ABSTRACT
This builds up a picture of the patient’s general health and possible contributory factors to the presenting complaint
For example:
Cyanosis
Jaundice
Down’s syndrome (may be associated with various pathologies including congenital heart disease, coeliac disease, Alzheimer’s disease)
Cachexia (signs of obvious weight loss and deteriorating physical condition)
Marfan’s syndrome (patients are typically tall with long, thin fingers. It is a genetic disorder of the connective tissue associated with heart valve and aortic defects, lung pathology, problems with eyes and skeleton)
Bilateral exophthalmos (abnormal protrusion of the eyes typically associated with Graves’ disease)
START WITH THE HANDS Inspect both hands
Fig. 1.1 shows some of the signs outlined below
Assess temperature
• Abnormally cold • Localized cool areas
This makes contact with the patient and can be reassuring while obtaining essential clinical information
Hypothermia
Impaired circulation, e.g. peripheral vascular disease or Raynaud’s disease (reduction of blood supply to fingers or toes when exposed to cold or stress. Extremities become pale or white)
• Abnormally hot, sweaty or moist skin Anxiety Exertion
Pyrexia
Liver disease
Obesity
Hyperthyroidism
Hyperhidrosis (abnormally excessive perspiration)
• Clamminess Acute coronary syndrome Myocardial infarction
• Localized hot areas Inflammation or infection
Fig. 1.1. Clinical signs on the hand.
