Principles of General Examination

These are the principles of general examination. these examination to be done before or after your regional examination in order to perform a complete comprehensive examination.

How to think regarding the regional examination to any part of the body is also mentioned in this table,, USE YOUR SENSES,,

General examination

4×4

Vital signs

General assessment

Regional

Systemic

  • RR
  • HR
  • BP
  • Temperature
  • Consciousness
  • Facies and body built
  • Gait, stand and decupitus
  • Cooperation, mood and intelligence
  • Head and neck
  • Trunk and back
  • Upper limb
  • Lower limb
  • Cardiology
  • Respiratory
  • Abdomen GIT & Genitourinary
  • Nervous
All body

  • Inspection
  • Palpation
  • Percussion
  • Auscultation
Joints

  • See
  • Feel
  • Move
  • Measure

Examination of an ulcer

Points to be emphasised while examining an ulcer in an OSCE station

Ulcers

Inspection

Palpation

Description

  • Number
  • Site
  • Shape
  • Size (and Depth)
  • Floor
  • Edge
  • Margin
  • Discharge
  • Temperature
  • Tenderness
  • As inspection
  • Base
    • Extent
    • Induration
    • Tenderness
    • Motility
Draining L.N.s
Neuro-Vascular Bundle

How to take a history from a patient with an ulcer

Differential Diagnosis of an Ulcer

According to the cause

Example

Character

Trauma Sloping edge
inflammation TB undermined edges

associated with pain

Venous various veins i.e. Venous Ulcer Sloping edges
Lymphatic With lymphoedema
Neurologic diabetic neuropathy Neuropathic ulcer

Without pain

Neoplastic SCC

BCC

Everted edges

Beaded edges

 

According the site
Face Leg Foot Tongue
Rodent ulcer

Epithilioma

Keratoacanthoma

Ulcerated seb. Cyst

Ulcerated M.M.

TB ulcer

Vascular Venous

Arterial

Lymphatic

neuropathic Dyspeptic

Dental

Malignant

TB

Herpes

syphilis

Traumatic Vascular Ischemia
Infection TB Traumatic
Neoplastic -1ry as MM or BCC

-Ulcerated deep malignancy

Neoplastic
Signs suggestive of malignancy in an ulcer
  • Rapid increase in size
  • Rapid increase in ulceration
  • Bleeding
  • Change in color
  • Halo of pigmentation
  • Satellite nodules
  • Irritation
  • Lymph node enlargement
  • Distant metastasis
Floor of an ulcer
  • Malignant necrotic tissue
  • Granulation tissue
    • Healing
      • Pink
      • Finley granular
      • Bleed in touch
      • Level with skin
    • Non-healing
    • Non specific
      • Pale or yellow
      • Very vascular
    • Specific
      • Like TB caseation

Principles of Examination of Lumps

 

 

Lumps

 

Inspection

Palpation

Description

  • Number
  • Site
  • Shape (sphere, hemisphere, asymmetrical, pear shaped, kidney shaped or others)
  • Size (in the 3 dimensions)
  • Surface (smooth or irregular)
  • Skin and color (smooth and shiny or thick and rough /scars or sinuses)
  • Special signs
  • Temperature
  • Tenderness
  • As inspection
  • Edge
  • Reducibility
  • Solid, fluid or gas
  • Consistence (Stony hard, firm, rubbery, spongy or soft)
  • Fluctuation by
    • Standard
    • Paget’s
    • Cross fluctuation test
    • Bipolar fluctuation test
  • Fluid thrill
  • Translucence
  • Vascular
  • Pulsation (Expansile or Transmitted)
  • Compressibility
  • Thrill

Relation to surrounding

  • Mobility

Relation to muscles:

Ask the patient to contract the muscle and reset mobility

Superficial to the muscle Swelling bulges more

Within the muscle No significant change in size

Deep to the muscle Swelling diminished in size

  • Mobility

Relation to skin:

 

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Confirm relation to the muscle

Draining L.N.s
Neuro-Vascular Bundle
Percussion
Auscultation