Description
A general physical examination is a systematic assessment of the body to evaluate overall health and detect any underlying conditions. It begins with observation of general appearance, vital signs (temperature, pulse, respiration, blood pressure), height, weight, and body mass index. The examination includes inspection, palpation, percussion, and auscultation of major systems—cardiovascular, respiratory, abdominal, musculoskeletal, and neurological. Skin, eyes, ears, and lymph nodes are also checked for abnormalities. This comprehensive evaluation helps in early diagnosis, risk assessment, and establishing a baseline for future comparison. A general physical examination is essential in preventive healthcare and effective management of chronic or acute illnesses.
Summary Listen
- The talk emphasizes the critical role of history and physical examination in patient care, highlighting them as the foundation for diagnosis and management, often providing more insight than immediate investigations. A comfortable, private, and quiet environment is crucial for a thorough examination, alongside introducing oneself and explaining the examination process to the patient to obtain consent. Maintaining hygiene through hand sanitization is important to prevent cross-infection.
- General physical examination starts with observing the patient's overall appearance, mental status (including level of consciousness, orientation, and speech), and build. It then progresses from head to toe, examining the head, eyes, ears, nose, and throat. Special attention should be paid to the mouth for conditions like thrush. A quick assessment of the skin, neck, chest, abdomen, legs, and feet follows before focusing on specific findings such as pallor, jaundice, clubbing, cyanosis, lymphadenopathy, and edema.
- Pallor suggests anemia, requiring examination of the lower palpebral conjunctiva, tongue, and nail beds. Jaundice, indicative of elevated bilirubin levels, is best assessed in natural light by retracting the upper eyelid. Cyanosis, reflecting reduced hemoglobin levels, can be peripheral or central, each with distinct causes and presentations. Clubbing, an enlargement of the nail bed, is associated with various respiratory, cardiovascular, and gastrointestinal conditions.
- Lymphadenopathy involves palpating all groups of lymph nodes, noting their size, shape, number, tenderness, consistency, and mobility. Edema, or swelling due to fluid accumulation, can be pitting or non-pitting, and its presence and location provide clues to underlying conditions like heart failure, nephrotic syndrome, or lymphedema.
- System-specific general examination focuses on additional observations relevant to each system. For the cardiovascular system, this includes chest deformities, scars (sternotomy, thoracotomy, leg scars), visible pulsations, and signs of superior vena cava obstruction. In neurological assessments, gait abnormalities, tremors, neurocutaneous markers (cafe au lait spots, neurofibromas), and signs of hepatic encephalopathy (jaundice, asterixis) are key.
- Respiratory system examination includes observing breathing patterns, accessory muscle use, pursed-lip breathing, and the presence of wheezing or stridor. Also crucial is noting the patient's physique, signs of cyanosis, and bedside items like oxygen masks or sputum cups. The gastrointestinal system assessment involves looking for signs of chronic liver disease such as palmar erythema, clubbing, spider nevi, ascites, and jaundice.
- Finally, while not covered in detail, the talk mentions that rheumatological conditions often have multi-system involvement, requiring careful examination of all systems. Systemic Sclerosis is used as an example condition where pulmonary, gastrointestinal and skin involvement may indicate progression. The importance of integrating observations from various systems for accurate diagnosis is emphasized.
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