Doctors should carefully observe patients like detectives during physical examinations. The document outlines the process of a physical assessment including preparation, examination methods, and conducting assessments from head to toe. Key steps involve introducing oneself, obtaining permission before examining, asking about pain or discomfort, inspecting various body systems, and documenting findings and vital signs. Physical assessments provide objective health information through direct observation and examination techniques.

2. DOCTORS SHOULD BE
OBSERVANT,LIKE A DETECTIVE
“CONAN DOYLE”
Introduction
• Introduce yourself
• Ask permission to examine
• Ask if any pain anywhere
• Are they comfortable lying flat?

3. DEFINITION
A physical assessment is the systematic
collection of objective information that is directly
observed or is elicited through examination
techniques

4. PREPREPARATION
FORASS•ESSMENT
- EXAMINATION ROOM
- EQUIPMENTS
- POSITION
- NURSE PREPARATION
METHODSOF
ASSESSM•ENT
-INSPECTION
-PALPATION
-PERCUSSION
-AUSCULTATION
-OLFACTION
HEADTO TOE
•
•
ASSES•SMENT
-VITAL PARAMETERS
-GENERAL EXAMINATION
-DETAILED EXAMINATION
ASSESSMENT

5. HEAD TO TOE EXAMINATIONS
• Vital data
• General examination
• Systemic examination

6. Vital Data
• Name Of The Institution :
• Name Of The Doctor:
• Ward No:
• Cot No :
• Case No :
• Date:
• Name Of The Patient :
• Age :
• Sex :
• Religion :
• Caste :
• Married Or Single :
• Children :
• Occupation :
• Income
• Address

7. General History
The general history is organized into the following
sections:
• Identifying data (ID)
• Chief complaint (CC)
• History of the present illness (HPI)
• Past medical history (PMHx)
• Family history (FHx)
• Medications (MEDS) and Allergies (ALL)
• Social history (SHx)
• Review of systems or functional inquiry (ROS/FI)

8. History of Present Illness
• Symptom characterization:
• 0 =Onset and duration
• P = Provoking and alleviating factors
• Q = Quality of pain (e.g. sharp, dull, throbbing)
• R = Does the pain radiate?
• S = Severity of pain ("on a scale from 1 to 10, 10 being
the most severe")
• T =Timing and progression ("Is the pain constant or
intermittent? Worse in the morning or at nighttime?")
• U = "How does it affect 'U' in your daily life?“
• V = Deja vu ("Has this happened before?")
• W ='What do you think it is?

9. General examination
• General examination is actually the first step of physical
examination and Key component of diagnostic approach.
• Inspection is the major method during general examination,
combining with palpation, percussion, auscultation, and
smelling.
• Aims
– Assess patient's general condition
– Detect manifestations of internal & systemic diseases
• 3 components:
– History taking – Clues are the symptoms
– Physical exam - Clues are the signs
– Investigations - Clues are test results

10. INSTRUMENTS AND EQUIPMENTS :
• Stethoscope
• Torch Light
• Fiber Glass
• Measuring tape(inches)
• Weighing machine
• Spatula
• Sphygmomanometer
• Clinical thermometer
• Red ring & blocks(for developmental
assessment)

11. Prerequisites:
• Examination environment
• Hand Washing
• Proper light
• Privacy & Confidentiality
• Presence of a chaperon when examining
female patients
• Correct position of Doctor & Patient - Ideally
examiner should be on right side of patient
• Proper Exposure
• Ensure your hands are warm

12. GENERAL EXAMINATION
– Head to Toe
 Skin
 Hair & Head
 Face
 Eyes/Ear/Nose
 Mouth
 Neck
 Nail & Limbs
 Pallor
 Icterus
 Cyanosis
 Oedema
 Lymph nodes
--Genitalia
– General Appearence
– Anthropometery
 Weight
 HC/CC/AG/MAC
 Height/length
 BMI
– Vital Signs
 Temperature
 Arterial pulse
 Respiration
 Blood pressure
 Capillary refill time
 Hydration
 Oxygen saturation

13. General Appearance
• General state of health: Healthy/ill/comfortable/Distressed
• Body Built and Nutritional status
– Obese/lean
– Tall/short
– Muscular/Asthenic/Cachexic
• State of awareness or level of consciousness
• Facial feature/expression/ Mood/Attitude
• Speech（tone/voice)
• Position/posture and Gait
• Personal Hygiene
• Breath/Odor

14. • General state of health:
Healthy/ill/comfortable/Distressed

15. • Body Built

16. Malnutrition

19. TECHNIQUE OF PHYSICAL
ASSESSMENT
• Looking/Inspection
• Feeling/Palpation
• Tapping/Percussion
• Listening/Auscultation
• Smell/Olfaction

