The document describes the purpose and components of a systemic health examination. The examination aims to understand diseases, prescribe treatments, diagnose conditions, and plan management. It involves assessment of specific signs and symptoms through examination of body areas and organ systems. The examination can be problem-focused, expanded problem-focused, detailed, or comprehensive. It examines areas like head/neck, chest, abdomen, extremities, and genitalia. Organ systems examined include eyes, ears, cardiovascular, respiratory, gastrointestinal, and others.

1. SYSTEMIC
HEALTH
EXAMINATION

2. PURPOSE
UNDERSTAND THE
DISEASE
PRESCRIPTION OF
THE TREATMENT
EVALUATE THE SPECIFIC
AND ASSOCIATED
FEATURE
TO DIAGNOSE
THE DISEASE
PLANNING THE
MANAGEMENT
ASESSEMENT OF
SPECIFIC SIGNS
AND SYPTOMS

3. Contents
Levels of Physical Examination
01
Body Areas Examination
02
Organ Systems Examination
03

4. PART 01
Levels of Physical
Examination

5. The various levels of physical exam
are defined as follows:
1. Problem
Focused
a limited examination
of the affected body are
or organ system
2. Expanded Problem
Focused
a limited examination of the affected
body area or organ system and other
symptomatic or related organ systems
3. Detailed
an extended examination of
the affected body area(s)
and other symptomatic or
related organ system(s)
4. Comprehensive
a general multi-system
examination
or complete
examination of a single
organ system

6. PART 02
Body Areas
Examination

7. BODY AREAS ASSESSMENT
1. Head, including the face
and Neck
2. Chest, including breasts and
axillae
3. Abdomen
4. Each extremity
6. Genitalia, groin, buttocks
5. Back, including spine

8. PART 03
Organ Systems
Examination

9. FOCUSED /
ORGAN SYSTEM
EXAMINATION
Eyes
Ears, Nose, Mouth, Neck,Throat & Head
Cardiovascular
Respiratory
Gastrointestinal
Constitutional (e.g.,vital signs,
general appearance)

10. Genitourinary
Musculoskeletal
Skin
conti...
Neurological
Psychiatric
Hematologic/Lymphatic/Immunologic

11. a) Vital Signs -
§ Temperature
§ Pulse rate
§ Respiratory rate
§ Blood pressure
§ Pain
b) General Appearance-
§ Grooming
§ Body built
§ Gait
§ Hygiene ect.

12. Inspection and palpation
• Inspect for symmetry of the eyes and eyelids.
• Note any swelling or redness around the eyelids, and assess whether
the eyelids can fully close.
• Inspection of the sclera (normal sclerae are white) and conjunctiva
• Ask the patient to look up while you hold lower lids with your thumb.
• Inspect for color, vascular pattern, and whether there is any swelling

13. conti...
a) PUPILS-
Pupilsize
• The pupils are generally between 3–5 mm.
• Note whether there is a difference in size between the two pupils
(anisocoria).
Indirect and direct pupillary light reflex
• Note whether both the illuminated and non-illuminated pupils
• constrict after light exposure.

14. conti...
b) VISUALAQUITY-
Procedure
• The patient from a predetermined distance from a Snellen chart (a chart used to
evaluate visual acuity), covers one eye and reads rows of letters out loud.
• Each row corresponds to a specific level of visual acuity.
• The patient's visual acuity is determined by the smallest row for which the
patient can correctly read more than half the letters.
Interpretation
• Visual acuity is expressed with two numbers.
• Normal visual acuity is 20/20.

15. conti...
c) CONFRONTATION VISUAL FIELD TEST-
Procedure
• Sit directly opposite the patient and ask the patient to cover one eye with their
hand while you cover your own contralateral eye (i.e., you left eye if the
patient covers their right eye).
• Look at the nose of the patient and ask him/her to do the same.
• Move your finger inwards from outside the edges of your visual field (the area
in which objects can be seen while focusing the eyes on a central point),
ensuring that the finger is located at the same distance from the patient and
yourself.
• Ask the patient to notify you when he/she can see your finger.
Interpretation
• If the finger is simultaneously seen by you and the patient, the visual fieldis
intact/unremarkable.

