Inspect the Tympanic Membrane

Right Normal Tympanic Memb

As the speculum is introduced farther into the canal in a downward and forward direction, the tympanic membrane is visualized. The tympanic membrane should appear as an intact, ovoid, semitransparent, pearly gray membrane at the end of the canal. The lower four fifths of the tympanic membrane is called the pars tensa the upper fifth, the pars flaccida. The handle of the malleus should be seen near the center of the pars tensa. From the lower end of the handle, there is frequently a bright...

Bone Spicule Retina Differential

Bone Spicules Retinitis Pigmentosa

Figure 10-141 shows a giant retinal tear. A large area of bare choroid is visible through the break. Retinitis pigmentosa is a very rare, genetically determined degenerative disease of the retina with an onset from the ages of 6 and 12 years. It is more common in boys than in girls and is almost always bilateral. Night blindness is the first symptom, followed by a gradually progressive constriction of the peripheral fields and eventually blurred vision. Evaluation of the retina reveals the very...

Differential Diagnosis Genital Wart Scrotum

Condylomata Acuminata Man

Figure 18-33 Position of the examining finger in the inguinal canal. examine the patient's right side and the left index finger for the patient's left side. Try both techniques to see which one is more comfortable for you. If there is a large scrotal mass that appears opaque on transillumination, an indirect inguinal hernia may be present in the scrotum. Auscultation of the mass can be performed to determine whether bowel sounds are present in the scrotum, a useful sign in diagnosing an...

Palpate the Prostate Gland

Prostate Physical

The prostate gland lies anterior to the wall of the rectum. The size, surface, consistency, sensitivity, and shape of the prostate gland should be assessed. The prostate is a bilobed, heart-shaped structure approximately 1.5 inches (4 cm) in diameter. It is normally smooth and firm and has the consistency of a hard rubber ball. The apex of the heart shape points toward the anus. Identify the median sulcus and the lateral lobes. Note any masses, tenderness, and nodules. Only the lower apex...

Basilar Skull Fracture Raccoon Eyes

Raccoon Eyes Medical

Zoster ophthalmicus at different stages of evolution (fresh and crusted vesicles) in the ophthalmic division of the trigeminal nerve. Treatment with antivirals can dramatically reduce the symptoms. Is orbital pigmentation present Orbital pigmentation, also known as raccoon eyes, is an important sign of a basilar skull fracture. This discoloration is caused by extravasated blood from the fracture of the base of the brain. This is an important sign to recognize, especially in an unconscious...

Inspect the Hard and Soft Palates

Palatal Petechiae Pharyngitis Otitis

Inspect the rugae and vault shape of the palates. Also inspect the palates for ulceration and masses. Masses are usually minor salivary gland tumors, mostly malignant. Are any white plaques present Is the soft palate edematous Is the uvula in the midline Is the palate intact Figure 12-32 shows a severe cleft palate. Clefts of the palate and lips are distinct entities but are closely related embryologically, functionally, and genetically. The incidence of an isolated cleft palate is 1 per 1000...

Roth Spot Fundus Photos

Hollenhorst Plaque Images

Figure 10-99 Diabetic retinopathy with neovascularization of the disc, neovascularization elsewhere in the retina, preretinal hemorrhage, and fatty macular exudates. Figure 10-99 Diabetic retinopathy with neovascularization of the disc, neovascularization elsewhere in the retina, preretinal hemorrhage, and fatty macular exudates. Figure 10-101 Proliferative diabetic retinopathy. Note the lesions of panretinal photocoagulation. Figure 10-101 Proliferative diabetic retinopathy. Note the lesions...

Clinicopathologic Correlations

Zinc Deficiency Skin

There are myriad vitamin and trace element deficiencies, and it is beyond the scope of this book to describe them. There are, however, several worth considering. Vitamin A, a fat-soluble vitamin, is an integral component of rhodopsin and iodopsin, the light-sensitive proteins in the rods and cones of the retina. A deficiency of vitamin A is associated with follicular hyperkeratosis and night blindness. Figure 5-6 illustrates a patient with vitamin A deficiency and follicular hyperkeratosis....

The Written Physical Examination

Left Lower Abdominal Tenderness

After the examination has been completed, the examiner must be able to record objectively all the findings of inspection, palpation, percussion, and auscultation. Be precise in stating locations of abnormalities. Small drawings may be useful to describe a shape or location better. When describing the size of a finding, state the size in millimeters or centimeters rather than comparing it with a fruit or nut, for example, because these can vary greatly in size. It is best not to use most...

Kayser Fleischer Ring

Kayser Fleischer Ring

Of the sclera with possible involvement of the cornea, uveal tract (i.e., iris, choroid, and ciliary body), or retina. Photophobia is common. Scleritis is usually related to a systemic disorder. It occurs much more commonly in patients with connective tissue disorders. It may be diffuse or localized and nodular. Nodular scleritis is marked by dark localized blue patches in the anterior portion of the sclera these are seen because the choroid is visible through the translucent sclera. The...