20. INSPECTION

21. GENERAL INSPECTION OF A
CLIENT FOCUSES ON
• Overall appearance of health or illness
• Signs of distress
• Facial expression and mood
• Body size
• Grooming and personal hygiene

22. PALPATIO
N
• A method of feeling
the body part
 Size
 Shape
 Firmness
 Consistency
 Location
• using the hands
(palm and fingers)

23. PRINCIPLES OF PALPATION
• You should have short fingernails.
• You should warm your hands prior to placing them on the
patient.
• Encourage the patient to continue to breathe normally
throughout the palpation.
• If pain is experienced during the palpation.
discontinue the palpation immediately.
• Inform the patient where, when, and how the touch will occur,
especially when the patient cannot see what you are doing.

24. PALPATION

25. DEEP PALPATION

26. PERCUSSION
• Tapping on surface
to determine the
underlying structure.
• Done with the
middle finger of one
hand tapping on the
middle finger of the
other hand using a
wrist action.

27. TYPE OF PERCUSSION
DIRECT PERCUSSION
INDIRECT
PERCUSSION

28. AUSCULTATION

29. FOUR CHARACTERISTICS
• 1.Pitch (ranging from high and
low):frequency or number of oscillations
generated per second by vibrating object
• 2. Loudness (ranging from soft to loud):
amplitude of sound
• 3. Quality (gurgling or swishing)
• 4. Duration (short, medium or long)

30. OLFACTION/smell

31. HEAD TO TOE EXAMINATION…..

32. SKIN
Pallor-Anaemia
EchymosisRash Discoid Rash- Ulcerative colitis
Petechial Rash
CyanosisYellow-Jaundice
Xanthlesma- Primary Bill. cirossis
Vitiligo

33. INSPECT THESCALP
• Cleanliness, color, dryness,
• Lump, lesions,
• Lice (pediculus humanus
capitus)
• Dandruff etc

34. HAIR
• ALOPECIA
• Non-scarring
-alopecia areta
-scalp ring worm
-traction alopecia
• Scarring
-burns,radiation,lupoid erythema,sarcoidosis

35. protein-deficiency malnutrition.

36. Piebaldism
Inflammatory
tinea capitis
Alopecia universalis
(a) Trichotillomania before treatment
(b) trichotillomania after treatment

37. Alopecia areata

38. Traction alopecia

39. Alopecia totalis

40. HEAD AND NECK
• ASSESSING THE SKULL
• for size, symmetry
• any nodules or masses

41. Craniosynostosis
•Scaphocephaly : premature closure of sagittal suture
•Trigonocephaly : premature closure of the metopic suture
•Plagiocephaly : Unilateral (a)coronal synostosis (b) lambdoid synostosis
•Brachycephaly : both the coronal sutures
•Oxycephaly/Turricephaly : coronal suture plus any other suture

42. Microcephaly
infections during pregnancy:
toxoplasmosis
Campylobacter pylori
Rubella
Herpes
Syphilis
cytomegalovirus
HIV and Zika
exposure to toxic chemicals:
maternal exposure to heavy metals like
arsenic and mercury, alcohol, radiation, and
smoking;
pre- and perinatal injuries : developing
brain (hypoxia-ischemia, trauma);
genetic abnormalities : such as Down
syndrome
severe malnutrition during fetal life.

44. INSPECT THE FACE

45. Down syndrome
Small Chin
Slanted Eyes
Poor Muscle Tone
Nasal Bridge
Single Crease Of The Palm
Protruding
Small Mouth
Large Tongue
Obstructive Sleep Apnea
Flat And Wide Face
Short Neck
Excessive Joint Flexibility
Extra Space Between Big Toe And
Second Toe
Short Fingers
Hip Dislocations
Short

47. Cushing’s syndrome

48. Facial feature/expression/ Mood/Attitude

49. Acromegaly
The enlargement of the
frontal and maxillary
sinuses results in an
prominent brow and long
face
Growth of
mandible leads to a
jutting jaw
(prognathism).
Alveolar bone
growth causes the
teeth to separate

50. ASSESS THE EYE
• Eye brows
• Eye lid :
ectropion(eversion ,lid margin turn out)
entropion(inversion, lid margin turns inwards)
ptosis( abnormal drooping of lid over pupil

51. ASSESS THE EYE
• Inspect external eye
structure
• Position and alignment
• Exophthalmoses
• strabismus

52. ASSESS THE EYE
• Eye lashes : sty.
• Eye balls
• Conjunctiva and sclera
{ Paleness, redness or purulent,jaundice}

53. ASSESS THE EYE
• Cornea and iris :arcus senilis
• Pupil :

54. Xanthelasma (primary biliary cirrhosis)
EYESConjuctival pallor (anaemia)
• Sclera: jaundice, iritis
Kaiser Fleischer’s rings
(Wilson’s disease)

