Medical Examination and Diagnosis

Physical Examination

• Doctor should stand on the right side of the patient during examination.
• Yellow discoloration of skin and mucous membranes indicates Jaundice.
• Bluish discoloration of skin and mucous membranes indicates Cyanosis.
• Sites of examination for pallor: inner aspect of lips, skin of the face, nails, and palm creases.
• Peripheral cyanosis is not detected on the tongue.

Anthropometry

• Height is defined as the distance from occiput to heel in an upright position.
• Span is defined as the distance between the tips of the middle finger with outstretched hands.
• Underweight is diagnosed when BMI is below 18.5.
• Overweight is diagnosed when BMI is 25-30.
• Obesity is diagnosed when BMI is over 30.

Clinical Signs

• Jaundice appears when bilirubin level is above 2.5 mg/dl.
• Cyanosis appears when reduced Hb level is above 5 gm/dl.
• Clubbing means proliferation of soft tissues at nail beds and terminal phalanges.
• Grades of clubbing:
  • Grade I: Obliteration of the angle between nail and nail bed.
  • Grade II: Increase convexity of nails in its longitudinal curve (parrot beak).
  • Grade III: Hypertrophy of terminal phalanx (drum stick).
  • Grade IV: Hypertrophy of distal ends of long bones at wrist and ankle (hypertrophic osteoarthropathy).

History Taking

• Name of the patient is important in history taking as it improves patient-doctor relationship.
• Congenital disease is common in young age.
• Malignancy is common in age more than 60 years.
• Bilharziasis is commonly present in farmers.
• Hepatitis C viral infection is endemic in Egypt.
• Covid-19 is not categorized as a blood-borne infection.
• History of previous diseases and operations are components of past history.
• Patient's smoking index is calculated by multiplying the number of cigarettes per day by the number of years.
• Toxic dose of alcohol is 60-80 gm per day.

Pulse and Heart Rate

• Pulse is the throbbing of arteries as blood moves through them.
• Pulse can be measured by using the fingers to feel an artery near the skin.
• Heart rate is the number of times the heart beats in one minute.
• Normal pulse rate is between 60 and 100 beats per minute.
• Pulse rate above 100 beats per minute indicates Tachycardia.
• Pulse rate below 60 beats per minute indicates Bradycardia.
• Palpation sites: radial, carotid, brachial.
• Apical pulse is measured over the heart.
• Factors that determine blood pressure: pumping action of the heart, peripheral resistance, and blood viscosity.