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1. Pallor

---- Pallor means looks pale or fades from the normal color of skin.

Pallors occur in:

a. Shock, syncope

b. Left heart failure

c. Hypopituitarism

d. severe anemia

Site  of  examination  of  pallor

-Lower palpebral conjuntiva

-Nail beds

-Palmer crease

--Mucous membrane of the lips, cheeks

2. Cyanosis---

 When skin and mucous membrane change into bluish color, it is called cyanosis. It occurs when the oxygen level in the blood is decreased.

TYPES

a. Central cyanosis--- It results from imperfect oxygenation of blood as a result of heart failure, lung disease, and right to left shunt in the heart.

--Cynosure extremities are warm.

--Cyanosis is seen in extremities as well as the tongue.

b. Peripheral cyanosis----It results from an excessive reduction of oxyhemoglobin

in the capillaries when the blood flow appears. It occurs in:

→Exposure to cold

→Heart failure

          . Coldness of cyanosed extremities  

          . No effect on the tongue

Site  of  examination

---Nail bed

---Tip of the nose

---Tips of fingers and toes

Cause  of  cyanosis

---Chronic obstructive lungs disease

---Obstruction of the respiratory way

---Pulmonary edema, bronchial asthma

---Heart failure

---Exposure to the cold environment

3.  Jaundice---

Jaundice is a condition in which skin and mucous membranes change into yellow color resulting from too much bilirubin in the blood. 

Site  of  examination

…Bulbar conjunctiva

….Soft plate

….Nail bed

….Lobule of the ear, tips of the nose

….skin

….Under the surface of the tongue

4. Dehydration--

It is a state of clinical condition due to decreased amount of water in the body.

Causes of dehydration

a. Decreased intake of fluid

b. Loss of body fluid--- Severe diarrhea and vomiting, intestinal obstruction, severe burn, bleeding, etc.

c. Hot climate

Site  of  examination

..Eye---Sunken eyes

..Tongue---Dry and thirsty

..Skin----Skin pinch goes  back  slowly  or  very  slowly

5. EDEMA---

Edema is a fluid buildup in the interstitial space caused by an excess of fluid.

Anasarca- It is a medical term used to describe generalized body enema.

 Types of edema----

a. Pitting edema

b. Non-pitting edema

Causes  of  edema

a. Decreased osmotic pressure

-- Nephrotic syndrome

-- Severe malnutrition

-- Cirrhosis of the liver                                                                                          

---Protein-losing enteropathy

b. Increased hydrostatic pressure

--Renal failure

--Heart failure

--Fluid overload

c. Obstruction of lymphatic channels

--Filariasis

--Post radiotherapy

--Post-surgical clearance of lymphatic channels

Site of examination of edema

---Sacrum

---Above the medial malleolus

---face

---Scrotum

6. Clubbing

It is a bulbous growth of the distal part of the digit due to accelerated sublingual gentle tissue

Causes  of   clubbing

.Respiratory disease:     Lungs abscess, Bronchiectasis, Interstitial lung disease, Bronchogenic carcinoma.

. Hepatobiliary disease:    Cirrhosis of the liver

. Gastrointestinal disease:   Ulcerative colitis

.Cardiac disease: Congenital cyanotic heart disease, Bacterial endocarditis

7. Temperature----

It is a degree of coldness and hotness of the body which is expressed on a specific scale.

** Conversion of centigrade to Fahrenheit:

--- C/5=F-32/9

Or, degree C= [F-32]×5/9

.degree fahrenheit= 1.8c+32

8. Common causes of lymphadenopathy are:

a.Infective

-- Hiv infection

--Tuberculosis, syphilis, 

--Toxoplasmosis, brucellosis

--Cytomegalovirus infection

--Infectious mononucleosis

b.Malignant

--Lymphoma

--Secondary metastases

--Chronic lymphatic leukemia

c. Others:

--Rheumatoid arthritis

--Systemic lupus erythematosus [SLE]

--Sarcoidosis

9. Causes of thyroid gland enlargement:

--Thyroid tumors

--Multinodular goiter

--Grave’s disease

--Simple goiter

--Hashimoto’s thyroiditis

10. Respiration

--It is the process of bringing oxygen into the body and expelling carbon dioxide from the lungs is called Respiration.

--The normal rate in an adult is about 14-18/min.

The main causes of fast breathing [tachyponea] are:

..Anxiety              

..Pulmonary disease.

..Nervousness

..Cardiac failure

..Fever                 

..Pleuritic disease

..Recent exertion    

..Metabolic acidosis

**Causes of slow breathing are:

…Increased intracranial pressure

…Overdose of sedative drugs

11. Blood pressure

It is described as the force or pressure that the blood applies to the blood vessel walls.

Types of blood pressure

. a.Systolic pressure:  It is the maximum pressure during cardiac cycles.  It ranges from 100-140 mm Hg. 120 mm Hg on average.

b. Diastolic pressure: This is the lowest pressure during the cardiac cycle. It ranges from 60-90 mm Hg.80 mm Hg on average

c. Pulse pressure: Systolic minus diastolic pressure is pulse pressure. It is about 30-40 mm Hg. 

d. Mean pressure: The diastolic pressure plus one-third of pulse pressure is the mean pressure. It is roughly 96 mm Hg.

KOROTKOFF SOUNDS---

 While gradually lowering the pressure inside an occlusion cuff wrapped around the upper arm, The korotkoff sounds can be heard at the brachial artery with a stethoscope.

-The sound heard during auscultatory determination of blood pressure is called Korot-Koffs’ sound.

-BP is normally measured in the brachial artery and femoral artery in the leg also.