55. ACCOMMODATION

56. PUPILLARY REFLEX TO LIGHT

57. VISUAL ACUITY

58. INSPECT INTERNAL EYE STRUCTURES

59. EXTRA OCULAR MOVEMENTS

60. PERIPHERAL VISION

61. EARS
• AURICLES
• EAR CANAL AND TYMPANIC MEMBRANE

62. HEARING
• WEBER’STEST:
• RINNE, S TEST:

63. NOSE AND SINUSES

64. Oral cavity
• The teeth and breath
• Check the oral cavity looking for
• MOUTH ULCERS
-Aphtous,drugs and trauma
-gastrointestinal disease;inflammatory bowel disease,coeliac disease
-rheumatological;Behcets syndrome,reiter
• -erythema multiforme
-infections;herpes zoster,simplex,syphilis,tuberculosis

65. Examination of Oral Cavity
Oral cavity is the window to the
GI-system and is likely to mirror
or exhibit the inflammatory
changes of Gi-system.

66. Lips Gums
Teeth
Tongue
Palate
Breath

67. LIPS
Colour
Blue in cyanosis
Pale in anemia
Any deformity
Clift lip
Corners of lips(fissuring
or angularstomatitis)
Any vesicles(HSV)
Ulceration

68. GUMS
Colour :
Anemia
Cyanosis
Pigmentation
Lead poisoning-blue line.
Hypertrophy
Bleeding

69. TEETH
Number -Growth And Age
Congenital teeth in newborn
babies
Hutchison’s teeth-
(Congenital syphilis)

70. TONGUE
 Colour
 Size
 Symmetry
 Dry(dehydration)or wet
 Surface of tongue(coated or raw)
 Bald tongue (Smooth tongue)in Vit-B12 deficiency,IDA
 Strawberry tongue in scarlet fever and kawaski disease
 Scrotal tongue in down syndrome
 Geographical tongue isbenign
 Tongue tie(ankyloglossia)

71. Tremors Dry
Macroglossia
 Tremors
Nervousness, Parkinsonism
 Size of tongue
Macroglossia (cretins)
 Surface of tongue
Dry tongue (dehydration)
Bald tongue (Anemia)
Furred tongue (smoking,
mouth breathing)
Ulceration
(Whooping cough, T.B.) furred Ulceration
Bald tongue

72. Atrophic glossitis
ThrushGeographical tongue
Bald tongue Pale tongue
Cyanosis

73. PALATES,ORO-PHARYNX MOUTH
Oral cavity and oro-pharynx is examined with the help of a tongue
depressor for:
• Colour
• Ulcers
• Deformity
• Inflammatory changes
Thrush(oral candidiasis)
Membranouspharyngitis in strep,diphtheria,infecious mononucleosis

74. NECK
• During palpation of lymph nodes the following
features should be considered;
• SITE
-Localised or generalised?
-palpable lymph node areas are;
Epitrochlear,axillary,cervical and
occipital,supraclavicular,para-aortic,inguinal
and popliteal.

75. lymphadenopathy
SIZE
CONSISTENCY
Hard -suggestive of carcinoma
Soft- may be normal
Rubbery may be due to Lymphoma
Tenderness-Acute infection of inflammation
Fixation--If fixed to the underlying structures its most likely
malignant
Overlying Skin-if inflamed then its suggestive of
infection,teethered suggests carcinoma.

76. LYMPHADENOPATHY

78. CAUSES OF LYMPHADENOPATHY
GENERALISED
-lymphoma
-leukemia
-infections
-viral;infectious mononucleosis,CMV,HIV
-bacterial;tuberculosis,syphilis
-protozoal;toxoplasmosis
-connective tissue disease
-infitration;sarcoidosis
-drugs;phenytoin

79. PALLOR
• Deficiency of haemoglobin can produce pallor of the skin.
• Should be noticeable especially in the mucous membranes of
the sclerae if the anaemia is severe- Hb of less than 7g/L.
• Facial pallor can also be seen in patients with shock,due to
the reduction of cardiac output. These patients usually
appear cold and clammy and significantly hypotensive.

