spot diagnosis - inspection

spot diagnosis - inspection

1. Respiratory distress

   • cyanosis
     • blue/purple colouration of the skin and mucosa
   • accessory muscles
     • muscles not normally used for breathing
   • dyspnoea
     • dif breathing

2. Neuological

   • Tremor, fine nodding movement (Parkinson’s)

3. SHE Eats Thicc Niggas

   • 1. Skin
     • psoriasis
       • Individual silvery/white plaques – often mistaken for eczema (autoimmune condition) up to 30% develop psoriatic arthritis
         • important skin COLOUR CHANGE: red with plaques= psoriasis
     • psoriatic arthritis
     • eczma
       • Atopical inflammation of the skin, usually not in well circumscribed patches like with psoriasis. It is an atopic allergic reaction, people with eczema are more likley to develop hayfever or asthma
         • important skin COLOUR CHANGE: red = eczma/ dermititis
       • dermititis
         • a type of eczma caused by skin being incontact with an allergent - skin becomes RED
     • neurofibromatosis
       • Autosomal dominant neurogenetic condition (type 1 and 2).
       • APPERAENCE: pedunculated/ subcutaneous/ brown pigment change/ N0 INC with age
       • COMPLICATIONS: INC pa on nerve roots and spinal cord/ malignancy/ scoliosis/ fibrous dysplaysia
     • moles/ naeli/ melanoma
       • important skin COLOUR CHANGE: brown = melanoma
   • 2. Hair
     • scalp psoriasis
       • autoimmune, white defined plaques
     • dandruff
     • coarse hair
       • hypOthyroidism
     • thin hair
       • hypErthyroidism
     • DON'T FORGET eyebrows etc
       • Other causes of partial/total eyebrow loss are chemotherapy, leprosy, psoriasis, eczema, dermatitis, syphillis, seborrhaic kerratosis, scars, sclerosis, seizure medication, anti-hypertensives…
       • hypOthyroidism - lateral eyebrow hair loss
       • alopecia - hair loss
       • SLE hair loss
         • Lupus is an inflammatory condition that can also cause loss of eyebrows, beards, and eyelashes.
   • 3. Ears
     • inside
       • infection
       • otitis media (M/C kids)
         • can proliferate, usually heals on its own within 2 months,
       • gromits can be inserted tto maintain the proliferation and allow fluid drainage (in kids)
     • outside
       • hearing aids (look inside, can do vibrational test)
       • otitis externa (M/C adults)
         • painful to tug ear
       • tophi (gout)
         • uric acid crystals deposited in the cartilage of the ear (lumps appearence)
           • also effects other synovial joints causnig acute arthritis e.g. big toe
       • cauliflower ear
         • trauma causing heamorage, healing to leave bulky ear
           • can cover external ear cannal and affect hearing
     • Examination Tips
       • adults pull ears back/ kids pull ears back and up
       • Look at the canal for signs of discharge, earwax (cerumen), inflammation (reddening), foreign bodies, swelling, blood
       • Look at the tympanic membrane, cone of light, malleus, short process of malleus, and incus
   • 4. Eyes
     • glasses ( test acuity)
     • Eyebrows
       • look in the hair section
       • Muscle control
         • tetanus (BOTH sides of the face affected)
         • bell’s palsy (only ONE side of the face is affected – look at the eyebrow AND THE MOUTH)
         • paralysis
     • External muscle control
       • ptosis - drooping of lower eyelid
         • neurological
         • Infections
         • Foreign bodies
         • Inflammation
         • Enopthalmos
         • Hereditary
         • Overuse
     • skin around the eye
       • xanthellisma
         • fatty deposits around the eye
     • conjunctiva
       • Bacterial/viral conjunctivitis
         • bilateral common, peripheral conjunctiva, normal cornea, normal pupil
       • Acute Iritis
         • Cilliary flush, unilateral, dull cornea (blurred vision), small irregular pupil – may be no light response
       • Acute (NOT Chronic) Glaucoma
         • Around cornea, unilateral, dull cornea, oval-shape pupil, no light response)
       • Subconjunctival haemorrhage
         • Localised haemorrhage on sclera, cornea and pupil normal
   • 5. Throat
   • 6. Neck
     • know the names and location of nodes
       • 1. Preauricular/2. Post. auricular/ 3. tonsillar/ 4. occipital/5. superficial cervical (SCM)/ 6. supraclavicular/ 7. submandibular/ 8. submental
         • PreA.PostA.Ton.Occ. SuperCer. SupraClav. SubMand. SubMent.
     • know 3 different conditions affecting the nodes
       • how does the pathology change the node, is there a palpable difference
   • FOREHEAD
     • temporal arteritis
       • Affects age 60+, F>M
       • Associated with Polymalgia rheumatica
         • Pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.
         • May feel tired or depressed and lose your appetite.
         • prescribed steriods treat by reducing inflammation
         • Affects age 70+
       • Severe local head Px = main symptom Visual loss – late symptom Tenderness over the artery
       • inflammation of temporal artery (swelling and narrowing). visually prominent. tender to touch
     • sinusitis
       • frontal and maxilla sinus most likely to get infected
       • polyps
         • mucosal outgrowth within the sinus
           • S&S = pressure and pain in sinus/ headache; dec smell and taste
       • infection
         • mainly viral
       • allergy
       • deviated septum
       • S&S chronic sinusitis with nasal polyps
         • running nose
         • persistent stuffiness
         • postnasal drip
         • decreased/ absent sense of smell
           • no sense of taste
         • facial px/ headache
         • px in upper teeth
         • a sense of pressure over the forehead/ face
     • avoid percussing over painful areas as PALPATION is usually sufficient