16. conti...
d) EXTRAOCULAR MOVEMENTS-
Procedure
• Ask the patient to follow the tip of a pen (or a similar object) with their eyes.
• Test all directions: The patient should look upwards/below/to the left/to the
right/diagonally.
Interpretation
• This part of the examination assesses the cranial nerves involved in ocular motility.
• See cranial nerve palsies.
• Note the presence of nystagmus or lid lag (caused by spasm of the smooth muscle
portion of the levator palpebrae superioris due to sympathetic overactivity; present if
the sclera can be seen above the iris as the patient looks down)
• Test the convergence reaction by asking the patient to follow the pen as you move it
towards the bridge of their nose.
• The eyes should converge while following the object to within 5–8 cm.

17. conti...
e) Fundoscopic examination and other special tests-
• The fundoscopic examination- is typically only performed in certain
situations (e.g., suspected intracranial hypertension or stroke

19. • Inspect the external ear and note any skin abnormalities or discharge.
• For patients complaining of ear pain or discharge, gently move the auricle up and down,
and apply pressure to the tragus and the mastoid process
a) Otoscopy Procedure
• Place the largest speculum that comfortably fits in the patient's ear on the head of the
otoscope and turn on the light source.
• Angle the otoscope handle either directly downward or towards the patient's forehead.
• Stabilize your otoscope hand by placing the fourth and fifth digits on the patient's head.
• With your free hand, pull the ear up and in a posterior direction to straighten the canal as
you insert the otoscope at a slightly downward angle.

20. conti...
Interpretation
• Inspect for the presence of discharge, redness, cerumen, swelling, and
foreign bodies.
• The tympanic membrane normally reflects the otoscope's light, which
is known as the light reflex (or “cone of light”).
• A pneumatic bulb allows for assessment of tympanic membrane
mobility.

21. conti...
b) Auditory acuity- Screening assessments
b). 1.Whispered voice test: While standing behind the patient, whisper
a phrase or numbers in each ear → Ask the patient to repeat what you
whispered.
b). 2. Finger rub test: Place your fingers several centimeters from
either ear → Rub your fingertips together and ask the patient if they
heard it.
Interpretation:If any asymmetry is detected, or the patient complains
of impaired hearing, further evaluation is indicated

22. conti..
c) Tuning fork tests- Performed in order to distinguish between conductive
hearing loss and sensorineural hearing loss
c). 1. Weber test: tests for lateralization (sound is heard louder in one ear than
the other)
• Place the base of a vibrating tuning fork on the middle of the forehead and ask
the patient from which ear the sound is louder.
• The sound is normally heard equally in both ears.
Interpretation
• Lateralization → asymmetric hearing loss
• No lateralization → normal hearing or bilateral hearing loss

23. conti...
c). 2.Rinne test: tests for air conduction vs bone conduction in the examined ear
• Place the base of a vibrating tuning fork on the mastoid process of the ear. Once the
patient no longer hears a tone, immediately hold the “U” part of the fork over the outer
ear and ask the patient if they can still hear it.
• Air conduction is normally greater than bone conduction, so the patient should still be
able to hear the tuning fork next to the outer ear after they can no longer hear it when
placed on the mastoid process.
Interpretation
• Unable to hear the tuning fork; → There is conductive hearing loss (bone conduction > air
conduction) in the examined ear (Rinne test is negative)
• Still able to hear tuning fork over the outer ear; → There is no conductive hearing loss
(Rinne test is positive); possible sensorineural hearing loss (air conduction > bone ) if
there is diminished hearing in the conductionexamined ear

24. conti...
d) Additional tests
• Audiogram,
• speech audiometry,
• impedance audiometry

25. • Examine the external nose and test the patient's ability to breathe through
either nostril by covering one at a time.
• Examine the nasal mucosa, septum, and turbinates using an otoscope.
• Use the largest available speculum that will comfortably fit inside the nostril.
• Direct the speculum posteriorly and superiorly as you inspect the nasal cavity.
• Palpate for tenderness over the maxillary and frontal sinuses.
• Inspect the lips.
• Inspect the oral mucosa.
• Inspect the gums for redness or ulceration

27. Inspection and palpation
• Inspect for any obvious deformities, asymmetry, masses, tracheal deviation
• Palpation of the lymph nodes of the head and neck
• Palpation of the parotid gland
• Assessment of range of motion of the cervical spine
• Ask the patient to tilt their chin so that it is resting against their chest or to flex their neck.
• See meningism.
• Assessment of spinal accessory nerve function
• Ask the patient to move their head to the left and right, and to lift their shoulders against
resistance.
• See cranial nerve palsies.
• Evaluate for jugular venous distention

28. conti..
a) THYROID-
Inspection
• The thyroid gland is located below the thyroid cartilage and is normally not visible.
• Enlargement should prompt further evaluation.
Palpation
• Stand behind the patient.
• Place your finger pads below the thyroid cartilage and assesses the size and consistency of
the thyroid.
• Ask the patient to swallow.
• The thyroid should slide beneath the fingers.
• The normal thyroid is usually not palpable.
• Note any asymmetry or enlargement.

