GENERAL CLINICAL PHYSICAL EXAMINATION

J. A OTEGBAYO

OBJECTIVES OF GCE• TO EXPLAIN THE PURPOSE AND CLASSIFY

CLINICAL EXAMINATION• DEFINE GCE• TO FAMILIARISE PARTICIPANTS WITH SYSTEMATIC

CONDUCT OF GCE• TO EXPLAIN THE SIGNIFICANCE OF GCE IN

PATIENT EXAMINATION.AT THE END OF THE LECTURE, PARTICIPANTS SHOULD BE ABLE TO :1, EXPLAIN THE PURPOSE OF GCE AND DEFINE IT,2,KNOW HOW TO SYSTEMATICALLY CONDUCT GCE,3, MAKE REASONABLE CLINICAL JUDGEMENTS FROM GCE

INTRODUCTION

• WHY CLINICAL EXAMINATION?

- Care

- -Diagnose

- Treat

- Cure

• ROUND UP THE CULPRITS

• SINGLE OUT THE OFFENDER

DEFINITIONS

• Very efficient direct observation of a PATIENT

• Carried out with a high degree of precision

• Usually involves the following steps:

A. Inspection

B. Palpation

C. Percussion

D. Auscultation

TYPES OF CLINICAL EXAMINATION

1. Local.

2. Regional

3. Loco-regional

4. Systemic

5. General

PURPOSE• To gather the information/signs of manifestation of

diseases

• Critically analyse the signs

• Relate the signs to specific disease(s)

• Come up with an assessment or differential diagnosis

• Chart the next line of action eg laboratory tests

• Make a final diagnosis

• Then treatment

SIGNIFICANCE of GCE

• Though non-specific for any organ-system, information gathered is useful in tracking down the disease or at least make differential diagnosis.

• It gives a clue to the area(s) of the body to pay particular or more attention to while conducting systemic or regional examination.

HOW TO CONDUCT GCE• Self-Comportment

• Greet and introduce yourself (Courtesies)

• Explain your mission

• Obtain permission or consent

• Chaperone if necessary

• Re-assure patient of privacy, comfort and gentleness.

• Before GCE- ?Gloves and other requirements. Cold palms

HOW TO CONDUCT GCE contd.

• Positioning of patient – Anatomical

• Positioning of examiner

• A cursory scan of the patient (Head to foot).

• General appearance of the patient: Dressing; Anxious? Conscious? Alert? Drowsy? Ill-looking? Acute or chronic; Healthy-looking? Restless? Aggressive? Calm? In distress?

• Feel for temperature (Thermometer)

Head• Scalp infection, swellings

• Hair – colour, distribution (alopecia), feel.

• Face – colour, expression, rash (distribution), puffiness etc

• Eyes – colour, pallor, icterus, haemorrhage, discharge, size (proptosis/exophthalmos) etcetera

• Nose – size, discharge, flaring

• Mouth – odour/fetor, colour (tongue, mucosa), hydration, tongue, central cyanosis, gum etc

• Salivary glands eg parotid fullness

• Neck – swellings, medical alert necklace

Hands• Palms- colour/pigmentation,

thenar/hypothenar eminences, wasting, deformed, contractures, moist, cold, warm, sweaty, velvety etc

• Dorsum

• nail (colour, shape, capillary refill) etc;

• Compare with yours.

• medical alert bracelet

Lymph nodes

• – various regions: List

Feet

• oedema

• Check if one sided or vary in size

• if oedema is present or lying down, check sacrum) etc.

• demonstrate pitting

SUMMARY

Present findings on GCE