Examination of the skin, lymph nodes, and individual body parts
12 topics with brief reviews: definitions, key facts, and seminar questions.
External examination of the patient (status praesens) is the foundation of the physical examination, which initiates any diagnostic workup. In this section, we review the methodology for assessing the skin, visible mucous membranes, hair, nails, and subcutaneous adipose tissue.
You will learn how to professionally describe changes in skin color, rash elements, trophic and scarring changes. We will thoroughly analyze the technique of lymph node palpation, assessment of skin moisture, temperature, and turgor, as well as the algorithm for detecting edema. A separate block is dedicated to the targeted examination of the head, neck, mammary glands, and extremities.
What is most commonly asked in classes? Instructors require you to clearly differentiate the origin of edema (cardiac, renal, cachectic), correctly classify morphological elements of rashes, and follow a strict sequence when palpating lymph node groups. Pay special attention to objective signs of alcohol abuse—these «stigmas» often serve as the key to understanding the true causes of the patient's illness.
Artificial lighting (especially incandescent lamps) can distort yellow and red shades. Because of this, the physician risks missing mild hyperbilirubinemia or misjudging the nature of hyperemia.
Artificial lighting (especially incandescent lamps) can distort yellow and red shades. Because of this, the physician risks missing mild hyperbilirubinemia or misjudging the nature of hyperemia.
How to quickly distinguish central cyanosis from peripheral?
Pay attention to the mucous membranes and their response to exertion. Central cyanosis colors the mucous membranes and worsens with movement. Peripheral cyanosis (e.g., acrocyanosis) primarily affects the distal parts of the body, while arterial blood oxygen saturation remains normal.
What is the difference between roseola and erythema?
The difference lies entirely in size. A roseola is a small inflammatory spot up to 1 cm. If the hyperemic area exceeds 1 cm in diameter, it is referred to as erythema.
What does a reticular bluish pattern on the skin of the extremities indicate?
This is the livedo phenomenon (mottled skin). It indicates venular microthrombosis and venous stasis, often occurring in systemic connective tissue diseases, Sneddon's syndrome, and antiphospholipid syndrome.
What is the difference between clubbing and watch-glass nails?
Clubbing («drumstick fingers») describes the bulbous thickening of the soft tissues of the terminal phalanx itself, whereas nail curvature changes («watch-glass nails») pertain exclusively to the alteration in the shape of the nail plate, which becomes excessively convex.
How to differentiate hypoglycemic coma from diabetic coma based on skin condition?
In hypoglycemic coma, the skin is moist (profuse sweating), whereas in diabetic comas (ketoacidotic, hyperosmolar), the skin is dry due to pronounced osmotic diuresis and dehydration.
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