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General Physical Examination

• Doctors should be observant like a detective.

Introduction to Examination

• Introduce yourself as the doctor or medical professional.
• Ask for patient's permission to conduct the examination.
• Enquire whether the patient is suffering from any pain.
• Check if the patient is comfortable lying flat.

Definition of Physical Assessment

• A physical assessment is a systematic collection of objective information.
• Objective information is directly observed or gathered through examination techniques.

Mnemonic: WIPER

• Wash hands before and after patient contact, and wear gloves as needed.
• Introduce yourself to the patient and seek consent.
• Position the patient correctly for the examination.
• Expose the area of the patient's body as needed for examination.
• Right side of the bed; position yourself on the right side of the bed.

Pre-Preparation for Assessment Includes

• Ensure the examination room is ready
• Assemble necessary equipment
• Position the patient

Methods of Assessment

• Inspection
• Palpation
• Percussion
• Auscultation
• Olfaction

Head-to-Toe Assessment

• Vital Parameters
• General Examination
• Detailed Examination

Vital Data

• Name of the Institution
• Name of the Doctor
• Date
• Name of the Patient
• Age
• Sex
• Religion
• Marital Status
• Information about any Children
• Occupation
• Address

General History Sections

• ID (Identification)
• Past Medical History
• Allergy History
• Social History
• Chief Complaint
• Neonatal History
• Vaccination History
• Family History
• History of Present Illness
• Drugs History
• Developmental History

History of Present Illness: Symptom Characterization

• O = Onset and duration of the symptom
• 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, with 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?"

General Examination

• It is the first step in physical examination and is a key component of the diagnostic approach.
• Inspection is the major method, combined with palpation, percussion, auscultation, and smelling.

General Examination Aims to

• Assess patient's general condition
• Detect manifestations of internal and systemic diseases

General Examination Includes

• History taking to identify symptoms
• Physical exam to identify signs
• Investigations for test results

Instruments and Equipment

• Stethoscope
• Torch Light
• Measuring tape (inches)
• Weighing machine
• Spatula
• Sphygmomanometer
• Thermometer

Prerequisites for Physical Examination Include

• Proper examination environment
• Hand washing
• Proper lighting
• Privacy & Confidentiality
• Presence of a chaperone, especially when examining female patients
• Correct positioning of doctor and patient, ideally with the examiner on the patient's right side
• Proper exposure of the patient
• Warm hands

General Examination: Areas to Check

• General Appearance and Anthropometry, including weight, height/length, and BMI
• Vital Signs, including temperature, arterial pulse, respiration, blood pressure, capillary refill time, hydration, and oxygen saturation
• Head to Toe assessment, including skin, hair & head, face, eyes/ear/nose, mouth, neck, nail & limbs, pallor, icterus, cyanosis, oedema, and lymph nodes, as well as genitalia

General Appearance

• General state of health
• Body build 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

Techniques of Physical Assessment

• Looking/Inspection
• Feeling/Palpation
• Tapping/Percussion
• Listening/Auscultation
• Smell/Olfaction

General Inspection

• Overall appearance of health or illness
• Signs of distress
• Facial expression and mood
• Body size
• Grooming and personal hygiene

Palpation

• A method of feeling the body part
• Assesses size, shape, firmness, consistency, and location using the hands (palm and fingers).

Principles of Palpation

• Keep short fingernails
• Warm your hands before touching the patient
• Encourage the patient to breathe normally throughout the palpation
• Discontinue immediately if palpation causes pain
• Inform the patient where, when, and how you will touch them, especially if they cannot see

Percussion

• Involves tapping on a 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

Auscultation Characteristics

1. Pitch: frequency or number of oscillations generated per second by vibrating object, ranges from high to low
2. Loudness: amplitude of sound, ranges from soft to loud
3. Quality: e.g., gurgling or swishing
4. Duration: short, medium, or long

Examination of Specific Body Parts

• Scalp: Check for cleanliness, color, dryness, lumps, lesions, and lice (pediculus humanus capitus), dandruff.
• Head and Neck: Assess the skull for size, symmetry, and any nodules/masses; Inspect the face.
• Eyes:
  • Assess the eyebrows and eyelids:
    • Ectropion is when the eyelid margin turns out
    • Entropion is when the lid margin turns inwards
    • Ptosis is when there is abnormal drooping of lid over pupil
  • Inspect external eye structure, position, alignment, exophthalmoses and strabismus
• Ears: Auricles and ear canal and tympanic membrane

Hearing Tests

• Weber's Test
• Rinne’s Test

Oral Examination

• Check Breath, Lips, Gums, Teeth, Palate and Tongue
• Lips:
  • Colour: Blue in cyanosis, pale in anemia.
  • Any deformity: Cleft lip.
  • Corners of lips: Check for fissuring or angularstomatitis.
  • Any vesicles (HSV).
  • Ulceration.
• Teeth:
  • Number: Growth and Age
  • Congenital teeth in newborn babies
  • Hutchison’s teeth (Congenital syphilis)

Pallor Paleness

• Can be checked via hands and arms

Hands and Arms

• Nails:
  • Clubbing
  • Koilonychia
  • Leuconychia
• Palmar erythema
• Dupuytren’s contractures

Assessing Nails requires checking

• Shape must be convex
• Angle between nail and its base should be 160 degrees
• Texture should be smooth and the nail base should be firm and non-tender
• Color should be pinkish nail bed with translucent white tips
• Capillary refill

Summary of Physical Examinations

• A systematic approach to the physical examination will ensure that the examination is complete.
• Always take the time to make a general inspection of the patient.
• The secret to successful physical examination (especially for student exams) is constant practice.
• Position the patient correctly for the examination.
• Ensure the patient has privacy during the examination.
• Never hurt the patient during the examination.
• Hand-washing and cleaning of equipment must be routine.