Descending Tracts



General Exam

General Observation

• 30 seconds - Look around

• Use bed side charts

• Eg:

o Moon face – cushings

o Large round eye – hyperthryoidism

Procedure

• Hands

• Lymphadenopathy

• Thyroid

• Oedema

Hands

Clubbing

• Ax stages eg

o Bogginess

o Loss of bed angle – 2 fingers diamond

o Curve of long axis of nail

o Drumsticks

• Causes of clubbing:

o Pulmonary:

▪ Bronchial Ca

▪ CF, bronchiectasis

▪ asbestosis

o Cardiac:

▪ Congen cyanotic heart disease

▪ Baterial endocarditis

o Other:

▪ Cirrhosis

▪ Coealiac/crohns disease

Others

• Splinter haemorrhages:

o sign of bacterial endocarditis

o Prox red streaks

• Palmer erythema - Sign of liver disease

• Spider naevi – sign of liver disease - best seen over shoulders

• Cyanosis – peripheral or cyanosis

( blue fingers/toes as more O2 extracted prior to reaching target peripheries

is a normal o2 content centrally

Head

Cyanosis

• Look at tongue

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