The document outlines the general physical examination (GPE) procedures for assessing a patient's overall health and detecting internal diseases. It details the examination steps, including patient interaction, environment considerations, vital signs assessment, and systematic examination of various body parts. It emphasizes maintaining patient comfort, privacy, and the importance of a structured approach to the examination.

1. General Physical
Examination
MR. SICHONGO CHRISPIN

2. Aims of GPE
 Assess patient's general condition
 Detect manifestations of internal & systemic
diseases

3. Examining a Patient: Diagnostic clues
 Diagnostic process has 3 components:
 History taking – Clues are the symptoms
 Physical exam - Clues are the signs
 Investigations - Clues are test results

4. Examining a Patient:
General Principles & Etiquettes
 Meet, greet, introduce
 Consent
 Explain to patient
 Be polite: say “please” & “thank you”
 Patient Comfort

5. Examining a Patient:
Examination environment
 Hand Washing
 Proper light
 Privacy & Confidentiality
 Use curtains & shades
 Presence of a chaperon when examining female patients
 Correct position of clinician & Patient
 Ideally examiner should be on right side of patient
 Proper Exposure
 Ensure your hands are warm

6. Components of GPE
Systematic approach
 General Appearance
 Height & Weight
 Vital Signs
 Skin & Hair
 Head & Neck
 Lymph Nodes
 Hands
 Edema
 Feet
Head to Toe

7. General Appearance
 OBSERVE your patient
 During the communication make judgment about the patient’s
general appearance
 Well presented
 Well spoken
 Clean
 Intelligence and level of education

8. General Appearance
 Age & Physique
 Posture & Attitude
 Look of Patient: Healthy/ill
 Mental & Emotional State
 Odour

9. Height & Weight
 Nutrition status
 Child Growth
 Fluid Status
 Metabolic Status

10. Vital Signs: Pulse
 Rate:
 beats/min
 Rhythm:
 Regular
 Irregular

11. Pulse: Technique
 Radial pulse commonly used to assess heart
rate
 Palpate with index & middle fingers
 Rhythm regular & rate normal: count for 30
seconds & multiply by 2
 Rate unusually fast or slow: count for 60
seconds
 Rhythm irregular: evaluate heart rate by
cardiac auscultation

12. Vital Signs: Respiratory
Rate
 Count respirations with your hand on pulse
 Count for at least 30 sec: multiply by 2
 Normal Adult R/R: 14-18

13. Vital Signs: Blood Pressure
 Patient seated in quiet, calm environment
 Arm supported: midpoint of upper arm heart
level
 Proper cuff size: bladder inside the
cuff should encircle 80% of arm
 Place midline of bladder over arterial pulsation
 Lower edge of cuff should be 2.5 cm above
the antecubital fossa
adapted from Perloff et al

15. Blood Pressure: Palpatory method
Method
 Inflate cuff while palpating the radial pulse
 Note reading at which pulse disappears & then
reappears during deflation
 This is Systolic Pressure

16. • Inflate bladder to pressure 20-30 mm above
level determined by palpation
• Deflate bladder at 2 mm/sec: listen for
appearance of Korotkoff sounds
• Note manometer readings at:
– Appearance of repetitive sounds: Systolic
– Disappearance of these sounds: Diastolic
• After last Korotkoff sound, deflate cuff slowly
for another 10 mm, then rapidly & completely
deflate
Blood Pressure: Auscultatory method

17. Blood Pressure
• Record systolic & diastolic pressures, to the nearest
2 mm Hg
• Measure blood pressure in both arms at first visit
• Measure in different positions (lying, sitting, standing)
if indicated

18. Vital Signs: Temperature
 Wash the thermometer before use
 Shake mercury down
 Wash after use
 For oral: ask patient to breath through nose
& keep lips firmly closed
 Keep thermometer for at least one minute

19. Vital Signs: Temperature
 Conscious Adults: Oral / Axillary
 Young Children: Groin/ Rectal
 Oral/ Rectal Temperature 0.5°C > Axillary/
Groin
 Normal: 36.6-37.2°C
 Febrile: >37.2°C

20. Pallor
 Conjunctiva
 Oral mucous membrane
 Nails
 Palms
Normal
Normal
Pale
Pale
Conjunctivitis
Conjunctivitis

21. Skin: Cyanosis
 Tongue
 Lips
 Ear lobes
 Fingers & toes
 Central Cyanosis: Generalize, Peripheries Warm
 Peripheral Cyanosis: Peripheral, Peripheries Cold

22. Skin: Jaundice
 Sclera
 Skin & mucous membrane

23. Skin & Hair
 Skin:
 Dehydration
 Pigmentation/ De-pigmentation
 Skin lesions
 Hair:
 Texture & grooming

24. Head
 General Appearance
 Eyes:
 Sclera: Jaundice
 Conjunctiva: Pallor
 Oral Cavity:
 Pallor
 Cyanosis
 Jaundice: undersurface of tongue
 Oral hygiene

25. Hands: Palms
 Pallor
 Sweating / Temperature
 Muscle wasting
 Palmar Erythema
 Dupuyten's Contracture
 Osler’s Nodes

26. Hands: Dorsum
 Muscle wasting
 Joints/ deformity
 Nails:
 Pallor
 Koilonychia
 Clubbing
 Cyanosis
 Leukonychia
 Splinter Hemorrhages
 Pitting
 Tremors

27. Normal First degree
Second degree
Third degree

28. Lymph Nodes
 Cervical
 Axillary
 Epitrochlear
 Groin
Assess:
•Number
•Size
•Tenderness
•Consistency
•Matted or Discrete
•Mobile or Fixed

29. Edema
 Pitting edema:
 Press firmly but gently for
at least 5 sec
 Foot:
 Dorsum
 Behind Medial Malleolus
 Shin
 Sacral

30. Feet
 Pitting edema
 Peripheral vessels
 Nail changes

31. GPE: Check List
 General Appearance:
 Age & Physique
 Posture & Attitude
 Look of Patient: Healthy/Ill
 Mental & Emotional State
 Height & Weight
 Vital Signs:
 Pulse
 BP
 Temperature
 Respiratory Rate
 Hands:
 Palmar
 Dorsum
 Head / Face:
 Eyes
 Oral Cavity
 Lymph Nodes:
 Cervical
 Axillary
 Groin
 Edema
 Feet

32. Twalumba , Zikomo