In this article, we will discuss the general physical examination of the patient with respect to the clinical aspect, and all types of general physical examination steps and procedures.
General Physical examination:
This is a procedure used by the medical practitioner to examine the signs and symptoms of the patients for certain diseases or conditions. This observation starts when you see the patient.
For this examine the following points are considered:
- General appearance
- Upper and lower look
- Sitting posture
- Physique
- Hands
- Consciousness
- Nails
- Fingers
- Posture and attitude
- Palm
- Pulse
- Blood pressure
- Face
- Neck
- Axilla
- Groin
- Feet
- Edema
- Respiratory rate
- Temperature
We will discuss every point one by one.
General appearance:
Normally in general appearance, we consider the two points that are given below.
- Young or old
- Healthy or ill
Posture and Attitude:
Posture and attitude are helpful about the illness of the patient.
Examples:
- A patient with severe heart failure prefers to sit in the propped position.
- Patients with severe airway obstruction will prefer to sit in the bending forward position.
Consciousness:
Consciousness is another factor for General Physical Exam. In consciousness, we check the following points.
- Alertness of patient
- Confused
- Drowsiness
- Deeply unconsciousness
Physique:
In the visual impression of the patient generally, we check the weight and height of the patient. In weight, we check whether the patient is undernourished or obese but for height, we check whether the patient is tall or short. For both weight and height, we compared it with the ideal body weight and height.
We check the weight and height in physique because we have to give the dose of medicine and diet with respect to the surface area.
Hands:
The shape of hands is very important for the General Physical Examination. In hands, we examine the following three things.
- Nails
- Fingers
- Palm
We will discuss hands in detail but before moving forward we have to learn the shape of hands.
Shape:
The shape of hands is also important for the GPE because hands adopt special shapes in different diseases.
Examples:
- 4th metacarpal becomes short in females in Turner’s syndrome.
- In tetany, hands adopt specific shapes due to Carpal spasms.
- Broad and large hands in the acromegaly.
Nails:
The shape of nails shows mainly four conditions.
- Pallor
- Cyanosis
- Clubbing
- Koilonychia
-
Pallor:
The normal individual also has marked deviation in the color of nails. But diseases like Anemia the color of the patient has been changed and nails become thin and curved inside this condition is also called Pallor.
-
Cyanosis:
The color of the nails in cyanosis also changed into a bluish color this condition is called cyanosis.
-
Koilonychia:
Nails become thin, brittle, and curved just like spoon-shaped.
-
Clubbing:
Clubbing of the nails is very important for General Physical Examination GPE. Nails changed a lot in the clubbing. These changes have been seen in the clubbing:
- Loss of angle between the nail and the nail base in clubbing.
- Space between the nails is absent in clubbing.
- Fluctuations are also present in the clubbing.
- Nails become convex-shaped.
- The curvature of the nails is increased in both longitudinal and transverse axis.
- Terminal phalanx becomes bulbous due to the swelling just like drumsticks.
- Shamroth’s signs (space between two nails) are also absent in the present.
- Sometimes the Splinter hemorrhages (streaks under the nails) are also present in clubbing.
- Leuco nychia ( white patches in nail plates) may be present in the clubbing.
- Sometimes pitting of nails is also seen. These are small and large pits in the nails.
References:
https://www.ncbi.nlm.nih.gov/books/NBK361/
https://www.amboss.com/us/knowledge/Physical_examination/
https://www.healthline.com/health/physical-examination
https://www.lecturio.com/blog/medical/physical-examination-learning-how-to-assess-patients/
