General

Examination
General
Examination

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General Examination
01 General look

02 Vitals

03 The hands

04 Head and Neck

05 Lower limb

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General look

1-Age :
 A-young : 14-40
 B-middle age: 40-65
 C-elderly : > 65
2-Gender : male or female
3-Posture
 A-lying flat
 B-lying flat with head rested on 2-3 pillows
(HF?)
 C-sitting and bending forward(COPD?)

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General look

1-Age :
 A-young : 14-40
 B-middle age: 40-65
 C-elderly : > 65
2-Gender : male or female
3-Posture
 A-lying flat
 B-lying flat with head rested on 2-3 pillows
(HF?)
 C-sitting and bending forward(COPD?)

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General look
4-level of consciousness Alert ,
Orientation To Time -palace – person
 Most of patients in wards are conscious
Comatose patients are usually in ICU
5-Environment : Any connection to
patient (IV Line ,Catheter , O2 Mask
,Wheelchair,……)
6-Body Built : Average ,thin , Obese (
Depends On BMI)
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 General look

7-Complexion :
A-pallor
- Next step?
- Examine the conjunctiva of lower eyelid, if pale then
Hgb<9
- Examine the palm of the hands (palmar creases) and
compare it to your hand, if pale then Hgb<7
- you can also examine the mucous membranes of the
mouth.

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General look
• Causes of pallor:
1. anemia:A. Microcytic (IDA, chronic
blood loss).
B. Macrocytic (megaloblastic anemia,
Excess alcohol and
hemolytic anemia).
C. Normocytic (Anemia of chronic
disease, CRF)
2. shock state: hypovolemic, anaphylactic
…….
3. peripheral vasoconstriction.(Pallor from
vasoconstriction occurs
during a faint or from fear.
4. Hypothyroidism.

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B. Jaundice : caused by (hyperbilirubinemia
)(Liver disease )
-Sites to be examined :
1. Upper bulbar conjunctiva
2. Sublingual mucosa
3. Palate
4. Palms and Soles
5. General skin surfaces

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D-Cyanosis:
Cyanosis refers to a bluish discolouration of the skin and
mucous
central cyanosis, the tongue appears blue due to an
abnormal
amount of deoxygenated blood in the arteries,
Causes of central cyanosis
- lung disease,
- right to left cardiac shunts and
- also seen in polycythemia and haemoglobinopathies

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 peripheral cyanosis :
Commonly due to poor peripheral circulation
Commonly associated with cold hands
-if you find cyanosis while examining the hands,
what is
your next step?
Examine the lips and undersurface of tongue.

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E-pigmentation :
Pigmentation problems are
commonly due to :
Addisons (buccal mucous
membranes, friction parts)
Hemochromatosis
NF1
Vitiligo
Burns

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Examples:
• Young aged male patient, conscious , lying comfortable in supine
position
of a thin body built; he is not dyspneic not jaundiced or cyanosed.

• Old aged female patient, conscious but lethargic, lying

uncomfortable in bed with head rested on 3 pillows, she looks
overweight; she is
dyspneic, tachypnea with supplemental oxygen via mask
without jaundice or cyanosis but with obviously swollen legs.

• Young aged male patient, conscious, rolling in bed with his hands
rested
on his right flank and appears uncomfortable , he is of a thin body
built, he is not dyspneic, jaundiced or cyanosed.

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 Vitals
• Pulse
• Blood pressure
• Temperature
• Respiratory rate
• SPO2

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Pulse
A What is the normal heart rate?
The general consensus is that :
Normal heart rate = 60-100bpm
<60 bpm = bradycardia
>100bpm = tachycardia

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Measuring pulse -Technique :

Find radial artery

Place index & middle fingers ( not
thumb)

Rate : For 30 s x 2

Rhythm : Regular Or Irregular

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Dorsalis pedis

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Carotid pulse

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Temporal artery

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Blood pressure

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BP
• Some advices :
1-the patient should be rested 5 minutes before
measurement
2-arm at the heart level
3-palpate the pulse and inflate the sphygmanometer to
avoid the auscultator gap.

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SpO2

Measures hemoglobin bound fraction

of oxygen(98.5%)
• Normal: 96%-100%

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– Temperature (oral , axillary . rectal )

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Respiratory rate

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The hands

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THE HANDS
• Examination of the hands involves :
1-Inspection of dorsum for shape, size, color,
rash
2-Inspection of nails for clubbing, half and
half nail, leukonychia
3-Inspection of palms for palmar erythema,
wasting, contractures, pallor.
4- Palpation for temperature, wasting and
radial pulse
5-Tremors
6-Palpation for epitrochlear and axillary LAP.

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 THE HANDS

A-clubbing :
• Respiratory : bronchial CA,
mesothelioma,
bronchiectasis , lung abscess, empyema,
cystic
fibrosis, fibrosing alveolitis.
• Cardiac : SBE, cyanotic CHDs, atrial
myxoma.
•GIT: IBDs, celiac, cirrhosis
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Other nail abnormalities :
- Half and half nail : CKD
- Leukonychia : hypoalbuminemia
- Pitting : psoriasis
- Koilonychia: advanced IDA
- Beaus lines: severe illness
- Splinter hemorrhages: SBE

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Tremors

A-fine tremor : anxiety,

thyrotoxicosis,
B-flapping tremor: End organ failure.
CHF, CRF, respiratory failure, liver
failure.
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Head and Neck

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 Head examination
Head examination involves :
1-inspection of hair and face(Edema and
swelling , Asymmetry, Malar flush
2-examination of eyes for pallor, jaundice.
3-examination of nose for deformity, discharge
4-examination of ears for deformity, discharge.
5-examination of mouth for cyanosis, pallor ,
jaundice ,
tonsillar enlargement, pigmentation…etc.

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Malar flush

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Asymmetry

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Facial swelling

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Neck examination
• Neck examination involves:
1-examination of cervical
lymph nodes
2-examination of Jugular
venous pressure (JVP)
3-examination of thyroid

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Lower limb examination

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LOWER LIMB
• Lower limb examination
involves:
1-inspection for deformity,
wasting, skin rash, color,
ulcers, hair loss.
2-palpation for temperature
and pulses
3-examination for leg edema

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• EDEMA:
Can be generalized or localized.
Generalized edema is due to:‫ط‬Fluid overload :
congestive heart failure, renal failure,
iatrogenic.
Hypoprotenemia : chronic liver disease, nephrotic
syndrome, malabsorption and malnutrition.

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Localized edema:
Venous thrombosis
Lymphatic
Inflammatory

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