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By Michael Glynn, (Gastroenterologist); W M Drake; Robert Hutchison, Sir

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16 Central cyanosis in a patient with severe respiratory disease (left) compared to the tongue of a normal person. (From Forbes and Jackson 2002 Color Atlas and Text of Clinical Medicine, 3rd edn, Mosby, Edinburgh. ) bluish pigment and its presence in peripheral blood vessels in increased amounts causes the clinical sign of cyanosis. There are two physiological types of cyanosis: peripheral and central. Peripheral cyanosis is associated with increased extraction of oxygen from capillaries when peripheral blood flow is slowed, often due to vasospasm caused by cold, heart failure or anxiety.

In general, it is most convenient to use the right hand to examine the left DP pulse; the right is often best felt with the right hand from the left side of the patient. To feel the posterior tibial (PT) pulse, with the patient’s foot relaxed between plantar- and dorsiflexion, press your curved fingers against the distal part of the tibia, approximately 1 cm behind and below the medial malleolus. The PT pulse may be difficult to feel and require extra patience and pressure in obese or oedematous patients.

From Forbes and Jackson 2002 Color Atlas and Text of Clinical Medicine, 3rd edn, Mosby, Edinburgh. 12 Gross enlargement of supraclavicular and cervical lymph nodes. (From Forbes and Jackson 2002 Color Atlas and Text of Clinical Medicine, 3rd edn, Mosby, Edinburgh. ) experience. In general, small, mobile, discrete lymph nodes are frequently found in normal individuals, particularly those who are slim and have little overlying adipose tissue. ’ (Fig. 12). Axillae Most information from examination of the axillae comes from palpation for possible lymphadenopathy (Fig.

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