🟪General examination

Initial approuch to the patient, introduce yourself, explain what are you going to do , take permission , ask about pain , hand hygiene

➡️General look
A / appearance
B / bulit
C / conscious level
S / skin (clour , rash , brucies , scar , pigmentation , fistula )
S / surroundings (cannula , O2 mask , medications )

➡️ head
1_Hair /for hair distribution
2_Eyes / for sings of anemia and jundice
3_Face / malar rash
4_Mouth / for sings of anemia (Angular stomatitis + pale mucous membrane , smooth tongue) , central cyanosis , mouth hygiene, artificial teeth.

➡️neck
1_Look for any Neck swelling
2_Palpate the Trachea/ centalized or deviated
3_Palpate Carotid artery and look for JVP
4_LN examination

➡️ hands
1_Inspect dorsal surface
2_Inspect palmer surface / for pale palmer creases , palmer erythema , atrophy of thenar and hypothenar ms
3_Inspect nails / for leukonykia, kolionykia , peripheral cyanosis , culbbing
طبعا لازم اديروا test for clubbing
inspect the nail angle
Fluctuation test
Window sing
4_Test for fine and flapping tremors
5_VS measurement

➡️ LL
1_Inspect for symmetry, sewlling and for any skin changes
2_Palpate for hotness and tenderness
3_Test for BLLE
4_Inspect between toes for fungal infection
5_Palpable dorsalis pedis artery and posterior tibilal artery


Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

#General
لو كانت الفايندينق jaundice

~يسألك بعدها عال DD of jaundice ؟

A_per_hepatic / Hemolysis
B_Hepatic / hepatitis , liver cirrhosis and its cases , malignancies
C_pos_thepatic / Stone , PBC , PSC , Cancer head of pancreas

~بعدها يسالك على ال investigations ؟
🔸️per_hepatic
CBC
Blood film
LDH
Heptoglobulin
Bilirubin
ESR , ANA , Anti ds
( على خاطر ال acquired causes of hemolytic anemia )

و باقي التحاليل اللي خاصة بكل نوع من ال congenital causes
HB electrophoresis
Osmotic fragility test
G6P level

🔸️Hepatic , post_hepatic
LFT
Abdominal US
MRCP
ERCP

#General
لو كانت الفاينديق Signs of anemia
~يسألك بعدها على أنواع الانيميا و ال DD لكل نوع؟
➡️Microcytic
1_ Iron deficiency anmia
2_ Thalassemia
3_ Sidroplastic anemia
4_ lead poisoning
5_ Anemia of chronic illness

➡️Macrocytic..
1_ Megaloplastic anemia
2_ Liver disease
3_ Alcholism
4_ Renal failure

➡️Normocytic..
1_ Anemia of chronic illness
2_ hemolytic anemia


~و يسألك بعدها عال investigations ؟
اول شي نبعت
CBC
🔸️لو طلعت microcytic
نبعت
Iron study
Upper and lower git endoscopy ( if old age)
Stool analysis
🔸️لو طلعت macrocytic
نبعت
Folic acid level
Methylmalonic acid
B12 level
🔸️لو طلعت Normocytic
نفكر في hemolytic
نبعت
Blood film
LDH
Heptoglobulin
Bilirubin
و لما التحاليل هادي تاكدلي انها فعلاً hemolytic
نبعت تحاليل باش نعرف السبب👇

ESR CRP ANA Antids...(على خاطر ال acquired causes / eg :- SlE )

و بالنسبة لل congenital causes هوني كل نوع عنده تحليل خاص بيه تقوله .
Osmotic fragility test
G6P level
Hemoglobin electrophoresis

#General

لو كانت الفايندينق Bilateral lower limb edema

~ بعدها يسألك على ال DD ؟
1_CHF
2_liver cirrhosis
3_Nephrotic syndrome, lupus nephritis
4_Hypothyroidism
5_Drugs SE ~ CCB

~بعدها يسألك على ال investigations ؟
Echo
➡️( investigations for CHF )
CBC
ESR
ANA , Antids DNA
Urine for RE
24 hr urine collection for protinuria
RFT
Abdominal US
➡️( Investigations for Nephrotic syndrome and lupus nephritis )
LFT
➡️ ( investigations for liver disease)
TFT
Free T4
➡️ ( investigations for hyothyrodisim )

Bilateral LLE

#General
🔸️لو كانت الفايندينق Generalized lymphadenopathy

~بعدها يسألك على ال DD ؟
1_Infection
Viral / IMN , EBV , HIV
Bacterial / TB , Syphilis
Protozoal / Toxoplasmosis
2_Malignancies
Lymphoma
Leukaemia
3_Autoimmune
SlE
RA
~ بعدها يسألك على ال Investigations ؟
CBC
ESR
CRP
Viral screen
Monospot test
Quantiferon test
Tuberculin skin test
Suputum examination, C/S
Throat swab and culture
Blood film
LN biopsy
Chest x ray
Abdominal US

🔸️ لو كانت الفايندينق Cevical LN enlargment

~ بعدها يسألك على ال DD ؟

⬅️و طبعاً DDعلى حسب الاقزامنيشن لو كانت tender بتفكري في infection
Dental carries
URTI / Tonsilitis , pharyngitis
LRTI / Pneumonia

فلازم ضمن خطوات الاقزامنيشن تقوله نبي نشوف ال Throat .

⬅️و لو كانت not tender و hardبتفكري اكثر شي في malignancies
Lung ca
Esophageal ca

◽لو كانت الفاينديقraised JVP

~بعدها يسألك على ال DD ؟
1_ Pulsatile / Rt side HF
2_ Pulsless / SVC Obstruction ( Bronchogenic carcinoma , Cervical rib syndrome)

~بعدها يسألك على ال investigations ؟
1_ Echo
2_ ECG
3_ CXR .

Raised JVP