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CLINICAL SKILLS UNIT EDUCATIONAL LOOPS BY CHSE Acknowledgements: All the images have been taken from...
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Transcript of CLINICAL SKILLS UNIT EDUCATIONAL LOOPS BY CHSE Acknowledgements: All the images have been taken from...
Acknowledgements: All the images have been taken from the following source
Diagnosis in colour
Physical
Signs in
General
MedicineSecond edition
Michael Zatouroff
Mosby-Wolfe
Published 1996
Copyright © Times Mirror International Publishers Ltd.
GCE EXAMINATION OF THE HAND
Inspect
Palpate and Feel
Test for temperature and for moisture
Tenderness
Special tests
Fists, Flairs and Finger Tests
AVOID LISTS WITH THINGS YOU CAN’T EXPLAIN
GCE EXAMINATION OF THE HAND
AVOID LISTS WITH THINGS YOU CAN’T EXPLAIN
DON’T FORGET TO COMPARE THE FINDINGS OF BOTH SIDES
INSPECTION
Size
Symmetry
Deformity
Tradition and culture
Habits or occupation
Disorders and Diseases
Colour
INSPECTION (CAN) BEGINS WITH THE PALM
a) Size
b) Shape
c) Symmetry (left with right and same side)
d) Tradition and culture
e) Habits or occupation
f) Disorders and Diseases
g) Colour (palm or finger pulps)
NAILS AND NAILBEDS
a) Allow fingers to be slighted flexed
b) Observe nail beds
c) Observe any irregularity of nails
Temperature can be felt with back of hand or palm
Calluses can be felt for with palm
Moisture is often detected best with finger pulps (very sensitive)
Once seen never forgotten, but seldom seen!!
Clear deformity (arthritis mutilans caused by Psoriatic arthritis)
THIS TEST IS FOR MUSCULAR AND NEUROLOGICAL INTEGRITY
MAKE A FIST
THEN MAKE A FLAIR
THEN DO THE THUMB-FINGER WALKING TEST
SELDOM SEEN TODAY, TABACCO STAINS OF AN ADDICTED SMOKER
Note too, badly kept nails suggesting a patient who does not look after himself or herself.
Leuconychia – commoner than you think,
Cause usually unknown may appear in several different way:
Punctate, striate or even complete. This appearance is not at all like the white nails of hypoalbuminaemia or that caused by a fungal infection
Striate Leuconychia
Punctate Leuconychia
NAIL BED PALLOR - ANAEMIA
There are two hands here one showing nail bed pallor due to anaemia the other for comparison
Make sure that what you see in a hand is agreed with by your observations elsewhere
Although some laughingly say that they can see pallor where ever it shows itself – be reasonable!!