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General examination
This document outlines a comprehensive guide on conducting a general physical examination, detailing key components such as general appearance, vital signs, and examinations of the head, neck, limbs, and lymph nodes. It includes specific criteria and measurements for assessments such as body mass index (BMI), pulse characteristics, and findings for various systemic conditions. The document serves as a systematic reference for healthcare professionals during patient evaluations.
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General examination
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- 2. Rule of 7 1.General appearance 2. Vital signs 3. Head examination 4. Neck examination 5. Upper limb examination 6. Lower limb examination 7. Lymph node examination + Breast Shaimaa Elkholy
- 3. 1. General appearance •Consciousness & Orientation (GCS) • Cooperation • Mentality • Memory • Mood • Decubitus • Body built 7 Shaimaa Elkholy
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- 10. Body Mass Index(BMI) It is calculated by the formula weight/ height2 (Kg/m2) BMI Underweight <18.5 Normal 18.5-24.9 Overweight 25-29.9 Obese 30-39.9 Morbidly obese >40 Shaimaa Elkholy
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- 13. 2. Vital signs 1.Pulse 2. Blood pressure 3. Respiratory rate 4. Temperature Shaimaa Elkholy
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- 16. Pulse • Rate • Rhythm •Volume • Special character • Equality on both sides • Peripheral pulsations • State of arterial wall 7 Shaimaa Elkholy
- 17. Pulse • Rate =60 -100 • < 60 -----------> bradycardia • > 100 ----------> tachycardia Shaimaa Elkholy
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- 19. Pulse • Irregular Regular irregularity Irregularirregularity Shaimaa Elkholy
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- 22. Pulse Extra systolesAF Can count4Cannot count 4 Pulse deficit < 10Pulse deficit > 10 NormalRapid NoSystolic expansion of neck veins Exercise - - -Exercise +++ Shaimaa Elkholy
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- 24. Pulse • Volume Small Big • Big (hyper dynamic) Anemia AR A-V fistula Pregnancy PDA, VSD LCF Paget disease Thyrotoxicosis Shaimaa Elkholy
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- 26. Pulse • Special character Pulsesparvus et tardus (plateau pulse) Water hummer pulse (collapsing) Bisferiens Pulsus alternans Pulsus paradoxicus Shaimaa Elkholy
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- 29. Pulse • Equality onboth sides Shaimaa Elkholy
- 30. unequal pulse ??!! ShaimaaElkholy
- 31. • Out side •Wall • Inside Shaimaa Elkholy
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- 33. Brachial pulse Flex thepatient’s elbow Medial to the biceps Shaimaa Elkholy
- 34. Carotid Arteries •At thelevel of thyroid cartilage Shaimaa Elkholy
- 35. The dorsalis pedisartery Lateral to the extensor hallucis tendon Absent in 10% Shaimaa Elkholy
- 36. The posterior tibialpulse. Shaimaa Elkholy
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- 48. Head examination • Facies •Hair • Eye • Nose & cheeks • Mouth • Ear • Parotid 7 Shaimaa Elkholy
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- 67. Causes of puffinessof eye lids Oedema (nephrotic & angioedema) Chronic cough Myxedema S.V.C obstruction (mediastinal S) Cavernous sinus thrombosis Shaimaa Elkholy
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- 76. Bitot spots .>>>VitA def. Shaimaa Elkholy
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- 78. Types of jaundice Prehepatic/ Hemolytic jaundice Hepatic jaundice Posthepatic / Obstructive/ Surgical jaundice Shaimaa Elkholy
- 79. Function test Pre-hepatic Jaundice Hepatic Jaundice Post-hepatic Jaundice T.Bil+++ +++ +++ D.BIL N +++ +++ inD.BIL +++ +++ N Urobilinogen N / + ++ -- / -ve Urine Color N Dark (urobilinogen + direct bilirubin) Dark (direct bilirubin) Stool Color N N /Pale Pale ALPH,GGT N +++ Marked +++ AST, ALT N ++++ +++ Conj Bil. Urine Not Present Present Present Shaimaa Elkholy
- 80. Nose & cheeks ShaimaaElkholy
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- 84. Mouth • Odor • Lips •Tongue • Teeth • Gums • Oral cavity • Palate Shaimaa Elkholy
- 85. Bad odor • Alcohol •Acetone: DKA • Ammonia: CRF • Fetor hepaticus: LCF • Halitosis Dental caries SLS GIT obstructio: Pharyngeal pouch, Achalasia Shaimaa Elkholy
- 86. Lips • 3 colors •Angular stomatitis • Ulcers Shaimaa Elkholy
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- 90. Central cyanosis Peripheralcyanosis Site All the body (tongue) Hands & feet Ears & nose Ext. lips Hands Warm cold Effect of warming ++ --- Effect of O2 Improve No effect Causes Cong., resp.failure, abnormal HB(met Hb) Cold , Shock, Raynaud’s Shaimaa Elkholy
