Can anyone provide me head to toe steps to do general physical examination?
General appearance Pre-exam checklist: WIPE: • Wash your hands • Introduce yourself to pt • Position pt • Expose the area Always examine from the R side of the pt. Ask pt. if tenderness anywhere, before start touching them.
Posture, weight, body shape If pt. enters, examine gait. Posture, stature, height.. Obesity [BMI = kg/m^2. Normal <25]. Limb amputations, deformities. Physique expected for age.
Hydration Sunken orbits. Mucus membrane dryness. Axillae. Skin turgor [pinch skin: normal returns immediately]. Postural hypotension [less BP when sit, stand]. Peripheral perfusion [press nose, time capillary return]. Examine weight loss over hours.
Hands Palms: • Palmar erythema (cirrhosis, polycythaemia, pregnancy). • Pigmentation of crease (Addison's, but normal in asians, blacks). • Pallor of palmar crease. Better results if hyperextend fingers, or stretch skin on either side of crease (anemia). • Dupuytren's contracture [fibrosis, contracture of palm's fascia] (liver dz, epilepsy, trauma, elderly). Joints: • Herberdens, Bouchards (OA). • Swollen PIP, distal PIP spared (RA).
Head Hair: deficiency, excess. Facial hallmarks (Down's, Grave's, acromegaly, Cushing's, etc). Teeth: nicotine stains.
Examination tips Initial examination is from the foot of the bed. Always ask if any part tender, before touching pt. Watch pt's head as palpate, to look for pain flinches. Percussion is R middle finger hitting middle of middle phalynx of L middle finger. To measure circumference of limbs, choose the bony landmark on each, measure down the correct distance, then take the circumference at that point.