According to age group, normal blood pressure

Infant:     70-90/50 mm Hg

Childhood:  80-100/50 mm Hg

Adolescence:    80-100/50 mm Hg

Adult: 90-140/60-90 mm Hg

12. postural hypotension:

Postural hypotension is defined as a drop in systolic pressure of greater than 20 mm of Hg [diastolic pressure greater than 10 mm of Hg] after standing for three minutes from a lying position. Blood pressure must be taken in lying down, sitting, and standing up positions, especially if postural hypotension is suspected.

Causes of postural hypotension

: Haemorrhage

: Body fluid loss

: Autonomic neuropathy

: Myocardial pump failure

: Antihypertensive drugs

13. Arterial pulse:

A pulse is a wave that can be felt by the finger, brought about by cardiac systole. It crosses the arterial tree in a peripheral direction. It gives a good indicator of the cardiovascular condition of the patient.

Common site of taking the pulse

A. Femoral artery        b. Carotid artery     

c. Brachial artery        d. Radial artery

e. Popliteal artery    f. Posterior tibial artery

g. Anterior tibial artery    h. Dorsalis pedis

Radial pulse------Assess rate and rhythm.

Carotid pulse----Assess volume and character.

Brachial pulse----Assess blood pressure.

Normal pulse rate:   60 - 100 per minute.

Sinus bradycardia:  pulse rate <60 beats/minute.

Sinus tachycardia:  Pulse rate >100 beats /minute.

***Causes of sinus tachycardia:

--Excitement, Exercise, Anxiety

--Pain, Anaemia, Pyrexia

--Children, infant

--Hypovolemia, cardiac failure

--Hyperthyroidism

--Drugs:

     .Atropine

     .Salbutamol

     .Adrenaline

***Cause of sinus bradycardia:

--Hypothermia, Hypothyroidism

--Athletes, sleep

--Obstructive jaundice

--Drugs:

.Beta-blockers - Digoxin,

-Verapamil/Diltiazem

14. Pulse deficit-It is the distinction between the heart rate and the pulse rate.

15. Step of systemic examination:

--Inspection

--Palpation

--Percussion

--Auscultation  

16.  Regions of the Abdomen:

a. Right Hypochondrium               

b. Left Hypochondrium

c. Epigastrium                                     

d. Right Lumber region

e. Left lumbar region                     

f. Umbilical region

g. Right iliac fossa                            

h. Left iliac fossa

i. Hypogastrium 

17. Common  causes  of  Hepatomegaly:

**Hepatoma

**Congestive cardiac failure

**Alcoholic liver disease

**Viral hepatitis

18. Common causes of splenomegaly:

*Enteric fever, Maleria, Kala-azar

*Haemolytic anemia

*Leukaemia

*Partial hypertension

19. Common causes of hepatosplenomegaly:

# Malaria, Kala-azar

#Lymphomas

# Myelofibrosis

# Dissiminated tuberculosis

#Infectious mononucleosis

20. Increased bowel sounds due to:

--Malabsorption

--Mechanical obstruction of the intestine

--Carcinoid syndrome

--Absent or sluggish bowel sounds

--Paralytic ileus, Peritonitis

21. Consciousness:  It is the state of responsiveness of self and the surroundings.

22. Confusion— it lacks clarity and coherence of thought, perception, and action.

23.  Coma—It is a condition of unconsciousness in which the patient does not react to any stimuli.

24. Stupor—It is a condition of disturbed consciousness from which only forceful external stimuli can produce movement.

25.  Installation----Application of the liquid form of drug by drop is called Installation.

---This is used for the administration of liquid medicine into the Eye, Ear, and Nose.

26. Catheterization

It is the process of drawing urine from the urinary bladder by the use of a catheter inserted through the urethra under aseptic precaution.

Indication of catheterization

a. Therapeutic

* Retention of urine

*During delivery

*Incontinence of urine

* Inoperable enlargement of the prostate

* During or following major pelvic and rectal surgery

b. Diagnostic

* Cystoscopy and cystography

* To differentiate pelvic swelling from the distended urinary bladder

* To differentiate anuria   from retention

* To obtain urine specimens per vaginal bleeding patient for routine and pregnancy tests.

* To obtain urine specimens from an unconscious  patient

Contraindication

a. Urethral structure

b. Traumatic urethral injury

c. Acute urethritis without retention of urine

27.  Nasogastric tube---Insertion of the tube into the stomach through the nose is called Nasogastric tube insertion. It is thin 30 inches long.

Indication of NG tube insertion

**Gastric lavage in case of  poisoning  and  pyloric  obstruction

**Feeding  an  unconscious  patient  or  a  patient  with  bulbar  palsy  who

has dysphagia or severe odynophagia

**Gastric content analysis

**For gastro-intestinal decompression as with paralytic ileus,

 intestinal obstruction  (dynamic)  or during laparotomy and after abdominal surgery.

28. Medical asepsis-----Medical asepsis means the cleaning technique which  includes  the

Procedures are applied to decrease the number of micro-organisms and

prevent their spread from one place or person to another.

---Changing a patient’s linen daily, hand washing, and using medication

cups are examples of medical asepsis.

---Medical asepsis is commonly followed at home washing hands

before preparing food or eating, using clean or disposable drinking

cups, and mopping the kitchen floor are medical asepsis practice.

29. Surgical asepsis-

 Surgical asepsis means a sterile technique that includes the procedure

used to eliminate microorganisms from any area. The process of sterilization

destroys all micro-organisms including spores.

The sterile technique is practiced by health workers in minor and major

surgical procedures such as catheterization, laparotomy, and I & D of the abscess.

Tags-pallor, respiration, blood pressure, medical asepsis, surgical asepsis, clubbing, cyanosis, temperature, jaundice, edema, etc 

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