4. CardioVS

   • Arrhythmias
     • sinus arrhythmias
       • increased heart rate upon INSPIRATION
     • ectopics
       • Atrial ectopic
         • RHYTHM: atrium beat fires early (inverted P wave)/ followed by compensatory pause
       • AV node ectopic
         • no P wave
       • Ventricular ectopic
         • no P wave
         • hx of myocardial infarction then yellow flag
         • if innocent dissapear on exercise
       • relatively innocent
     • tachycardias
       • increased heart rate
       • regular
       • Atrial fibrilation
         • AV node fires irregularly...quivering atria, random firing
         • irregular
         • no P wave, norml QRST
         • DRUG: Digoxin (dec transmission of impulses to bindle of his)
       • atrial flutter
         • v. rapid atrial contraction/ ventricles only respond every 2-3 contraction.
           • 'sawtooth image'
         • treated with: Digoxin
     • Bradycardias
       • decreased heart rate
       • regular

5. Related to Aging

   • Musculoskeletal
     • Osteoporosis
       • Bone pores” – condition characterised by decreased bone density due to imbalance between bone resorption and deposition. Many factors can cause it (hormonal male/female; medications, glucocorticoids, smoking). Bones break more easily. Humans reach full bone density around 21 years and start to lose bone density around 35
     • Osteoarthritis
       • “bone joint inflammation” (or degenerative joint disease) - degenerative condition affecting the joints of the body. Believed to be caused by life-long postural habits and mechanical stresses
     • Fracture
     • Muscular atrophy
       • “muscle wasting” – caused my many factors (ageing – lack of exercise or immobility but can be other causes such as Rhabdomyolisis caused by long term statins – muscle wasting, weakness and pain – 6-7 million statin users in the UK)
   • Neurological
     • Parkinson’s
       • Tremour (fine nodding movement)
       • wide stanced, short step, slow - shuffling gait
         • stooped posture
         • balance issues
       • Rigid muscles
       • Slowed movement (bradykinesia)
       • soft/ quick/ hesitant/ slurred speech
       • handwriting becomes small, writing is hard
       • Loss of automatic movements. You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
     • Hearing loss
     • visual change
       • Glaucoma
       • Senile myopia
     • loss of balance
       • proprioception + cerebella + CVS + sight + arthritis + medications
     • Dementia
   • FALLS

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