General Physical Examination PDF

General Physical Examination  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?  DEFINITION A physical assessment...

General Physical Examination  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?  DEFINITION A physical assessment is the systematic collection of objective information that is directly observed or is elicited through examination techniques.  - EXAMINATION ROOM PRE-PREPARATION - EQUIPMENTS FORASS ESSMENT - POSITION -INSPECTION METHODS OF ASSESSMENT -PALPATION ASSESSM ENT -PERCUSSION -AUSCULTATION -OLFACTION -VITAL PARAMETERS HEAD TO TOE -GENERAL EXAMINATION -DETAILED EXAMINATION ASSESSMENT  HEAD TO TOE EXAMINATIONS Vital data General examination Systemic examination  Vital Data Name Of The Institution : Sex : Name Of The Doctor: Religion : Date: Married Or Single : Name Of The Patient : Children : Age : Occupation : Address :  General History The general history is organized into the following sections:  History of Present Illness Symptom characterization: O =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?"  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 INSTRUMENTS AND EQUIPMENTS : Stethoscope Torch Light Measuring tape (inches) Weighing machine Spatula Sphygmomanometer Thermometer  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 – General Appearence GENERAL EXAMINATION – Anthropometery Ø Weight – Head to Toe Ø Skin Ø Height/length Ø Hair & Head Ø BMI Ø Face Ø Eyes/Ear/Nose – Vital Signs Ø Mouth Ø Temperature Ø Neck Ø Nail & Limbs Ø Arterial pulse Ø Pallor Ø Respiration Ø Icterus Ø Blood pressure Ø Cyanosis Ø Capillary refill time Ø Oedema Ø Hydration Ø Lymph nodes --Genitalia Ø Oxygen saturation  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  General state of health: Healthy/ill/comfortable/Distressed  Body Built TECHNIQUE 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 Ø Size Ø Shape Ø Firmness Ø Consistency Ø Location using the hands (palm and fingers)  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.  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.  AUSCULTATION 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) HEAD TO TOE EXAMINATION…..  Pallor-Anaemia Yellow-Jaundice Cyanosis SKIN Xanthlesma- Primary Bill. cirossis Petechial Rash Rash Discoid Rash- Ulcerative colitis Vitiligo Echymosis  INSPECT THE SCALP Cleanliness, color, dryness, Lump, lesions, Lice (pediculus humanus capitus) Dandruff etc  HEAD AND NECK ASSESSING THE SKULL for size, symmetry any nodules or masses INSPECT THE FACE Facial feature/expression/ Mood/Attitude  ASSESS THE EYE Eye brows Eye lid : Ø ectropion(eversion ,lid margin turn out) Ø entropion(inversion, lid margin turns inwards) Ø ptosis( abnormal drooping of lid over pupil  ASSESS THE EYE Inspect external eye structure Position and alignment Exophthalmoses strabismus  EARS AURICLES EAR CANAL AND TYMPANIC MEMBRANE  HEARING WEBER’S TEST: RINNE,S TEST:  Breath Lips Gums Palate Teeth Tongue  LIPS Colour Blue in cyanosis Pale in anemia Any deformity Clift lip Corners of lips(fissuring or angularstomatitis) Any vesicles(HSV) Ulceration  TEETH Number -Growth And Age Congenital teeth in newborn babies Hutchison’s teeth- (Congenital syphilis) PALLOR  HANDS and ARMS Nails – Clubbing – Koilonychia – Leuconychia Palmar erythema Dupuytren’s contractures  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  SUMMARY 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.