General Physical Examination- Dr.Bhakti Kharate, #medicine #mbbs

Summary

This video script provides a comprehensive guide to general examination and history taking in clinical practice. It emphasizes the importance of a comfortable environment, patient consent, and proper exposure during examination. The acronym 'PICKLE' highlights key areas to assess: pallor, icterus, cyanosis, clubbing, lymphadenopathy, and edema. Additionally, the video covers how to examine vital signs such as temperature, pulse, respiration, and blood pressure. Through a structured approach, the video offers practical tips for clinicians to perform effective and thorough physical examinations, ensuring accurate diagnosis and patient comfort.

Takeaways

• 😀 Ensure the patient is comfortable and in a quiet, well-lit environment before beginning the general examination.
• 😀 Always stand on the patient's right side during the examination to properly assess abdominal organs and other key features.
• 😀 Always take consent from the patient before starting the general examination to ensure patient comfort and cooperation.
• 😀 The 'PICKLE' acronym helps remember the six key signs to assess during a general examination: Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy, and Edema.
• 😀 Pallor indicates anemia and can be assessed in areas like the conjunctiva, tongue, soft palate, palms, and nails.
• 😀 Icterus (yellowish skin) is a sign of jaundice, which can be caused by various liver or blood conditions like hemolysis or hepatic disease.
• 😀 Cyanosis, the bluish discoloration of skin, suggests low oxygen levels in the blood and can be peripheral or central.
• 😀 Clubbing of nails indicates serious underlying conditions like lung diseases, heart abnormalities, or endocrine disorders.
• 😀 Lymphadenopathy refers to swollen lymph nodes, which can be due to infections or malignancies. Key areas for examination include the neck and axilla.
• 😀 Edema, or swelling due to fluid retention, can be caused by cardiac, renal, or liver issues. The type of edema (pitting or non-pitting) helps in diagnosis.
• 😀 Vital signs (temperature, pulse, respiration, and blood pressure) are essential for monitoring the patient's health status and identifying underlying conditions.

Q & A

What are the six major parameters to assess during a physical examination, as mentioned in the script?

The six major parameters are Pallor, Ictress (Jaundice), Cyanosis, Clubbing, Lymphadenopathy, and Edema, summarized by the acronym 'Pickle'.

How should a patient's posture and movement be examined during the physical exam?

The patient’s posture, gait, and movement should be observed as part of the initial physical examination. The examiner should note if the patient appears healthy or ill, which could provide valuable diagnostic information.

What is the significance of pallor during a physical examination?

Pallor indicates paleness, which can suggest anemia, shock, or blood loss. The examiner should check the lower conjunctiva, nails, palms, and tongue for signs of pallor.

What is icterus, and what causes it in a patient?

Icterus, or jaundice, is the yellowing of the skin and sclera due to the accumulation of bilirubin. It is often caused by liver diseases such as hepatitis, cirrhosis, or bile duct obstruction.

What are the types of fevers mentioned, and what conditions do they correspond to?

The three types of fevers are: Continuous fever (seen in urinary tract infections), Remittent fever (often associated with infective endocarditis), and Intermittent fever (seen in conditions like malaria).

What is the significance of cyanosis during a physical examination?

Cyanosis is the bluish discoloration of the skin and mucous membranes, indicating oxygenation problems in the blood. It is commonly seen in conditions such as heart or lung disease.

What does clubbing of the nails indicate, and how can it be examined?

Clubbing of the nails, characterized by bulbous enlargement of the nail beds, can indicate chronic lung or heart conditions. It can be assessed by looking for changes in the curvature of the nails, fluctuation, and performing the Schamroth sign test.

How can lymphadenopathy be examined, and what does it signify?

Lymphadenopathy involves the enlargement of lymph nodes, which may indicate infection, malignancy, or autoimmune diseases. The examiner should palpate the cervical, axillary, and inguinal regions to check for enlarged lymph nodes.

What is edema, and how is it examined during the physical exam?

Edema is the swelling caused by the accumulation of fluid in the tissues, often seen in heart, kidney, or liver conditions. It can be examined by checking for pitting edema in dependent areas like the feet and ankles.

What are the normal ranges for vital signs such as temperature, pulse, respiration, and blood pressure?

The normal ranges for vital signs are: Temperature - 98-99°F, Pulse - 70-80 beats per minute, Respiration - 12-16 breaths per minute, Blood Pressure - 120/80 mmHg.