General

Examination

Prepared by: Rawan Alzayed

Presented by: Rema Alkahtani
Abdulelah Aldossari
Mohammed Alshalan
Objectives 1. To know what constitutes general
examination
2. To know the vital signs that need to be
measured
3. To know how to comment on the patient’s
appearance
4. To know the different components of a
general examination
5. To know what to examine
 Pay attention !

Before you touch the patient, there are some

RED FLAG rules you must know and do.
WIIPPPE
R
W I I P

Wash your hands Introduce yourself Identify the patient Permission

P P E R

Privacy Position Exposure Stand to the right of the

patient
What constitutes general examination ?
 General Examination Components

Vital signs

Appearance

Examination
What vital signs need to be measured ?
 Vital signs
Normal = 60-100 Beats per Normal = 12-20 Breaths per
Heart rate minute Respiratory minute
Bradycardia = < 60 bpm rate Bradypnea = < 12 bpm
Tachycardia = > 100 bpm Tachypnea = > 20 bpm

Blood
Temperature
pressure

Oxygen
saturation
Video
How to comment on patient’s general appearance ?
 General appearance ( A B C D E)

Appearance Body built

A B
Note : Don’t forget to take
BMI and comment on it

Color Connection

C C
 General appearance ( A B C D E)

Distress Else

D ●
●
Is the patient in pain ?
is there a use of accessory muscles in
breathing ?
●
●
●
Consciousness
Alertness
Orientation ( to person, place and time)
E
● is there any abnormal movements ?
 Examples
Middle Age Male , Sitting On The Bed And
Looking ill. He is slightly Overweight. He
is Conscious, Alert and Oriented to Time,
Place and Person. He is not in Pain but
seems in Respiratory Distress and was
using his Accessory Muscles He Looks Pale
and Jaundiced with Yellowish Sclera and
Skin but not Cyanosed. He was Connected
to IV Cannula which is not Connected to
IV Fluid or Medication.
Old age female , sitting on the bed and
looking very ill. She is very thin
( cachexic ) she is conscious but not
oriented to time, place and person. She
is in pain and she was using her
accessory muscles while breathing. She
looks very pale and cyanosed , She was
connected to IV cannula with IV fluid ,
oxygen mask and holter monitor.
What are the examination components ?
General examination component

Inspection Palpation

Percussion Auscultation
What to Examine ?
 Upper limbs
Inspection of Description Illustration

● Look for muscle wasting

● Look for skin pigmentations

Dorsum ● Look for skin lesions including any

scars
● Look for tendon xanthomata Hyperpigmentation
Tendon
xanthomata
caused by hyperlipidemia

koilonychia
● Blue nails → Cyanosis
● Red nails → Polycythemia.
koilonychia Blue nail
● Pale nail bed → anemia
● Check for clubbing
Nails ●
●
Check for splinter hemorrhage Splinter hemorrhage Leukonychia Red nail
Check for koilonychia
● Check for leukonychia caused by
hypoalbuminemia, liver disease, Pale nail bed
or nephritic syndrome.
 Upper limbs
Inspection of Description Illustration

● Look for Osler's nodes.

● Look for Janeway lesions.
● Look for Palmar xanthomata.
● Look Palmar erythema.
● Look for Dupuytren's contracture.

Palm ● Look for Callosities→ it may indicate

the patient's occupation. Flapping
tremor
● Check for Raynaud' phenomenon. Raynaud's phenomenon Dupuytren's contracture

● Check for Asterixis: Flapping tremor

(hepatic encephalopathy due to
hyperammonemia & uremia)

Palmar Palmar
Palmar erythema xanthomas callosities
● Look for Arteriovenous fistula.
● Look for Scratch marks (uremic pruritus)
Arm ● Look for Bruising and bleeding (uremia
can affect the platelet function)
● Look for spider naevi
 Upper limbs
Palpation of Description Illustration

● Ask the patient if he is in pain

before touching him
● Take the patient's pulse
● Check the the temperature of

Limbs ●
the arms
Assess tenderness (keep your
eyes on the patient’s facial
expressions)
● Assess joint movement
● Check capillary refill time

Note : Capillary refill time ! If a CRT that is greater than two seconds suggests poor peripheral perfusion (e.g. hypovolaemia, congestive heart failure).
 Head, Face and Neck
Inspection of Description Illustration

Scalp ● Check for hair deficiency or excess Hair loss

Face ● Check for skin lesion and pigmentations Malar rash

such as malar rash( seen In SLE)

● Inspect eyes movements.

