General Survey

1. General Survey Shelley Yeager Instructor DeSales University

2. Purposes of the General Survey • To give an overall impression, a "gestalt", of the patient

3. Techniques of Examination

4. Age • Technique: • observe the patient from all angles

5. Age (cont.) • Normal findings: • patient appears his/her stated age

6. Age (cont.) • Deviations from normal findings: • patient's appears older than his/her stated age

7. Sexual Development • Technique: • observe the female patient's breast and pubic hair development from all angles and observe the male patient's penis, testes, scrotum, and pubic hair development from all angles

8. Sexual Development (cont.) • Normal findings: • Tanner’s stages of breast, penis and scrotum, and pubic hair development

9. Tanner 1: Breast Development • Preadolescent • only the nipple is raised above the level of the breast, as in the child

10. Tanner 2: Breast Development • Budding stage • Bud-shaped elevation of the areola • Areola increased in diameter and surrounding area slightly elevated

11. Tanner 3: Breast Development • Breast and areola enlarged • No contour separation

12. Tanner 4: Breast Development • Increasing fat deposits • The aerola forms secondary elevation above that of the breast • This secondary mound occurs in approximately half of all girls and in some cases persists in adulthood

13. Tanner 5: Breast Development • Adult stage • The areola is (usually) part of the general breast contour and is strongly pigmented • Nipple projects

14. Tanner 1: Female Pubic Hair Development • Preadolescent • No growth of pubic hair

15. Tanner 2: Female Pubic Hair Development • Initial, scarcely pigmented straight hair, especially along the medial border of the labia

16. Tanner 3: Female Pubic Hair Development • Sparse, dark, visibly pigmented curly pubic hair on the labia

17. Tanner 4: Female Pubic Hair Development • Hair coarse and curly • Abundant, but less than the adult

18. Tanner 5: Female Pubic Hair Development • Lateral spreading • Type and triangle spread of adult hair to medial surface of the thighs

19. Tanner 6: Female Pubic Hair Development • Further extension laterally, upward, or dispersed (occurs in only 10% of women)

20. Tanner 1: Penis and Scrotum Development • Testes, scrotum, and penis are the same size and shape as in the young child

21. Tanner 2: Penis and Scrotum Development • Enlargement of the scrotum and testes • The skin of the scrotum becomes redder, thinner, and wrinkled • Penis no larger or scarcely so

22. Tanner 3: Penis and Scrotum Development • Enlargement of the penis, especially in length • Further enlargement of the testes • Descent of the testes into the scrotum

23. Tanner 4: Penis and Scrotum Development • Continued enlargement of the penis and sculpturing of the glans penis • Increased pigmentation of the scrotum • This stage is sometimes best described as "not quite adult"

24. Tanner 5: Penis and Scrotum Development • Adult stage • Scrotum ample • Penis reaching nearly to the bottom of the scrotum

25. Tanner 1: Male Pubic Hair Development • Preadolescent • No growth of pubic hair • That is, hair in pubic area no different from that on the rest of the abdomen

26. Tanner 2: Male Pubic Hair Development • Slightly pigmented, longer, straight hair • Usually at the base of the penis • Sometimes on the scrotum

27. Tanner 3: Male Pubic Hair Development • Dark, definitely pigmented, curly pubic hair around the base of the penis

28. Tanner 4: Male Pubic Hair Development • Pubic hair definitely adult in type but not in extent (no further than the inguinal fold)

29. Tanner 5: Male Pubic Hair Development • Adult distribution • Hair spread to medial surface of thighs, but not upward

30. Sexual Development • Deviations from normal findings: • precocious puberty • delayed puberty

31. Level of Consciousness • Technique: • observe the patient's response to external stimuli

32. Level of Consciousness (cont.) • Normal findings: • patient responds immediately to minimal external stimuli

33. Level of Consciousness (cont.) • Deviations from normal findings: • lethargic • obtunded • stuporous • comatose

34. Lethargic • Definition • patient appears drowsy, but opens his/her eyes and looks at you, respond to your questions, and then falls asleep

35. Obtunded • Definition • patient opens his/her eyes and looks at you, but responds slowly to your questions and is somewhat confused • alertness and interest in the environment are decreased

36. Stuporous • Definition • patient arouses from sleep only after painful stimulus • verbal responses are slow or even absent • lapses into a unarousable state when the stimuli ceases • minimal awareness of the self or the environment

37. Comatose • Definition • patient remains unarousable with eyes closed • there is no evident response to inner need or external stimuli

38. Signs of Distress • Technique: • observe the patient for signs of distress

39. Signs of Distress (cont.) • Normal findings: • no visible signs of distress

40. Signs of Distress (cont.) • Deviations from normal findings: • signs of distress, e.g.: • from cardiopulmonary insufficiency, e.g.: • labored breathing, shortness of breath, wheezing, cough • from pain, e.g.: • wincing, sweating, holding painful part, protectiveness of painful part • signs of anxiety, e.g.: • anxious face; fidgety movements; cold, moist palms

41. Stature • Technique: • observe the patient's stature from all angles

42. Stature (cont.) • Normal findings: • height appears within normal range for age, genetic heritage

43. Stature (cont.) • Deviations from normal findings: • height appears unusually tall for age, genetic heritage, e.g.: • giantism • acromegaly (hyerpituitarism) • Marfan's syndrome • height appears unusually short for age, genetic heritage, e.g.: • Turner's syndrome • achondroplastic dwarfism • hypopituitary dwarfism

44. Giantism • Description • excessive growth hormone secretion before closure of bone epiphyses in puberty causing overgrowth of all bones

45. Acromegaly (Hyerpituitarism) • Description • excessive growth hormone secretion after closure of bone epiphyses in puberty causing overgrowth of the bones in the face, hands, and feet

46. Marfan's Syndrome • Description • connective tissue disorder resulting in a tall, thin stature with long extremities and long, hyperextensible fingers

47. Turner's Syndrome • Description • a chromosonal abnormality seen in about 1 in 3000 live female births, characterized by the absence of one X chromosone, congenital ovarian failure, genital hypoplasia, cardiovascular anomalies, short stature, short metacarpals, shield chest, underdeveloped breasts, uterus, and vagina

48. Achondroplastic Dwarfism • Description • a genetic abnormality in the ability to convert cartilage to bone resulting in dwarfism characterized by a relatively large head, short stature, short limbs, thoracic kyphosis, prominent lumbar lordosis, and prominent abdominal protrusion

49. Hypopituitary Dwarfism • Description • deficiency in growth hormone secretion in childhood characterized by a short stature

50. Weight • Technique: • observe the patient's body weight from all angles