Examination

  • Always undress the patient adequately (especially when working with small children). It is important not to miss a rash or evidence of past skin disease, such as Herpes zoster (Shingles).
  • Have a good light source, gloves and gauze.
  • Some skin lesions may be harder to see on a darker skin.
  • Have a good light source, gloves, gauze and speculum for careful close examination of all lesions, e.g., inside the mouth, genital area.

Lymphadenopathy
Small nodes (< 1 cm) are not usually considered pathological. If they are larger, more numerous and tender or indurated (as opposed to soft and rubbery), they may be more significant, e.g., due to lymphadenitis, TB or lymphoma. Palpation may also be easier in emaciated patients.

Danger signs include:

  • RR ≥30 / minute
  • HR = ≥120 / minute
  • Unable to walk unaided
  • fever ≥39°C
  • Systolic blood pressure (BP) < 90mmHg
  • Saturation < 90%
  • Moderate to severe dehydration (always check urine in elderly)
  • Unable to walk unaided
  • Altered mental state (check orientation for place, person and time)
  • Other neurological problems, e.g., paralysis seizure, loss of vision

The lower the CD4 count, the greater the risk of opportunistic infections:

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