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The warmth of the skin to the touch usually provides a good indication of fever, but the skin of a patient with a normal temperature may feel cold, and an apparently normal skin temperature does not exclude hypothermia.

Fever is usually due to organic disease. An otherwise inexplicable transient rise may be due to a recent hot drink

Lipodystrophy Due Insulin
Fig. 2.7 Insulin-induced lipodystrophy.

or a hot bath. Individuals sometimes falsify their temperatures by a variety of tricks, including the use of hot-water bottles, in order to feign illness.

Hypothermia may be overlooked, particularly if the ordinary clinical thermometer, which reads from 35=C, is not shaken down below this level before use.

Low-reading clinical thermometers are readily available and should be used when hypothermia is suspected. Temperatures as low as 27°C are not uncommon and core body temperatures below 20°C have been recorded in patients who subsequently survived.

Hypothermia is associated with various situations:

• elderly patients living alone who have lain overnight after falling

• near-drowning

« prolonged unconsciousness in low environmental temperatures, especially as a result of alcohol intoxication (which causes peripheral vasodilation), other drug overdosage or head injury

• severe hypopituitarism and hypothyroidism.

Because many of the features of severe hypothyroidism and near-drowning mimic death, such subjects may require to be fully resuscitated and re warmed before assessing viability.

Facial Appearance Cushings Disease

Fig. 2.8 Paiient witti Cushing's syndrome showing H mooned 1ace and [b| facial appearance 6 months after removal of ectopic ACTH-producirtg tumour.

TABLE 2.fi Other features of Cushing's syndrome



Facial mooning

Face round and plethoric (see Fig, 2.8)

Plethonc appearance

Caused by thinning of dermis

Purple striae

Noticeable on trunk and limbs


Increased capillary fragility


Glucocorticoid effect


Mineralocorticoid effect

Vertebral collapse

Osteoporosis may lead to shortening of stature

Personality change

May progress to psychosis


• First Impressions are often invaluable.

• The concept of performing a complete physical examination is inappropriate. As a general rule 'you only find what you look for'.

• Check to make sure that the patient's right hand is functional before shaking hands.

• Skin complexion is influenced by artificial lighting.

• A liver llap' may only become apparent when the outstretched hand is dorsiflexed.

• Regional fat distribution can be roughly assessed from the waist-hip ratio and Is probably as useful a prognostic index as overall degree of obesity.

• Hypothermia may be missed if a clinical thermometer is not shaken down to below 35"C,


In an adult, body water comprises 60-65ÇÎ of the body mass. It follows that a subject weighing somewhat more than 70 kg has about 45 litres of body fluid. Two-thirds of this is intracellular (30 litres); of the remainder, two-thirds comprises interstitial lluid ( 10 litres) and roughly 5 litres is included in the circulating blood volume.

Examination sequence

□ Assess the state of hydration by testing skin elasticity and intraocular pressure, recording the blood pressure and looking for a postural drop.

□ Check for dependent oedema by firm pressure at the ankle behind the medial malleolus and, when present, assess its extent elsewhere by pressing over the tibia, in the medial thigh and in the sacral area.

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Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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  • markus aaltonen
    What does Hypopituitarism look like?
    8 years ago

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