80. localised
PALLOR

81. Causes of anaemia
MICROCYTIC ANAEMIA
Iron deficiency anaemia
Chronic bleeding
Malabsorption-
Hookworm
Thalassemia
Sideroblastic anaemia
Anaemia of chronic blood loss

82. Macrocytic anaemia
Vitamin B12
Deficiency
•-Pernicious Anaemia
•-Gastrectomy
•-Tropical Sprue
•-Ileal Disease;crohns
Disease,ileal Resection
•-Fish Tapeworm
•-Poor Diet In Vegetarians
MEGALOBLASTIC BONE MARROW
Folate deficiency
•Malabsorption
•Increased Cell Turnover
Eg;pregnancy,leukemia,chronic-
Haemolysis
•Anti Folate Drugs –
Phenytoin,methotrexate,sulphasal
azine- Non Megaloblastic Bone
Marrow
•Alcohol,cirrohis Of The
Liver,hypothyroidism,myelodysplas
tic Syndrome

83. Normochromic anaemia
• Bone Marrow Failure
-Aplastic Anaemia
-Ineffective Haematopoiesis
-Infiltration
• Anaemia Of Chronic Disease
-Chronic Inflammation
-Liver Disease
-Malignancies,chronic Renal Failure
• Haemolytic Anaemia

84. jaundice
• It is the yellowish discolouration of a patient’s
skin and sclerae that results from
hyperbilirubinemia.
• It happens when the serum bilirubin level rises
twice above the normal upper limit.
• It is deposited in the tissues of the body that
contains elastin.

85. JAUNDICE
• It is the yellowish discolouration of a patient’s skin
and sclerae that results from hyperbilirubinemia.
• It happens when the serum bilirubin level rises twice
above the normal upper limit.
• It is deposited in the tissues of the body that
contains elastin.

87. CYANOSIS
• Blue discolouration of the skin and mucous membranes;it is due to the presence of
deoxygenated haemoglobin in the superficial blood vessels.
• Occurs when there is more than 50g/L of deoxygenated haemoglobin in the capillary
blood.
Types-central and peripheral
• Central cyanosis- abnormal amount of deoxygenated haemoglobin in the arteries and
that a blue discolouration is present in parts of the body with good
circulation.eg;tongue.
• Peripheral cyanosis-occurs when blood supply to a particular part of body is
reduced,eg;lips in cold weather becomes blue but the tongue is spared.

89. Causes of cyanosis
• Central Cyanosis
1)decreased Arterial
Oyygen Saturation.
-High Altitude
-Lung Disease
-Right To Left Cardiac
Shunt 2)polycythaemia
3)haemoglobin
Abnormalities;methaemoglobinemi
A,sulphaemoglobinemia
• Peripheral CYANOSIS
1)all THE CAUSES OF CENTRAL
CYANOSIS 2)exposure TO COLD
3)reduced Cardiac Output
-Left Ventricular Failure
-shock
4)Arterial or venous obstruction

90. EDEMA

91. PITTING EDEMA

92. PITTING EDEMA
GRADES
• Grade 0 : (none)
• Grade +1 :( trace , 2 mm)
Disappear rapidly
• Grade +2 ( moderate , 4 mm)
10-15 sec
• Grade +3 (deep, 6 mm)
≥1min
• Grade +4 (very deep, 8 mm)
2-5min

93. HANDS and ARMS
• Nails
– Clubbing
– Koilonychia
– Leuconychia
• Palmar erythema
• Dupuytren’s
contractures
• Hepatic flap

94. ASSESSING NAILS
• Shape; convex
• Angle : between nail and its base is 160
degrees
• Texture: smooth, nail base should be firm
and non tender
• Color: pinkish nail bed with translucent
white tips
• Capillary refill

98. Nicotine Staining Onycholysis: Separation of
Nail from Underlying Bed
Onychomycosis:
FungalInfection of the Nail
Paronychia: Infection of skin
adjacent to nail of middle finger

99. CLUBBING CAUSES
1)Cardiovascular
-cyanotic congenital heart disease,IE
2) Respiratory
-lung carcinoma
-bronchiectasis,lung abscess,emphyema
-lung fibrosis
3)Gastrointestinal
-primary biliary cirrohis,IBd,Coeliac disease, Bilhazial polpososis ,GI lymphoma
4)Thyrotoxicosis
5)Familial

100. • Blue nails-cyanosis, Wilson ds
• Red nails-polycythaemia,CO poisoning
nails- yellow nail syndrome
• Splinter haemorrhages-IE,vasculitis
• Koilonychia-iron def anaemia,fungal infection,raynauds
• Onycholysis-thyrotoxicosis,psoriasis
• Leuconychia-hypoalbuminemia
• Nailfold erythema-SLE
• Terry’s nails-CRF,cirrohis

101. HANDS
Palmar
erythema
Dupuytren’s
contractures

103. ARMS
• Spider naevi (telangiectatic
lesions)
• Bruising
• Wasting
• Scratch marks (chronic
cholestasis)

104. Thank
You