CMS 112 General Examination and Clinical Diagnosis

Clinical Examination Overview

• Clinical examination is crucial for accurate diagnosis and effective treatment planning.
• A thorough examination helps identify patient complaints and uncover unknown diseases in seemingly healthy individuals.
• It involves assessing the patient’s status through basic sensory examination rather than relying on complex diagnostic tools.
• Essential to obtain patient permission before conducting an examination.

Observation Methodology

• Clinicians should adopt a detective-like approach to observation, analogous to Sherlock Holmes.
• Key areas to assess include the patient’s general appearance, including their face, hands, and body.

Examination Techniques

• Four primary components to clinical examination:
  • Inspection: Visual examination of the patient.
  • Palpation: Feeling for abnormalities through touch.
  • Percussion: Producing sounds by tapping on body areas to assess underlying conditions.
  • Auscultation: Listening to internal sounds using a stethoscope.

First Impressions

• Initial assessment determines the patient's level of illness:
  • Are they alert and conversive, or appearing severely ill or unresponsive?
• Vital signs and general patient assessment encompass the ABCDE framework:
  • Appearance: including skin color, built, consciousness, decubitus position, and facial expression.

Vital Signs to Monitor

• Pulse
• Blood pressure
• Temperature
• Respiratory rate

Physical Examination from Head to Toe

• Assess overall physical condition: healthy, fair, or poor.
• Determine apparent age compared to stated age.
• Evaluate personal hygiene: clean versus unkempt.

Body Built Assessment

• Body built relates height and arm span adjusted for age, race, and gender.
• Measurements include:
  • Height: measured from head to heel.
  • Span: distance between middle fingers with arms extended.
• Definitions of built:
  • Average build: Height = Span.
  • Overbuilt: Height > Span.
  • Underbuilt: Span > Height.

Weight, Body Habitus, and Posture

• Considerations for obesity (BMI ≥ 30) and muscle wasting.
• Pay attention to patient’s physical movement upon entry into the examination room.

Skin Color Assessment

• Normal skin color variations depend on pigmentation, skin thickness, and circulation.
• Pallor: Indicates anemia with normal skin thickness and circulation.
• Central cyanosis: Bluish discoloration of core areas indicating oxygen deficiency.
• Peripheral cyanosis: Bluish discoloration of extremities.
• Jaundice: Yellowing, best observed in the sclera, often indicating liver dysfunction.

Consciousness and Expression Analysis

• Consciousness levels should be evaluated.
• Decubitus: Observing body position and comfort levels.
• Facial expression and features can reveal specific diagnostic clues, termed "diagnostic facies," which are characteristic of particular diseases.