This document outlines the steps for performing a general physical examination, including assessing the patient's vital signs, appearance, skin, oral cavity, hair, nails, lymph nodes, and edema. The exam involves measuring temperature, pulse, blood pressure, and respiratory rate. It describes how to evaluate the character of the patient's pulse and classify their blood pressure. Key areas of inspection include the skin, oral cavity, hair, nails, lymph nodes, and checking for edema. The examination provides objective clinical clues and establishes baseline anthropometric measurements and vital signs.
6. Pulse
Rate- normal 60-100 per minute
Rhythm- regular or
irregular (atrial
fibrillation, ectopics)
Volume- rough guide of pulse pressure
Character
Radio-femoral delay- atherosclerosis,
aortic dissection, Takayasu arteritis
R & R- radial, Vol. & Charac.- carotid
7. Character of pulse
Slow rising- aortic stenosis-AS
Collapsing- aortic regurgitation-AR
Bisferiens- AR & AS
Pulsus paradoxus- heart sounds heard,
but no radial pulse- seen with
cardiac tamponade or severe asthma
Pulsus alternans- alternate strong &
weak beats- seen in severe LVF
8. Blood pressure
Measured by sphygmomanometer
Patient comfortable
Manometer at the level of arm
Proper cuff width- 2/3rd
of arm- 12.5 cm.
Cuff length- >40% of arm circumference
Korotkoff sounds heard by stethoscope
Appearance- systolic BP
Disappearance- diastolic BP
Pulse pressure- systolic - diastolic
10. Respiration
Rate- for 1 minute, normal 14-18/min.
Abdominothoracic or thoracoabdominal
Shallow or not?
Labored or not?
Accessory muscles of respiration
working or not?
Audible stridor or wheeze
11. Colors
Pallor- lower palpebral conjunctiva,
tongue, nail bed, palmar creases
Jaundice (yellowish)- conjunctiva, skin
Cyanosis (bluish)-
Central- tip of tongue, oral mucosa, lips, fingers/toes
Peripheral- lips, tips of fingers/toes
Dark brown – Addison’s disease
Bronze- Hemochromatosis