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General Inspection and Vital Sign

General Inspection and Vital Sign. The first step in every physical examination is the general inspection of the patient.

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General Inspection and Vital Sign

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  1. General Inspection and Vital Sign

  2. 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.

  3. 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.

  4. Male: • Testes,scrotum,axillary and pubic hair,depth of the vioce • Female: • Nipple,breasts,vagina,ovaries • Premature development indicates premature stimulation by the hormones.

  5. Age • Age is closely related to the occurrence and prognosis of the sickness.

  6. Vital SignsTemperature: • Normal body temperature is kept within narrow limits. • Temperature regulation centre of the hpothalamus determines the set point.

  7. 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

  8. Pulse • Palpating radial artery is convenient for rate determination. • The pulse is best counted for a full minute. • Noting the rate,rhythm,etc.

  9. Respiration • Respiration rate is the number of inspiration per minute.

  10. Blood Pressure

  11. Development and habitus • Thyroid hormone promotes linear growth. • Androgens accelerate growth and muscular development.

  12. . • 呆小症

  13. Habitus Clinical 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.

  14. Nutrition State 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.

  15. State of consciousness

  16. 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.

  17. 图

  18. 5．Hyperthyroidism facies:widened palpebral fissures,being startled expression,alert and flushed facial feature.

  19. 6．Myxedema face: • Dull expression,periorbital edema, sparse eyebrows and hair.

  20. 图

  21. 7．Mitral facies:cynosis in facies and lip,seem in the condition of mitral stenosis of rheumatic heart disease.

  22. 图

  23. 8．Acromegaly facis:prominent nose and jaw,enlarged skull etc.

  24. 9．Moon face:round like full moon and reddish skin • Indicating Cushing’s syndrome caused by adrenal cortical hyperfunction. • Often with buffalo shoulders.

  25. 图

  26. 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.

  27. Position and posture • 3．Compulsive position: relief from pain. • Orthopnea:decrease dyspnea • Forced standing position:due to the attack of angina pectoris.

  28. 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.

  29. 3.Scissors gait:walking with the thighs close together,because of the rigidity of the adductor muscles. • Seen in spastic paraplegia.

  30. 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.

  31. 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.

  32. 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:

  33. 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.

  34. 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.

  35. Lymph nodes • There are several nodes bearing regions which are easily examined.

  36. 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,

  37. 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

  38. Axilla fossa including an apex and four walls:anterior,posterior,lateral and medial.

  39. 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.

  40. notes • Vital signs • Normal body habitus • Overweight or obesity, Underweight(cachexia) • Facial features • Position and posture • Gait

  41. 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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