Comprehensive Guide to Conducting a General Physical Examination

 

Physical Inspection

As soon as you see the patient, you should start the examination. Take note of the patient's overall appearance and, if he enters, his walking style. Examine his conduct, mental health, and educational attainment during the taking of his history. To ensure that no crucial stage is missed, an examination routine should be created. The order of the examinations should be such that the patient is disturbed as little as possible while still being thoroughly examined quickly. It ought to be more regional than systematic. Each doctor will have a different regimen, and it should be adjusted based on the situation and the patient's health. When a patient enters a clinic, it will be different from when they are admitted to a hospital unconscious. Determine the patient's sickness severity in general. Examining a very ill patient should be limited to what is required to establish a tentative diagnosis. It is not appropriate to postpone starting therapy in order to finish a standard assessment. When a male doctor or student examines a female patient, a chaperone a female assistant, nurse, or student should be present.

Doing The Examination In Writing

The examination is conducted regionally, although the results are documented under heading-based systems. Although it takes some practice at beginning, proficiency comes about fairly rapidly. This book provides a regional sequence of examination in the end, along with methodologies provided under systematic topics. The plan that follows will help ensure a quick and comprehensive GPE (General Physical Examination). Even though a physical indicator may be observed at multiple locations, it should only be noted and described in one location.

Overall Look

Determine the patient's level of illness quickly, based on whether he appears well, moderately sick, or terribly sick.

Stance and Attitude

Sometimes a patient's attitude and posture reveal details about his condition. As an illustration:

• A patient with severe heart failure finds that sitting upright is preferable because sleeping flat exacerbates their dyspnea.
• In order to correct his shoulder girdle and activate his additional respiratory muscles, a patient experiencing severe obstruction of his airways sits upright, bending forward and supporting himself with his arms.
• In cases of meningitis, the neck may bend backwards (neck retraction); in cases of peritonitis, the patient sleeps quiet, while the patient with severe colic is agitated.

Being Aware

Take note of the patient's appearance: is he or she clearly unconscious, confused, or drowsy?

Physical

Even though a patient's height and weight are typically determined visually, it is preferable to measure both and compare the results to tables of optimal height and weight, especially if the patient appears fat, malnourished, excessively tall, or short. Medication dosage is also based on the patient's weight or surface area (measured with a nomogram). Frequent weight monitoring helps track a patient's reaction in cases of ascites or edema. Sitting height, arm spread, and overall height should all be compared in patients who are excessively tall or short. Sitting height, or the height of a person when seated on his buttocks, is often equal to half of his or her entire height, or the distance between the tips of the middle fingers on both hands when the arms are completely extended. The arm spread in hypogonadism and Marfan's syndrome is more than twice as long as the sitting height. Sitting height is greater than leg length, measured from the pubis to the feet, in achondroplasia because the arms and legs are small and the trunk is normal.
The trunk and limbs are proportionate, but the overall height is smaller than usual in congenital hypopituitarism (pituitary dwarf).

Hand

Examine the palm, nails, and fingers thoroughly; however, first take a general look at the hand and make the following observations

Shape

Due to carpal spasm, hands take on a specific shape during tetany (see under nervous system testing). Turner's syndrome is characterized by a female's short fourth metacarpal, which is visible when she makes a fist. There is also evidence of short 4th/5th metacarpal in pseudohypoparathyroidism.

Size

Acromegaly, hands are broad and huge. Examining the neurological system leads to the discussion of tremor, grip, and muscle atrophy.

Typical indicators at hand

Calluses on the

• nails
• Pallor
• Cyanosis
• Koilonychia
• Cliffing

The Heberden's nodes and fingers

• Arthritis in joints

Palm, Pallor, and Perspiring Nails

Pallor:

In healthy individuals, there is a noticeable variance in the color of the nails. In anemia, it grows paler.

Cyanosis

Cyanosis is the term for blue discoloration.

Koilonychia

The nails become spoon-shaped, thin, and brittle. Long-term iron deficiency anemia exhibits it.

Clubbing:

It includes the subsequent adjustments:

When the nail is felt from its distal end towards its base, the angle between it and the nail base has decreased) usually by laying a piece of paper between the nail and the nail base.

Osteoarthropathy due to hypertrophy

Clubbing is linked to subperiosteal new bone development, which causes swelling and discomfort above the wrist and ankle. Pulmonary hypertrophic osteoarthropathy is the term for the condition that is most frequently linked to respiratory disorders, though it can occur in any pathology that causes clubbing. Schamroth's sign indicates that there is no longer an opening between the paper and the proximal portion of the nail. There is usually a space between two nails when two fingers are approached. It's not there when clubbing

Colitis that ulcerates
Cirrhosis of the biliary system

Other

• Biological
• Pseudo clubbing (seen in hyperparathy roidism; terminal phalanx resorption creates the illusion of clubbing)

Splinter hemorrhages

Often observed in manual laborers, they are vertical hemorrhagic streaks beneath nails. They may also show up in cases of infectious endocarditis.

Leuconychia

These are white patches in the nail plates that are frequently seen in healthy individuals. They can also occasionally be found in cases of chronic liver disease and other disorders that result in low albuminemia.

Nails that are half and half

The distal part of the nails is red or brown, and the proximal part is white to pink. These are observed in long-term kidney failure.

Nail pitting

The nails have a lot of little pits in them. Psoriasis causes this.

Fingers

These painful, pea-sized swellings in the pulps of the terminal phalanges are called Osler's nodes. These are caused by vasculitis and are observed in infective endocarditis.Bony swellings on the side of terminal interphalangeal joints are known as Heberden's nodes. 

Joint swelling/deformity

Rheumatoid arthritis causes swelling in the proximal interphalangeal joints and spindle-shaped fingers. Long-term rheumatoid arthritis patients may develop the following deformities. Ulnar deviation and anterior subluxation of the metacarpo phalangeal joints.

Swan neck deformity, which is characterized by constant flexion at the distal interphalangeal joint and hyperextension at the proximal interphalangeal joint
Fixed flexion at the proximal interphalangeal joint and extension at the terminal interphalangeal joint characterize the button-hole deformity.

Arachnodactyly

A condition associated with long, thin fingers that is present in Marfan's syndrome.

Palm Pallor

Pale palmar skin is a sign of anemia.

Palmar erythema

In certain healthy individuals, there is redness in the thenar and hypothenar eminences. In addition, it is a side effect of oral contraceptive medication, rheumatoid arthritis, pregnancy, and liver failure.

Sweating

While excessive perspiration on the palm may be idiopathic, it can also be a sign of thyrotoxicosis (palm heated) and worry.

Dupuytren's contracture

The palmar fascia thickens, causing a thicker plaque or cord to form between the palm, ring, and little fingers. Later on, the ring and little fingers in particular, may develop flexion contracture. That characterizes cirrhosis caused by alcohol.