2. General Physical Examination includes -
GENERAL SURVEY
1. It includes quick overview of patient from the head to toe
Mental state
Vitals
Built and Nutrition status
Hydration status
Performance status
Facies
Decubitus and Gait
Pallor
Icterus
Cyanosis
Clubbing
Lymphadenopathy
Edema
2.LOCAL EXAMINATION
3. SYSTEMIC EXAMINATION
3. GENERAL SURVEY
MENTAL STATE (LEVEL OF CONSCIOUNESS)
1.
Mental state is of particular importance in a patient of head injury
There are 5 stages of level of consciousness-
Fully conscious with well oriented to time, space and person.
Fully conscious with lack of orientation to time, space and person
Semiconscious but CAN BE AWAKENED- DROWSY
Unconscious but RESPONDING TO PAINFUL STIMULI- STUPOR
Unconscious and NOT RESPONDING TO ANY PAINFUL STIMULI- COMA
4. GENERAL SURVEY
2. BUILT
Built or Physique is the Skeletal structure of an individual in relation to a normal
individual of the same age, sex and race.
It can be described as Short/ Average/ Gigantic built.
3. NUTRITIONAL STATUS is assessed by-
General appearance of the patient- EMACIATED/ AVERAGE/ OVERWEIGHT
Calculating the BMI
Assessing the Thickness of subcutabeous fat.
Assessing the bulk of muscle by measuring MUAC.
Assessing any evidence of Vitamin Deficiency.
5. BMI
Calculated by : WEIGHT (in KG)/ SQUARE OF HEIGHT (in M)
WHO Criteria to classify patients according to BMI-
UNDER WEIGHT
NORMAL
OVERWEIGHT
OBESE TYPE 1
OBESE TYPE 2
OBESE TYPE 3
<18.5
18.5 - 24.9
25 - 29.9
30 - 40
40.1 - 50
MORE THAN 50
6. GENERAL SURVEY
4. HYDRATION STATUS
Hydration status assessed by-
Looking at the appearance of tongue and oral mucosa. Normally Moist, In
Dehyadration, it appears Dry.
Skin Turgor: Pull the skin and release. Normally skin is Elastic, In Dehydration,
SKIN TURGOR IS LOST .
In dehydrated patient, THIRST IS INCREASED, URINE OUTPUT IS DECREASED.
7. 5. PERFORMANCE STATUS
Can be assessed by 2 different ways-
ECOG PERFORMANCE STATUS
KARNOFSKY PERFORMANCE SCALE
9. 6. DECUBITUS
The attitude of the patient on the bed is known as DECUBITUS.
7. Gait
Abnormal gait may occur due to various reasons including Pain, Bone and
Joints abnormalities, Neuromuscular diseases, etc.
8. Facies
The typical appearance of face in certain diseases can
be diagnostic.
FACIES HIPPOCRATICA in GENERALISED PERITONITIS
RISUS SARDONICUS in TETANUS
MASK LIKE FACE in PARKINSONISM
MOON FACE in CUSHING’S SYNDROME
ADENOID FACIES in ADENOID HYPERTROPHY
HYPERTHYROID FACIES
10. PALLOR
Assessed by looking at LOWER PALPEBRAL CONJUNCTIVE, DORSUM AND TIP OF
TONGUE, MUCOUS MEMBRANES OF LIPS AND CHEEKS, PALMAR CREASES, NAILBED.
ICTERUS
Yellowish discolouration of skin, eyes and mucous membranes due to excessive
levels of Unconjugated Bilirubin in the blood.
Assessed by looking at SCLERA, UNDERSURFACE OF TONGUE, NAILBED, EAR
LOBULES, TIP OF NOSE.
CYANOSIS
Bluish discolouration of skin and mucous membranes due to excessive amount of
reduced hemoglobin in blood.
Assesed by looking at EAR LOBULES, TIP OF NOSE, TIPS OF FINGERS AND TOES,
PALMS AND SOLES.
11. CLUBBING
Defined as diffuse enlargement of the terminal phalanges with increase in
transverse and longitudinal curvature of the nails.
EDEMA
Abnormal accumulation of fluid in the interstitium and in the body cavities.
LYMPHADENOPATHY
Examination of the diseased lymph nodes in terms of site, size, numbers and
consistency.
