The document provides guidance on performing a basic physical examination of patients, beginning with observations of vital signs and overall appearance. It describes examining the head, eyes, oral cavity, neck, chest, abdomen, and extremities while assessing for signs of common conditions like anemia, jaundice, and clubbing. Proper hand hygiene using soap and water or alcohol rub is emphasized before examining each new patient.

1. BEGINNINGTHE
EXAMINATION

2. DON’TTOUCHTHE PATIENT—STATE
FIRSTWHATYOU SEE,
CULTIVATEYOUR POWERS OF
OBSERVATION.
Sir William Osler

3. Basic examination
It is good practice to perform a brief CVS, RS, abdo. and neuro exam on all patients but focus
your examination according to their history. Check observations (temp, BP, HR, RR, O2 sats.)
■ Ask a nurse to chaperone you if
necessary
■ Get consent before touching the
patient, ask where it hurts
■ First assess briefly whether the patient
looks well or ill.

5. Hand-washing

6. ■ If there is any dirt or material on your
hands, use soap and water, covering all
hand surfaces for at least 40 seconds.
■ If there is no soiling on your hands, use
a palmful of alcohol-based formulation
(alcohol rub) applied for at least 20
seconds

7. ■ The correct sequence is to rub:
– hands palm to palm
– right palm over the left dorsum with interlaced fingers,
then vice versa
– palm to palm with interlaced fingers
– back of the fingers to opposing palms with interlocked
fingers
– each thumb rotationally
– the palms rotationally.
■ Finally, if using soap and water, rinse your hands, dry with
a towel and use the towel (or your elbow) to turn off the
tap. If using alcohol rub, let dry and proceed.

9. First at a glance see
A—Appearance
B—Behavior and body built
C--co –operative or not
D-Decubitus -- on choice or
specific decubitus
I- Intelligence
N-Nutrition
Then in eye
Anaemia
Jaundice
Other abnormality in eye and lid
subconjuntival haemorrhage
Arcus senilis
Xanthelasma
Tip of nose and lip -cyanosis
Oral cavity
Tongue
Anaemia
Jaundice
Cyanosis
Candida
Ulcer
Fasciculation
Other change in tongue
dehydration
Gum change
Soft and hard palate
Lip – cyanosis and angular
stomatitis
Sequence of general examination

10. NECK
Cervical lymphnode in
lying position
JVP
Chest
Look for boney
tenderness
gynaecomastia
Spider navei
Body Axiliary hair and
chest hair
Any scar mark and
pigmentation
Arm
Nutritional status
mid-arm circumference
Skin fold thickness over
triceps
BP – usually seen at
brachial artery
Edema
Sole of the foot
Pre-sacral area– for edema
Spine for any deformities
Ask the patient to sit
see thyroid
lymph node
In hand
Pulse
Anaemia
Jaundice
Cyanosis
Clubbing
Koilonychia
Leuconychia
Abdomen
Dehydration
Shape of abdomen
Distended or shrunken
Engorged vein
Pigmentation and scar marks
Other deformities
Respiratory rate
Temperature
Inguinal and popliteal lymphn

11. First impressions
Is the patient relatively well or very ill? Look particularly for:
• laboured breathing
• jaundice (yellow discolouration of the skin and sclerae)
• cyanosis (blue discolouration of the skin)
• pallor (suggesting anaemia)
• diagnostic facies

17. Koilonychia due to iron
deficiency

18. Leuconychia due to protein deficiency

21. ■ Finger clubbing is likely if:
• the interphalangeal depth ratio is > 1 (that is, the
digit is thicker at the level of the nail bed than the
level of the distal interphalangeal joint)
• the nail fold angle is > 190 degrees
• Schamroth’s window sign is absent

26. Types of cyanosis

27. Vital signs
Vital signs are indicators of the function of essential
parts of the
body. They should be assessed in all patients at the
time of the initial examination and then as often as
necessary.
1. Start by examining the radial pulse. It is
usually palpable just medial to the distal radius with
the
pulps of the forefinger and middle finger of the
examining hand. Count the rate over 30 seconds

28. 2. Measure the blood pressure .
The normal width of the blood pressure cuff is 12.5
cm.
This is suitable for a normal-sized adult upper arm.
However, in obese patients with large arms, this
cuff will
overestimate the blood pressure and therefore a
large cuff must be used. A range of smaller sizes is
available for children.
The cuff is wrapped around the patient’s upper arm
(which should be supported at the level of the

32. Five sounds will be heard as the cuff is slowly
released. These are called the Korotkoff
sounds:
• the pressure at which a sound is first heard over the
artery is the systolic blood pressure (Korotkoff I [KI])
• as deflation of the cuff continues the sound increases in
intensity (KII)
• then decreases (KIII)
• becomes muffled (KIV)
• and then disappears (KV). Disappearance is normally
taken to indicate the level of the diastolic pressure. A
normal auscultatory gap may sometimes occur (the
sounds disappear just below systolic pressure but
reappear above diastolic).

39. Respiratory Centers

41. Oxygen hemoglobin dissociation curve

42. Nasal cannula vs face mask

43. Oxygen delivery mechanisms

49. What to do?

66. how to examine anemia

67. how to examine jaundice

68. how to examine palmar erythema

70. What Is Palmar Erythema?
Palmar erythema is a rare skin condition where the palms of both hands become
reddish. This change in color usually affects the base of the palm and the area
around the bottom of your thumb and little finger. In some cases, your fingers may
also turn red.

71. palmar erythema causes

72. neck vein examination

73. neck vein examination

77. hyper vs hypo pigmentation

78. thyroid gland examination

80. Goitre- enlargement of thyroid gland

84. Item questions
■ Where do we see anemia? Common causes of anemia in
Bangladesh?
■ Where do we see jaundice? Common causes of jaundice in
Bangladesh?
■ Properties of a pulse? Character of pulse?
■ Causes of lymphadenopathy?
■ Causes of clubbing?
■ Where do we see cyanosis? Types and Causes of cyanosis?
■ Types and site of dehydration?
■ Equipment needed?

85. Item questions
■ Causes and sites of edema?
■ Causes of koilonychia, leukonychia, spider angioma, palmar
erythema?
■ How do we see pulse and measure BP?
■ Common abnormal respiratory patterns?
■ Where do we see core body temperature?
■ Causes of thyroid gland enlargement?
■ Causes of raised JVP?
■ Bedside etiquette?

86. Item Questions
■ What are the points in history proforma?
■ How do you take history of presenting illness/Chief complaints?
■ Importance of past medical history/personal history/family history/address?
■ What questions we ask for pain?
■ Characters of different pain?
■ How do we take history of fever?
■ Types and causes of fever?