Structure and Physiology

Accidentes Vivo Pulidores

This section covers some of the anatomic and physiologic changes that are attributed to aging, as well as some of the physical findings that result. There is atrophy of the epidermis, hair follicles, and sweat glands, which results in thinning skin. The skin becomes fragile and discolored. Wrinkling and dryness result from reduced skin turgor. In addition, the nails become thin and brittle, with marked ridging. There is decreased vascularity of the dermis, which contributes to prolonged healing...

Physical Examination

White Patch Mons Pubis

The equipment necessary for the examination of the female genitalia and rectum consists of a vaginal speculum, lubricant, cervical scrapers, cotton-tipped applicators, gloves, glass slides, occult blood testing card and Hemoccult developer, culture media (as appropriate), fixative, tissues, and a light source. Unlike most other parts of the physical examination, the pelvic examination is often viewed with apprehension by the patient. This is frequently related to a previous bad experience. An...

Inspect the Penis and Scrotum

Penis Syphilis

In the examination of the penis and scrotum, note the following Any lesions on the penis and penile edema Figure 18-11 shows ectopic sebaceous glands on the shaft of the penis. The glands appear as pinhead-sized, whitish-yellow papules. These are commonly seen in normal men on the corona, the inner foreskin, and the shaft of the penis. Their appearance is very similar to Fordyce's spots of the oral mucosa (see Fig. 12-18). Ectopic sebaceous glands also may be found in normal women on the labia...

Swollen Right Carotid Artery

Inspection Thyroid Gland

Cervical chain along the sternocleidomastoid muscle to feel for the superficial cervical chain hooking around the sternocleidomastoid muscle to feel for the deep cervical chain deep to the muscle into the anterior triangle region up to the jaw margin to feel for the tonsillar group along the jaw to feel the submaxillary chain to the tip of the jaw for the submental nodes and up to the anterior auricular chain in front of the ear. This sequence of examination is shown in Figure 9-9. Enlarged...

Ancyclostoma Brazillienses Force Out Of The Skin

Digital Sclerosis

Figure 20-69 A, Exostosis at the metatarsocuneiform joint. B, X-ray film of the affected metatarsocuneiform joint. Figure 20-69 A, Exostosis at the metatarsocuneiform joint. B, X-ray film of the affected metatarsocuneiform joint. Approximately 30 of patients with diabetes mellitus have disease-related dermatologic problems. Neurotrophic foot ulcers are very common in diabetic patients. Figure 20-72 shows bilateral neurotrophic ulcers. Painless plantar ulcers heal slowly after apparently...

Examination Vagina By Finger

Clito Finger Exam

The speculum is introduced to full depth. When it is inserted completely, the speculum is rotated to the horizontal position, with the handle now pointing downward, and is opened slowly. With the bills open, the vaginal walls and cervix can be visualized. The cervix should rest within the bills of the speculum. This is demonstrated in Figure 19-21 and diagrammed in Figure 19-22. To keep the speculum open, the set screw can be tightened. If the cervix is not immediately seen, gently turn the...

Angular Cheilitis Early Hiv Symptom

Hiv Simptom Photos

Alteration of taste, gingival pain, malaise, fever, and halitosis. As the disease progresses, a whitish pseudomembrane develops along the gingival margins, with ulceration and blunting of the interdental papillae. Acute necrotizing gingivitis, pictured in Figure 12-57, may be an early feature of HIV infection. On August 6, 2008, the Centers for Disease Control and Prevention (CDC) released a new estimate of the annual number of new HIV infections (HIV incidence) in the United States, revealing...

Overriding Metopic Suture

Skull Anatomy Overriding Sutures

Examination of the head involves a thorough assessment of its shape, symmetry, and fontanelles. The skull may be molded, especially if the labor was prolonged and the head was engaged for a long period. The skull of a child born by cesarean section has a characteristic roundness. In the newborn, the sutures are frequently felt as ridges as a result of the overriding of the cranial bones by molding as the skull passes through the vaginal canal. Palpate the fontanelles, or ''soft spots.'' The...

Auditory Acuity Testing

Testing for auditory acuity is the next part of the physical examination. The easiest method of testing for a gross hearing loss is for the examiner to occlude one external canal by pressing inward on the tragus and to speak softly into the other ear. The examiner should hide his or her mouth to prevent lip reading by the patient. The examiner should whisper words such as ''park,'' ''dark,'' or ''daydream'' in the nonoccluded ear and determine whether the patient can hear them. This procedure...

Transilluminate Scrotal Masses

Testicular Atrophy Images

If a scrotal mass is detected, transillumination is necessary. In a darkened room, a light source is applied to the side of scrotal enlargement. Vascular structures, tumors, blood, hernias, and normal testicles appear opaque on transillumination. Transmission of the light as a red glow indicates a serous fluid-containing cavity, such as a hydrocele or a spermatocele. A hydrocele is an abnormal collection of clear fluid in the tunica vaginalis. The testicle is contained within this cystic mass,...