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History Taking
Personal History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complaint: In the patient’s own words  & duration
History of the present illness ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Past history: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Example of a symptom’s analysis Pain :  ask about 1-Site:   ,[object Object],[object Object],[object Object],[object Object],[object Object],3-Character of pain:  aching, colicky, stabbing, burning……. 2- Radiation :
Pain   (cont .) 4-Severity of pain 5-Duration: e.g.  - Trigemimd  neuralgia  ( seconds) - Intestinal  colic  (minutes) 6-Frequency &  Periodicity 7-Time of occurence: e.g. ,[object Object],[object Object],[object Object]
Pain   (cont .) 8- Aggravating factors :  e.g. swallowing in esophagitis 9- Relieving factors:  e.g. stop walking in ischemic pain 10-Associated phenomena:  e.g. marked swaeting in cardiac pain
General Examination
Routine Data or Vital Signs : ,[object Object],[object Object],[object Object],[object Object]
Radial Artery
Pulse Examination
Sphygmomanometer cuff
Length of the cuff
Stethoscope
Brachial Artery
BP measurement
Temperature Normal:  36 .5 - 37.2 0 c -Diurnal variation -Age -Menstrual cycle  variation Fever: T>  37.4 0 c -Infection  -Tissue injury
Hyperpyrexia :T>   41.5 0 c ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hypothermia:
Types of fever ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Color changes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pallor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cyanosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cyanosis
Body Built 1 Body Built  (weight & Hight)  BMI = BW (kg) / Ht (m 2 ) >40 30-40 25-30 20-25 Morbid Obesity Obese Over weight Normal
Body Built 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Body Built
Decubitus :   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tri Pod position Patient with emphysema bending over in  Tri-Pod  Position
Examination of the  HEAD & FACE
HEAD & FACE Head : Face : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Facial swelling causing asymmetry Facial swelling
Facial swelling:Rt periorbital
Normal Eye
Jaundice
Jaundice2
Eye Lids Edema  Xanthelasma  Dark ring Ptosis  3rd nerve paralysis  - Horner’s syndrome Myathenia gravis  Congenital retraction  Thyrotoxicosis
Edema of the eye lids
Eye ball ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pupils ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],< 1mm  ( 1- 2.5 nm ) Unilateral Bilateral small pupils
Horner syndrome
Pupils 2 “ Large” dilated  pupils   anoxia Bilaterally dilated pupils (fixed):   drugs (atropine - phenothiazine- tricyclic  antidepressants) (Reactive)   Unilaterally dilated pupil ( Fixed dilated)   Oculomotor paralysis Temporal lobe herniation ---Mid brain . ,[object Object],[object Object],[object Object],[object Object]
Conjunctiva ,[object Object],[object Object],[object Object],[object Object],[object Object],Chemosis: edema
Conjunctivitis
Sclera ,[object Object],[object Object]
Scleritis
Nodular Episcleritis in a patient with CD
Cornea Nose Ear ,[object Object],[object Object],[object Object],[object Object],[object Object]
Parotid glands ,[object Object],[object Object]
Unilaterally enlarged parotid
Mouth: Lips ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Breath ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mouth :  Dryness and increased salivation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Normal oral cavity
Left peritonsillar abscess
Teeth ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],xxxxx
Tooth abscess Tooth Abscess
Gums ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tongue 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tongue 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Buccal mucosa 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Buccal mucosa 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neck ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thyroid gland:anatomy Isthmus
Palpation of the thyroid gland:posterior approach
Palpation of the thyroid gland: anterior approach
Neck  veins Jugular Vein Carotid Artery No  pulsations palpable. Palpable pulsations. Pulsations obliterated by pressure above the clavicle. Pulsations  not  obliterated by pressure above the clavicle. Level of pulse wave decreased on inspiration; increased on expiration. No effects of respiration on pulse. Usually two pulsations per systole (x and y descents). One pulsation per systole. Prominent descents. Descents  not  prominent. Pulsations sometimes more prominent with abnominal pressure.  No effect of abdominal pressure on pulsations
Cervical lymph nodes
Examination of Axillae ,[object Object],[object Object]
Examination of the axilla 1
Axillary lymphadenopathy
Examination of the axilla 2
Examination of the  Breast   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epitrochlear LN
Examination of the Upper Limbs:Edema
DVT of the right arm
Cellulitis of the upper limb Examination of upper limbs:Cellulitis
Cellulitis of the upper limb  2
Examination of Hands ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],See also joint examination
Acromegaly
Peripheral Vascular Disease of the UL
Wasting of the thenar eminance
Nicotine staining
Wrist: Ganglion
Skin 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Skin 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Locaalized Generalized
Skin 3 2-Texture: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Skin 4 3.Elasticity  :   cutis loxa - old age - progeria 4.Thickness :   -Acromegaly - Elephantiasis  - Occupational 5.Striae: ,[object Object],[object Object],[object Object]
Skin 5 6-Eruption: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Skin 6 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Telangiectasia
Skin-Hair ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lymph nodes 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lymph nodes 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Examination of the Lower Limbs
Peripheral pulsation :Dorsalis pedis
Peripheral puls ations  :Dorsalis pedis  2
Peripheral pulsations :post tibial artery
Peripheral pulsations : posterior tibial artery 2
Popliteal artery
Acute vascular insufficiency: mottled appearance
Chronic arterial insufficiency
Digital gangrene
Chronic Venous Insufficiency
Neuropathic ulcer in a diabetic patient
Lower limbs: edema 1 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Lower limbs:Edema 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LL edema
Pitting edema of the lower limb
Erythema nodosum
Onychomycosis
Genitalia and Joints Genitalia   Joints  :   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rheumatoid arthritis
RA: boutonniere finger
Rheumatoid arthritis 2
Heberdens nodes Heberdens nodes
Gout:  MCP joints
Leprosy

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History Taking &General examination