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.

1. General examination
Finding objective clues

2. Necessary
Conscious & cooperative patient
Decubitus

3. Anthropometry
Height, weight, BMI
Build- thin, average, stocky

4. Vital signs
 Temperature- document
 Fever- >98.9 am &/or >99.9 pm
 Pulse rate- measure for 30 (if regular)
or 60 (if irregular) seconds
 Blood pressure
 Respiratory rate

5. Pulse
Palpable- temporal, CAROTID,
brachial, RADIAL, femoral, popliteal,
posterior tibial, dorsalis pedis

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

9. Classification of BP
 Normal- 90-119/60-79
 Pre-HT- 120-139/80-89
 Stage 1- 140-159/90-99
 Stage 2- >160/>100
 Systolic- >140/<90
AHA,2003

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

12. Skin lesions
 Macule- flat
 Papule <5 mm.
 Nodule >5mm.
 Vesicle <5mm.
 Bulla >5mm.
 Pustule
 Plaque
Color & pigmentation
 Petechiae
 Purpura
 Ecchymosis
 Weals
 Scales
 Ulcers
 Scar

13. Oral cavity
 Angles of mouth- cheilitis
 Teeth- staining, caries
 Gums- healthy, inflammed
 Tongue- smooth, coated, color
 Mucosa- color, fibrosis, leucoplakia
 Tonsils- inflammed, enlarged
 Odour- alcohol

14. Hair
Color
Distribution

15. Nails
 Flat/concave- koilonychia- iron deficiency
 Horizontal Beau’s lines- arrested growth
 Pitting- psoriasis, eczema, alopecia, fungal
infection
 Splinter h’age- trauma, RA, SABE, psoriasis
 Clubbing-congenital heart disease,
bronchiectasis, lung cancer, SABE, IBD

16. Lymph nodes
 Cervical
 Axillary
 Inguinal
 Occipital
 Epitrochlear
 Number
 Consistency
 Mobility
 Tenderness
 Fluctuation

17. Edema
Unilateral or bilateral
Pitting or not
Inflammation ±

18. Obvious deformity or defect
Now go systemic