PHYSICAL EXAMINATION : THE

BASICS
DR O.G.EGBI
Consultant Physician, NDUTH,
Okolobiri
 PHYSICAL EXAMINATION
• Examination usually follows history taking
• It is an important step in the medical diagnostic
process
• It is needed to compliment history taking
• Physical examination may be general or systemic,
• The basic sequence in clinical examination is as
follows: Inspection → Palpation → Percussion →
Auscultation
 GENERAL EXAMINATION
• Physical appearance eg. Breathless
• Mental state eg. Anxious, distressed
• Undernourished, obese
• Record height, weight, waist circumference
• Skin eg. Cyanosis, pallor, jaundice, any specific
lesions or rashes
• Hands, finger clubbing or abnormalities of skin and
nails, lymph nodes
• Presence of peripheral oedema
 Cardiovascular system
• Pulse – rate, rhythm, character and volume. Normal
pulse rate is 60-100 beats per min. Bradycardia < 60 ,
Tachycardia > 100.
• Blood pressure: Normally < 120/80mmHg
• Jugular venous pressure(JVP). Normal JVP <4cm of water.
• Apex beat. Apex beat is lowermost and outermost point
of maximal cardiac activity. Take note of position,
character, presence of added sounds and murmurs.
• Normal apex beat is at the 5th left intercostal space,
midclavicular line
 RESPIRATORY SYSTEM
• Inspect for any chest wall deformity
• Palpate [check if trachea is central(normal]
• Palpate (check if chest expansion is uniform)
• Palpate(check for tactile fremitus)
• Percuss over the chest to detect any abnormality
• Auscultate(listen to the breath sounds). Normal breath
sound is vesicular(the inspiratory phase of respiration is
longer than the expiratory and there is no gap between
them)
• Auscultate (listen to the vocal resonance)
 ABDOMINAL SYSTEM
• Examine for the following
• Inspect for Size of abdomen, Scars, Hernia orifices
• Palpate for abdominal tenderness.
• Palpate for masses
• Palpate for enlarged liver, spleen or kidneys
• Palpate for ascites. Ascites is presence of fluid in the
peritoneal cavity
Auscultate for bowel sounds
• Rectal examination
 CNS EXAMINATION
Examine for the following
• Level of consciousness. Use the Glaxo coma scale
• Speech
• Cranial nerves
• Motor system: muscle bulk, muscle tone, muscle
power, relexes
• Sensory system: light touch, pain, temperature,
propioception
• Co-ordination
 Musculo-skeletal system
Observe for the following:
• Gait: this simply means the manner or style of
walking
• Muscle or soft tissue changes
• Swelling, colour, heat, tenderness in muscle,
soft tissue or joint
• Deformities in the bones and joints
• Limitations of movement across any joint