4. General Physical Examination

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General Physical Examination

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General Examination

Build of the patient◦ Slender or muscular or stocky

HeightWeightH/WBMI

24-hour dietary recall

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General Examination

Appearance of the patient◦ Apparent state of health

Acutely or chronically ill

Frail/Feeble/robust/vigorousLevel of Consciousness◦ Awake/Alert/Responsive/Oriented X 3Signs of distress◦ Cardiac or respiratory distress◦ Pain/anxiety or depression

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General Examination

Posture, Gait, & motor activityObvious skin changes◦ Pallor/Cyanosis/Jaundice/rashes/bruises

Dress, Grooming, & Personal HygieneFacial ExpressionOdors of body & breath

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General Examination – head to toe

Ears◦ Discharge/ lesions

Teeth◦ Hygiene/ implants/ dental problems

Gums◦ Any bleeding/ Color

Tongue◦ Moist or dry/ pink or not/ appearance/ any

lesions

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General Examination – head to toe

Face◦ Symmetry

Neck◦ Visible pulsations/masses

Hands◦ Tremors/ muscle mass

Nails◦ Clubbing/ Cyanosis/ pallor/ grooming

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General Examination – head to toe

Chest◦ Usage of intercostal muscles/ visible pulsations

Abdomen◦ Masses/ distension/ dilated veins/ visible

movements

Legs◦ Swollen or not/ If swollen – Pitting or not◦ Masses/ ulcers

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Vital signs

BPRRHRTemperature

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BP – Korotkoff sounds

Systolic BP – Pressure at which thesounds startDiastolic BP – Pressure at which thesounds become muffled or totally absent◦ Total absence point gives best estimate of the

true diastolic BP◦

Gap between muffling and absence should besmall

If more, then note both the values

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HR

RateRhythmVolumeContour

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RR

RateRhythmDepthEffort of breathing

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Temperature

Oral temp.Rectal temp.Axillary temp.Tympanic membrane temp.

Glass vs. Electronic thermometers