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- 92. Angular stomatitis Oralulcers Shaimaa Elkholy
- 93. Teeth & gums ShaimaaElkholy
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- 96. Tongue Fiery red (B3) PellagraPaleglazed Magenta (B2) Beefy (B12)Shaimaa Elkholy
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- 98. Oral cavity &Palate Shaimaa Elkholy
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- 105. Trachea • Central • Tracheallength • Tracheal tug (A.A, Cambell’s sign) • Mobil or fixed Shaimaa Elkholy
- 106. Vessels (carotid A) ShaimaaElkholy
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- 113. Carotid pulsation • Medialto sternomastoid • One peak • Unaffected by posture • Unaffected by respiration • Better felt than seen JVP • Lateral to sternomastoid • Wavy pulsation • Prominent on lying down • Decrease by inspiration • Seen and not palpable Shaimaa Elkholy
- 114. Thyroid gland • Inspection •Palpation • Percussion • Auscultation Shaimaa Elkholy
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- 116. Lymph nodes 1. Circularset: -Inner ring (Waldyer’s ring) Retropharyngeal, tonsils, Eustacian tube -Outer ring: Sub mental Submandibular Pre-auricular Post-auricular Occipital Shaimaa Elkholy
- 117. 2. Vertical set: -Superficialgroup: Along body of sternomastoid -Deep group: • Ant. cervical: infrahyoid, pre –laryngeal, pre-tracheal • Post. Cervical: along border of trapezius • DEEP CERVICAL: upper & lower groups : deep to the sternomastoid : along IJV Supra clavicular LNs Shaimaa Elkholy
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- 122. Hand examination • S(shape, sweating) • T (tremors , temp.) • N (nail, nodule) • Palmer erythema • Pallor Shaimaa Elkholy
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- 133. Signs of infectiveendocarditis • Splinter hemorrhages : multiple linear, reddish brown marks along the axis of fingernails and toe nails Shaimaa Elkholy
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- 135. Half & halfnail Shaimaa Elkholy
- 136. Cyanosis in thenails with Clubbing Shaimaa Elkholy
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- 142. Nodules • Janeway lesions:painless, erythematous maculopapules on the palms and soles that do not blanche. They are caused by thrombi in small vessels, without vasculitis • Osler's nodules: painful, red papulo- nodules with a pale center. They are found on the fingertips, and last days to weeks. Caused by microabscesses in the dermis, they may even contain gram-positive cocci. Shaimaa Elkholy
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- 144. Heberden's and Bouchard'sNodes Shaimaa Elkholy
- 145. Skin • Stria • Scratchmarks • Scar • Spider nevi • Purpura • Ecchymosis • Thin or thick Shaimaa Elkholy
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- 149. DONot BLAnch (Purpiriceruption) Shaimaa Elkholy
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- 153. • Tendon xanthoma •Injection sites • Epitrochlear LNs • Axillary LNs. Shaimaa Elkholy
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- 158. Lower Limb • Oedema •Dorsalis pedis • Post. Tibial • Lax calf muscles • Varicosities • Skin + ulcer • Pretibial myxedema • Erythema nodsum Shaimaa Elkholy
- 159. Pitting seen inthe left limb Shaimaa Elkholy
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Editor's Notes
- #9 Fallot tetraology
- #43 Sooooooo wrong
- #67 Causes of puffiness Chronic cough Oedema (renal) SVO obstruction
- #74 D.M, hypocalcemia Cushing S, steroids Wilsons, galactosemia, mytonia atrophica
- #91 Tongue: closed cavity, internal cavity, no sympathetic supply.
- #94 Pink teeth: porphyria Gum hyperplasia: epanutin, monocytic leukemia
- #111 Atrial contraction, atrial relaxation, venous return (filling), opening of T (emptying).
- #124 Broad and thick hands :Acromegaly
- #125 Polydactyly
- #126 Marfan syndrome
- #128 Flapping tremors : failure to maintain extension
- #130 Fe deficiency anemia
- #131 White nails: hypoalbuminemia
- #132 Infection
- #133 Damage of the nails with separation due to infection
- #136 Liver cirrhosis
- #142 In severe stressful conditions as critically ill patients
- #144 Figure 1 ; Osteoarthritis while figure 2 gottron’s nodules in dermatomyosities
- #145 Osteoarthritis
- #149 Scratch marks due to purititis as in renal failure or obstructive jaundice
- #150 They don’t blanch on pressure to differentiate it from the insect bite due to platelet defect (thrombicytopenia or thrombocytopathy)
- #151 It fades on pressing on the central arteriole
- #152 Spider nevi
- #153 Ecchymosis due to coagulation defect as in liver cirrhosis or hemophilia
- #155 Tendon Xanthoma (hypercholesterlolemia)
- #156 Injection sites
- #157 Epi-trochlear lymph node enlargement indicates that almost all lymph nodes of the body are enlarged
- #158 Injection sites
- #161 Varicose Viens
- #163 Erythema nodosum