Internal Medicine (Physical
Examination)
Overall Condition of the Patient
MUDr. Andrea Křivanová – IHOK FN Brno + LF MU Brno
„STATUS PRAESENS“
 Main „objective“ findings:
⚫ Blood Pressure (norm. to 139/89
mm Hg)
⚫ Periferal Puls (frequency,
regular/irregular, norm: 60-
90/min)
⚫ Body Temperature - fever – more
than 38 stC, „subfebrilie“ – 37-38
stC
⚫ Frequency of breathing
⚫ Hight
⚫ Weight
Consciousness
 Disturbances of consciousness
⚫ Quantitative disturbances:
⚫ short duration– SYNCOPE
⚫ long duration
 SOMNOLENCE – patient is sleepy, but can be
awakened
 SOPOR (STUPOR) – patient is in deep sleep,
cannot be fully awakened, but reacts on strong
painful stimuli
 COMA – complete alteration of consciousness,
reflexes are diminished or lost
 Qualitative disturbances: disturbances
of sleeping, hallucinations, delirium,
agitation, orientation of WHO…, WHERE…
and WHAT DATE…….etc
Position, Abnormal Movements and
Body Habitus
 Active position
 Pasive position
 Obligatory posture
 Disturbances of Gait
 Tremor (shaking)
 Convulsions
Position – abnormal (Obligatory
posture)
Ortopneic – sitting position with the head propped
up with pillows (left heart insufficiency)
Restless, unquiet – the patient is restless,
changing position, unquiet (colica biliaris,
colica renalis)
Supine position – the patint prevents
movements (peritonitis)
Lying on one side – the patient is lying on the
side of pathological process trying to reduce
pain from the breathing motion of the affected
side (pleuritis)
„on all four extremities" – the patient reduces
pain from intraabdominal tumors (tumor of
pancreas)
Obligatory posture
⚫ Ortopneic posture
⚫ Pasive posture
Body Habitus
⚫ Normostenics
⚫ Astenics (lean, slender people)
⚫ Pycknics (hyperestenics, obese
people)
⚫ Cachexia – patological weight
loss
Changes in Voice and
Disturbances of Speach
 A coarse voice
(hypothyreoidism)
 Aphonia – a complete loss of
speach
 Aphasia – an inability to form
words
(cerebral damage)
 Dysarthria (a defect in articulation)
Moisture and Color of Skin and Skin
Eruptions
 Pallor (anaemia, decreased number of red
cells)
 Jaundice (icterus, increase level of
bilirubin in blood)
 Cyanosis (violet coloration, when reduced
blood hemoglobin exceeds 50g/l)
 Rashes
 Bleeding into the skin
 Edema (swelling)
Skin Colour
 Pallor
 ANEMIA Raynaud´s disease
(decreased flow in
small arteries)
„Rubor“ – redness of the
skin
Cyanosis – violet to
bluisch coloration of the
skin
heart or/and pulmonary disease
Icterus (Jaundice)
 Liver disease
Icterus (Jaundice)
Disorders of Pigmentation
– Lack of Pigment
 Local – vitiligo
 Global - albinism
Increased skin
pigmentation
Disease of veins Hypocorticolism
Skin pathological formations
Macula = flat
Papula = prominent
Vesicula = blister
Pustula = blister with infection
Skin Bleeding
Petechiae – decreased number of trombocytes
Suffusions, ecchymoses – flat, larger areas
Hematoma – collection of blood that extends
into deeper tissuees
Skin Turgor
Dehydratation (decreased skin turgor)
Sweling (Edema)
Accumulation of fluid (heart disease, liver disease
atc..)
Swelling (Edema)
Disease of vessels
Nails
Nails in patients with
pulmonary and/or heart
disease
onychomykosis (fungi)