caught - in astenik.

33. The abdomen
 The abdomen may increase in ascites, obesity,
flatulence, the formation of large cysts in the
abdominal cavity (cyst of the pancreas, ovaries).
Shape of abdomen with ascites : in standing
position fluid accumulates in lower abdomen,it has
the shape of the bag. In the supine position – the
expanding belly sides and flat in the middle part
(the frog’s belly). When flatulence stomach is
globular shape, with no bulging navel as in
ascites.

34. The abdomen
 In some parts of the abdomen (white line, navel,
groin) hernia can be detected in a soft and
rounded protrusion that better determined
upright, scars of pregnancy.
Caput
medusae

35. Musculoskeletal system
Bone changes are observed in fractures, bone tumors,
osteomyelitis. During the inspection of joints pay attention to
their shape, amplitude movements, skin’s condition over the
joints
In severe chronic lung and heart disease, in patients
can change terminal phalanges of fingers typing
appearance drum sticks and nails - watch glass

36. Who has a question.

37. Thank you