Việc đánh giá ban đầu của bệnh nhân sẽ được thực hiện trong khi tham gia một lịch sử. Sự xuất hiện chung của bệnh nhân là quan sát đầu tiên, và sau đó tự kiểm tra sẽ khác nhau. | CHAPTER 2 General Examination The initial assessment of the patient will have been made whilst taking a general appearance of the patient is the first observation and thereafter the order of examination will vary. The system to which the presenting symptoms refer is often examined first. Otherwise devise your own routine examining each part of the body in turn covering all example is general appearance alertness mood general behaviour hands and nails radial pulse axillary nodes cervical lymph nodes facies eyes tongue jugular venous pressure heart breasts respiratory system spine whilst patient is sitting forward abdomen including femoral pulses legs nervous system including fundi rectal or pelvic examination gait Whichever part of the body one is examining one should always use the same routine 1 Inspection. 2 Palpation. 26 Hands 27 3 Percussion. 4 Auscultation. General inspection The beginning of the examination is a careful observation of the patient as a whole. Note the following o Does the patient look ill what age does he look febrile dehydrated alert confused drowsy cooperative happy sad resentful fat muscular wasted in pain or distressed Hands Note the following o Temperature unduly cold hands low cardiac output unduly warm hands high-output state . thyrotoxicosis cold and sweaty anxiety or other causes of sympathetic overreactivity . hypoglycaemia o Peripheral cyanosis. o Raynaud s. o Nicotine staining. Normal o Nails bitten leukonychia white nails can occur in cirrhosis koilonychia misshapen concave nails Plate 2d can occur in iron-deficiency anaemia clubbing loss of angle at base of nail Plate 2a Koilonychia 28 Chapter 2 General Examination a Fingers held together space seen at X as a result of normal angles in the fingers. b Positive Schamroth s sign space is lost as a result of clubbing. Nail clubbing occurs in specific diseases Heart infectious endocarditis cyanotic congenital heart disease. Lungs carcinoma of the bronchus