29. • Inspect the tonsils
• Inspect the soft palate
• Inspect the posterior pharynx by having the patient stick out their
tongue.
• Inspect the tongue.
• Assess tongue motility: See cranial nerve palsies.

30. • Inspect the skull and face.
• Inspect the skin and scalp.
• Palpate skull (especially if patient complains of tenderness or recent trauma).
• Assess facial sensation and motor function.
• Trigeminal nerve function: Lightly touch the forehead of the patient on both
sides and the upper and lower areas of the cheek with the index finger. Ask the
patient whether this feels the same on both sides of the face.
• Facial nerve function: Ask the patient to furrow their forehead, close their eyes,
show their teeth, and inflate their cheeks.
• See examination of cranial nerves and cranial nerve palsies.

31. • Blood pressure (BP) is measured in both arms and, for suspected
congenital cardiac disorders or peripheral vascular disorders, in both
legs.
• Heart rate and rhythm are assessed by palpating the carotid or radial
pulse or by cardiac auscultation if arrhythmia is suspected; some
heartbeats during arrhythmias may be audible but do not generate a
palpable pulse.

32. Conti...
Cardiovascular
1) Palpation of the heart (location, size, thrills)
2) Auscultation of the heart with notation of abnormal sounds and murmurs
3) Assessment of lower extremities for edema and/or varicosities
4) Examination of the carotid arteries (e.g., pulse amplitude, bruits)
5) Examination of abdominal aorta (e.g., size, bruits)
6) Examination of the femoral arteries (e.g., pulse amplitude, bruits)
7) Examination of the pedal pulses (e.g., pulse amplitude)

33. Conti...
Assessment of Chest Pain Using PQRST Mnemonic- Assess the
following characteristics with each new report of pain and following
anyintervention:
(P) Provocative or Palliative: What makes the symptom(s) better or
worse?
(Q) Quality: Describe the symptom(s).
(R) Region or Radiation: Where in the body does the symptom occur?
Is thereradiation or extension of the symptom(s) to another area of the
body?
(S) Severity: On a scale of 1-10, (10 being the worst) how bad is the
symptom(s)?
(T) Timing: Does it occur in association with something else (e.g. eating,
exertion,movement)?
Other Symptoms: Dyspnea, Fatigue, Edema, Cyanosis, Pallor,
Nocturia,Orthopnea and Coughing

34. Conti...
• Assessment of The Neck Vessels:
Inspection- At a glance, if the patient is sitting in the supine position at 45
degrees or higher, you should not be able to see jugular venous pulsations
unless there is underlying pathology.
Auscultation-You are listening for the presence of a bruit, which is a blowing
or swishing sound, indicatingturbulent blood flow.
Palpation -allows you to assess the neck fortenderness, abnormal temperature,
excessive moisture, pulsations, or masses

35. Conti...
• Circulatory Assessment:
Inspection-Areas for evaluation you may inspect include skin color (central
and peripheral cyanosis), location of any lesions, bruises or rash, symmetry
of motion, size of body parts, and any abnormal findings, sounds, and odors
Auscultation-Auscultate your patient’s blood pressure.
Palpation-Begin by palpating the peripheral arteries. These include the
brachial, radial, femoral, popliteal, dorsalispedis, and posterior tibial. Note
the contour and amplitude of each pulsation. These should feel similar
bilaterally.

36. Conti...
• The Precordium:
Inspection
Inspect the anterior chest for pulsations. You may or may not see the apical pulse. If
it is visible, you will see it in the fourth or fifth intercostals space.
Auscultation
Before you begin your auscultation of the precordium, preface your exam by telling
the patient you will be listening in many different places for what might be a while.
Then, you must identify the areas you need to ausculate. You may want to inch your
stethoscope in a “Z‐pattern” across the precordium, from the base of the heart to the
apex. Concentrate to the sound of the “lub” and the “dub.” The “lub” or first heart
sound is known as S1. The “dub” or the second heart sound is known as S2.

