General Physical Examination

General Examination

Build of the patient

Slender or muscular or stocky

Height Weight H/W BMI

24-hour dietary recall

General Examination

Appearance of the patient

Apparent state of health Acutely or chronically ill Frail/Feeble/robust/vigorous

Level of Consciousness Awake/Alert/Responsive/Oriented X 3 Signs of distress

Cardiac or respiratory distress Pain/anxiety or depression

General Examination

Enquire regarding (depending on appearance)

Recent weight changes Events occurring in the pts life change in job/relationships to get an idea of physical & psychological status of pt Fatigue/Weakness Recent changes & relation to amount of work
How to do this in infants?

General Examination
Posture, Gait, & motor activity Obvious skin changes

Pallor/Cyanosis/Jaundice/rashes/bruises

Dress, Grooming, & Personal Hygiene Facial Expression Odors of body & breath

General Examination head to toe

Hair
Distribution/appearance/grooming

Eyebrows
Distribution/ any loss of eyebrows

Eyes
Sclera Yellow discoloration Fornices Pallor

Nose
Flaring of nostrils/ any discharge

General Examination head to toe

Ears
Discharge/ lesions

Teeth
Hygiene/ implants/ dental problems

Gums
Any bleeding/ Color

Tongue
Moist or dry/ pink or not/ appearance/ any lesions

General Examination head to toe

Face
Symmetry

Neck
Visible pulsations/masses

Hands
Tremors/ muscle mass

Nails
Clubbing/ Cyanosis/ pallor/ grooming

General Examination head to toe

Chest
Usage of intercostal muscles/ visible pulsations

Abdomen
Masses/ distension/ dilated veins/ visible movements

Legs
Swollen or not/ If swollen Pitting or not Masses/ ulcers

Vital signs
BP RR HR Temperature

BP Choosing proper cuff

Width of the inflatable bladder of the cuff should be about 40% of upper arm circumference (about 12-14 cm in the average adult) Length of the inflatable bladder should be about 80% of upper arm circumference (almost long enough to encircle the arm). The standard cuff is 12 23 cm, appropriate for arm circumferences up to 28 cm Standard thigh cuff is 18 x 42 cm

BP Korotkoff sounds
Systolic BP Pressure at which the sounds start Diastolic BP Pressure at which the sounds become muffled or totally absent

Total absence point gives best estimate of the true diastolic BP Gap between muffling and absence should be small
If more, then note both the values

BP Auscultatory gap
Beware of Auscultatory gap To avoid it

First determine systolic BP by palpation Then determine systolic & diastolic BP by auscultation

If present, auscultatory gap should always be mentioned in the case sheets

BP - Comparison

Compare BP in both limbs

Normally should not vary more than 5-10 mm of Hg

Compare BP in Upper & lower limbs

With usage of proper cuffs, they should almost be equal

HR
Rate Rhythm Volume Contour

RR
Rate Rhythm Depth Effort of breathing

Temperature
Oral temp. Rectal temp. Axillary temp. Tympanic membrane temp.

Glass vs. Electronic thermometers