● Inspect for Asymmetry of the position ,
size or colour of the eyes.

Eyes ● Check for jaundice in the sclera. Jaundice Xanthelasma

● Check for Pallor in the conjunctiva

● Check for Xanthelasma in the periorbital
regions caused by hyperlipidemia and
primary biliary cirrhosis
 Head, Face and Neck
Inspection of Description Illustration

● Look for any neck swelling or visible

pulsations (neck veins).
Neck ● Palpate the carotid artery.
● Palpate the lymph nodes.
● Check the thyroid gland.

● Check for oral hygiene

● Check for central cyanosis
● Check for oral ulcers
● Tongue (movement, symmetry and surface).
● Check, teeth, gum soft palate, tonsils colour Central cyanosis Oral ulcers
of lips
Mouth ● Check for special odors such:

1. Sweet smell "fetor hepaticus''due to liver

disease.
2. Ammoniacal fish breathe" uremic fetor" due
Gingival
to renal failure. hypertrophy
3. Cigarette smell in smokers.
 Chest

○ Shape and symmetry of the chest

(Barrel shaped, Kyphosis, Scoliosis, Pectus excavatum, Pectus
carinatum).
○ Lesions of the chest wall
(Scars from previous operations or inserted chest tube drainage, Prominent
veins which may indicate superior vena caval obstruction, Erythema and
thickening of the skin “due to post-irradiation for breast cancer, lung
cancer or lymphoma”).
○ Movement of the chest wall
(Asymmetrical movement or reduced movement).
 Lower limbs

Inspection of Description Illustration

● Check for any change in nails, Ischemic ulcer Varicose vein

dorsal or sole of foot
Lower ● Check for any skin lesion or
discoloration
limbs ● Check for muscle wasting
● Varicose veins or any
discoloration / pallor .

Palpation of Description Illustration

● Ask the patient if he is any pain

before proceeding.
Lower ● Check for any tenderness( keep
your eyes on the patient’s face)
limbs ● Check the temperature
● Check peripheral pulses
● Check lower limb edema
 Back
➔ Check for sacral edema which could be due to congestive heart failure , renal failure .. exc
 General Palpation
Your eyes should be on the patient’s face throughout the examination for signs of discomfort. Ask if the patient has pain or
tenderness anywhere before you begin and examine this area last!

Palpate the Chest and Neck for: Palpate the Abdomen using:

○ Tracheal position (at the suprasternal notch). ● Superficial palpation:

○ Measure the Jugular Venous pulse . Look for superficial masses, tenderness or guarding and
○ Tactile vocal fremitus monitor the patient's face for signs of
(pneumonia increases conduction through the lung and tactile vocal discomfort.
fremitus is increased). ● Deep palpation:
○ Apex beat Look for deep masses or organomegaly:
(the lowest and most lateral point at which you can feel the cardiac ● Liver: usually not palpable, look for its :
➢ Edge: tenderness, consistency, regularity, and pulsation.
impulse).
➢ Surface: smooth or nodular.
○ Palpate both axillae and the Neck ➢ Span: (Normal liver span 8-12 cm)
( for lymph node enlargement ). ● Gallbladder: usually not palpable (Murphy’s sign should
be sought if cholecystitis is suspected. )
● Spleen: usually not palpable
● Kidneys: usually not palpable
 General Percussion

Chest Abdomen
○ Percuss the chest anteriorly and posteriorly and ○ Percuss over spleen, liver, and bladder
look for dull areas e.g. pleural effusion ○ Percuss for ascites ( Shifting dullness,
( percussion over normal lung produces a resonant thrills )
note).
○ Percuss both axillae and supraclavicular areas.
 General Auscultation

Chest Abdomen
○ Normal heart sounds (first and second), extra ○ Listen for Abdominal aorta / Renal bruit /
heart sounds (third and fourth). Bowel sounds.
○ Additional sounds (e.g. snaps, clicks or prosthetic ○ Friction rub (indicate peritonitis).
heart sounds) and Murmurs . ○ Venous hum (present in portal
○ Normal (vesicular) breath sounds. hypertension).
○ Vocal Resonance.
 Resources

● Clinical Surgical Skills.

● Browse’s introduction to the symptoms and signs
of surgical disease.
 Useful videos

1- https://youtu.be/_0BrhixooZc

2- Part 1 : https://youtu.be/V8NAduY3NHc

3- part 2 : https://youtu.be/UQ7fiVQpxOg
● The 3 P in WIIPPPER stand for what ?
● What are the examination components ?
Thank you for
listening