37. Conti...
Abnormal Heart Sounds
• Summation Gallop & Opening Snap
• Ejection Click & Mid‐Systolic Click
• Pericardial Friction Rub & Mediastinal Crunch
• Murmurs

38. 1) Assessment of respiratory effort (e.g., intercostal retractions, use of
accessory muscles, diaphragmatic movement)
2) Percussion of chest (e.g., dullness, flatness, hyperresonance)
3) Palpation of chest (e.g., tactile fremitus)
4) Auscultation of the lungs

39. 1) Examination of the abdomen with notation of presence of masses or
tenderness
2) Examination of the liver and spleen
3) Examination for the presence or absence of hernias
4) Examination (when indicated) of anus, perineum, and rectum,
including sphincter tone, presence of hemorrhoids,rectal masses
5) Obtain stool for occult blood testing when indicated

40. Male-
1) Examination of the scrotal contents (e.g., hydrocoele,
spermatocoele, tenderness of cord, testicular mass)
2) Examination of the penis
3) Digital rectal examination of the prostate gland (e.g., size, symmetry,
nodularity, tenderness)

41. conti...
Female-
Pelvic examination (with or without specimen collection for smears and cultures,
which may include-
1) Examination of the external genitalia (e.g., general appearance, hair
distribution, lesions)
2) Examination of the urethra (e.g., masses, tenderness, scarring)
3) Examination of the bladder (e.g., fullness, masses, tenderness)
4) Examination of the cervix (e.g., general appearance, discharge, lesions)
5) Examination of the uterus (e.g., size, contour, position, mobility, tenderness,
consistency, descent or support)
6) Examination of the adnexa/parametria (e.g., masses, tenderness,
organomegaly, nodularity)

42. 1) Examination of gait and station
2) Inspection and/or palpation of digits and nails (e.g., clubbing, cyanosis,
inflammatory conditions, petechiae, ischemia, infections, nodes)
Examination of the joints, bones, and muscles of one or more of the following
six areas:
a) head and neck
b) spine, ribs, and pelvis
c) right upper extremity
d) left upper extremity
e) right lower extremity
f) left lower extremity

43. conti....
The examination of a given area may include:
1) Inspection and/or palpation with notation of presence of any
misalignment, asymmetry, crepitation,
2) defects, tenderness, masses or effusions
3) Assessment of range of motion with notation of any pain, crepitation or
contracture
4) Assessment of stability with notation of any dislocation, subluxation, or
laxity
5) Assessment of muscle strength and tone (e.g., flaccid, cogwheel, spastic)
with notation of any atrophy or abnormal movements

44. 1) Inspection of skin and subcutaneous tissue (e.g., rashes, lesions,
ulcers)
2) Palpation of the skin and subcutaneous tissue (e.g., induration,
subcutaneous nodules, tightening)

45. 1) Test cranial nerves with notation of any deficits
2) Examination of DTRs with notation of any pathologic reflexes
(e.g., Babinksi)
3) Examination of sensation (e.g., by touch, pin, vibration, proprioception)

46. ABC mental health assessment- This involves rapid assessment of mental health status within
three domains.
Affective domain
• This domain focuses on observation of the patient’s emotional state and expressed feelings. It
involves objective interpretation by the nurse of the patient’s non-verbal communication, and
documentation of the patient’s mood, which is a subjective finding.
Behaviour domain
• This domain focuses on observation of the patient’s behaviour. It involves subjective
interpretation by the nurse of the patient’s behaviour and appearance. Caution is needed when
interpreting the patient’s behaviour as a sign of mental disorder (e.g. inability to maintain eye
contact can be a sign of depression, but this behaviour can also be due to a social or cultural
convention).
Cognition domain
• This domain focuses on evaluation of the patient’s cognitive function. Within this domain there
is overlap with neurological assessment. It involves objective interpretation by the nurse of the
patient’s orientation to person, place, and time, and observation of any signs of confusion or
change in alertness.

47. Physical clues that will aid in assessing oxygen carrying capacity
include:
• Skin coloration
• Respiratory rate
• Pattern of respiration
• Capillary refill
• Heart rate
• Skin temperature

48. Palpation of lymph nodes two or more areas:
1) Neck
2) Axillae
3) Groin
4) Other

49. Physical Clues- Physical clues that will aid in assessing the immunity
status of your patient include:
• Inspection of open sores in the mouth
• Signs of chronic inflammation, such as body aches or pains
• Presence of wounds that are not healing in a timely manner
When assessing a patient’s immunity status, the healthcare professional
should examine the patient’s white cell count and differential.

50. THANK
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