First impressions

The first impression of the patient is always striking in some way and we should discipline ourselves to be as analytical as possible.

A rapid inspection from a trained observer may be all that is necessary to allow the observer to pinpoint specific disorders such as anaemia, hyperthyroidism, jaundice, acromegaly and alcohol abuse. Such 'spot' diagnosis is not justifiable unless the original signs are supported by further examination, which must be comprehensive. The following observations should therefore be made:

• facial characteristics

• abnormalities of the head and neck

• examination of the mouth

• character and distribution of hair

• examination of the skin (in general)

• height and weight

• posture and gait

• examination of extremities (hands, feet, nails, etc.)

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