Perform complete physical examination in a

patient who presents with elevated blood sugar.

General examination:
Seated comfortably with bed elevated to 45 degrees.
Conscious, well oriented to Time, Place, Person.
On IV saline inserted on the right side of neck. He had a catheter
inserted.
Hands had no sign of discolouration, scars, deformities or trophic
changes. Nails had no sign of clubbing and nailbed was well perfused.
Reddish purple blotching at antecubital fossa both arms due previous
to IV insertion.
No tremors.
Face was symmetrical and tanned complexion without abnormal facies.
Eyes appeared yellow but conjunctival mucosa was pink. No nasal
discharge. Mouth had pink mucosa and tongue. Frenulum was pink.
Healthy dentition. Had yellow ear discharge on both sides.
Neck was unremarkable and no lymph nodes were palpable.
Legs appeared to have multiple hyperpigmented scars up to knee level.
Right foot had flaky and dried skin. No trophic changes were seen.

Vital sign:
BP: 164/95 mmHg.
Resp Rate: 16 bpm.
Pulse rate: 92 bpm.
SpO2: 99%
CVS:
JVP was not appreciated on this patient.
Chest appeared symmetrical. A 2x3 cm raised, firm purple
growth was seen on the right medial chest. No other deformities.
Radial pulse was palpable with god volume and rythm, no radioradio delay. Post tiabial pulses were absent, dorsalis pedis pulse
on right leg was present but faint; absent on left leg.
Apex beat was localized at 5th intercostal space at midclavicular
line.
No heaves were seen on patient. No thrills were elicited.
S1 and S2 heard, no unusual murmurs/ sounds.
Capillary refill <2s.
No pitting oedema.

Resp:
The patient displayed thoraco-abdominal breathing without the use of
accessory muscles.
On palpation, the trachea was localized in the midline.
No unusual pain on the thoracic cavity was reported by the patient. Chest
expansion was approximately 5cm and symmetrical on both sides.
On percussion, all lung fields were resonant in the anterior, posterior and lateral
aspects. Hepatic, splenic and cardiac dullness were elicited.
Focal fremitus and tactile fremitus was not elicited.
On auscultation, only vesicular breathing was heard in all lung fields.
Abdominal Examination:
On inspection, the abdomen appeared symmetrical but distended and with light
coloured striae.
The abdomen is soft and not tense. No tenderness was elicited on superficial
and deep palpation.
Liver span was 11cm. Splenic dullness was percussed at 9 th and 11th intercostal
space. No palpable organs.
Kidneys were not palpable nor ballotable and no aortic pulsation of the
abdomen was palpable.
Shifting dullness performed on this patient yielded a positive result. Fluid thrill
negative.
On auscultation, bowel sounds were heard at approximately 3 times a minute.

Central Nervous System Examination:

Gait was not assessed due to cathetherization.
Reflexes were present on Jendrassik
manoeuvre. Plantar flexor reflex.
Impaired proprioreception on left toe.
Loss of sensation (light touch and pin prick) in
both legs. Up to ankle in right leg; up to mid
foot on left leg. Crude touch was reduced in
sensation until below knee level on both legs.
Power was 5/5 for the myotome movements.
Musculoskeletal Examination:
Range of movements of joints were intact.