Physical Examination Findings in Common Medical Conditions
NUMERO TREDICI: First Impression and Fever
First Impression
Observing a patient’s entrance and demeanor provides valuable information. We can assess pain, mobility, vision, and overall well-being by noting their gait, posture, facial expressions, and need for assistance.
Consciousness
Evaluate the patient’s level of consciousness, ranging from alertness to coma.
Position and Movements
Observe the patient’s posture (active, passive, or obligatory) and any abnormal movements like tremors or convulsions.
Body Habitus
Assess the patient’s body type (mesomorph, endomorph, ectomorph, or cachexia) and note any significant weight changes.
Speech and Skin
Evaluate speech disturbances (aphonia or aphasia) and examine the skin for color, rashes, lesions, scars, moisture, turgor, edema, and any abnormalities in hair or nails.
Body Temperature and Fever
The hypothalamus regulates body temperature. Normal body temperature ranges from 36-37°C. Fever is defined as a temperature above the normal range due to an increased body temperature set point.
Types of Fever
- Continua: Permanent fever
- Remittent: Fluctuating fever with no return to normal temperature
- Intermittens: Alternating fever with periods of normal temperature
- Recurrens: Recurrent episodes of fever followed by normal temperature
Causes of Fever
- Infectious diseases (e.g., HIV, malaria, Ebola, mononucleosis)
- Immunological diseases (e.g., lupus, Horton disease, Kawasaki)
- Skin inflammations (e.g., boils, abscesses)
- Cancer
- Metabolic disorders
Symptoms of Fever
Sweating, headache, muscle aches, irritability, loss of appetite, dehydration, weakness
Treatment of Fever
Antipyretic drugs like ibuprofen, acetaminophen, and aspirin can help lower fever.
ECG and Arrhythmias
Supraventricular Arrhythmias
Arrhythmias originating above the ventricles include:
- Atrial fibrillation (AF)
- Atrial flutter
- Supraventricular tachycardia (SVT)
- Wolff-Parkinson-White syndrome (WPW)
- Atrial extrasystole
ECG Characteristics
- AF: No P wave, irregular rhythm
- Flutter: Atrial rate >250/min, no flat baseline between P waves
- SVT: Heart rate >100 bpm, narrow QRS complex, some P waves not followed by QRS complexes
- WPW: Short PR interval, delta waves, wide QRS complex
- Extrasystole: Premature P waves, PR interval may be prolonged, QRS complex may be wide
Ventricular Arrhythmias
Arrhythmias originating in the ventricles include:
- Ventricular escape
- Ventricular extrasystole
- Ventricular tachycardia
- Ventricular fibrillation
ECG Characteristics
- Escape: Ventricular rate 20-40 bpm, absent P wave, wide and abnormal QRS complex
- Extrasystole: Wide QRS complex, abnormal T wave, R-on-T phenomenon
- Tachycardia: Wide and abnormal QRS complex in all leads, T waves difficult to identify
- Fibrillation: No identifiable QRS complex, disorganized ECG
NUMERO QUATTORDICI: Endocrine and Respiratory Disorders
Symptoms/Signs of Endocrine Disorders
- Adrenal Insufficiency: Fatigue, stomach upset, dehydration (e.g., Addison’s disease)
- Cushing’s Disease: Excess cortisol production leading to weight gain, fatigue, and other symptoms
- Gigantism/Acromegaly: Excessive growth hormone causing sweating, weakness, headaches, and sleep disorders
- Hyperthyroidism: Weight loss, tachycardia, sweating, nervousness (e.g., Grave’s disease)
- Hypothyroidism: Fatigue, constipation, dry skin, depression
- Hypopituitarism: Deficiency of pituitary hormones causing various symptoms
- Polycystic Ovary Syndrome: Oily skin, acne, irregular periods, weight gain, difficulty getting pregnant
- Diabetes Mellitus Type 1: Insulin deficiency causing polydipsia, polyuria, polyphagia, fatigue, weakness
Causes of Endocrine Disorders
Overproduction, underproduction, or absence of hormones, as well as lesions like nodules or tumors.
Tests for Endocrine Disorders
Blood and urine tests are commonly used to diagnose endocrine disorders.
Signs in Respiratory Disorders
Pleural Effusion
Abnormal fluid accumulation in the pleural cavity causing reduced respiratory movement, mediastinal shift, dullness to percussion, and decreased breath sounds.
Pneumothorax
Abnormal air accumulation in the pleural cavity causing similar signs to pleural effusion but with hyper-resonant percussion.
Bronchial Asthma
Chronic inflammation and narrowing of bronchial tubes causing wheezing, prolonged expiration, and normal breath sounds.
Pneumonia
Inflammation of the lungs causing reduced respiratory movement, dullness to percussion, bronchial breath sounds, and crackles.
Symptoms of Respiratory Disorders
Cough, breathlessness, hemoptysis, chest pain
Diagnostic/Therapeutic Punctures
Diagnostic Punctures
- Lumbar Puncture (Spinal Tap): Collects cerebrospinal fluid to diagnose CNS diseases/infections
- Cisternal Puncture: Collects CSF for analysis or to relieve intracranial pressure
- Sternal Puncture: Collects bone marrow to diagnose hematopoietic diseases
Therapeutic Punctures
- Thoracentesis (Pleural Tap): Removes fluid or air from the pleural space to treat pleural effusion or pneumothorax
- Paracentesis: Removes peritoneal fluid from the abdominal cavity to treat ascites
NUMERO QUINDICI: Palpation of Liver and Spleen
Liver Palpation
- Place your right hand on the patient’s right lower quadrant.
- Move your hand up to the right upper quadrant, lateral to the rectus muscle.
- Press gently in and up while the patient takes a deep breath. A palpable liver edge may indicate enlargement.
Spleen Palpation
- The patient lies flat on their back.
- Sit or stand on the patient’s right side and place your right hand on their lower left abdomen.
- Place your left hand under the patient’s left side, above the hip, and lift slightly.
- Ask the patient to take a deep breath and gently press your right hand into the abdomen, feeling for the spleen tip.
Note: Spleen palpation should be done gently due to its fragility.
Dyspnea
Definition
Dyspnea refers to difficulty breathing or shortness of breath.
Types
- Expiratory: Difficulty exhaling, often seen in asthma
- Inspiratory: Difficulty inhaling, often due to upper airway obstruction
Causes
Asthma, pneumonia, interstitial lung disease, congestive heart failure, chronic obstructive pulmonary disease (COPD), anxiety, allergic reactions, anemia, hypotension, obesity
Signs
Coughing, wheezing, heart palpitations, rapid/shallow/labored breathing, chest tightness