Date:

Practical No. 2
GENERAL EXAMINATION

Competency PY 11.13
Perform general examination in the volunteer / simulated environment

General examination involves examination of the patient from head to toe fo.
identification of signs and for diagnosis. It should be done before systemic
examination. The intention is to find out which system should be examined first. It aids
in diagnosis. It is done according to the following points.
1. Decubitus: This term implies position adopted by the patient in bed. For example
orthopneic decubitus in cardiac failure.
2. Gait: This term implies position adopted by patient while walking.

3. Temperature, Pulse and Respiration (Vital data): These findings are altered in
many conditions. TPR chart is maintained in all patients for monitoring the progress
of the disease. In addition, the pattern of temperature is diagnostic in conditions
like malaria, whereas rate, rhythm of respiration and pulse, are characteristic of
some respiratory and cardiac disorders.
4. Body constitution:
a) Built: Built is judged from the height, weight, and chest girth. According to
the built, subjects are consider average, sthenic (short and stalky) or
asthenic (tall and thin)
b) Nutrition: To examine one looks for undernutrition or obesity as both
predispose to certain diseases. Undernutrition is characterized by
(i) loss of weight due to poor caloric intake
(ii) manifestation of avitaminosis, e.g scurvy (vitamin C deficiency) or
pellagra (vitamin Bdeficiency)
(ii) anaemia due to poor iron intake
Deficit of water leads to dehydration. Deficit of protein leads to wasting
of muscles and edema.
c) Measurement: height, weight, anthropometric measurements, Body Mass
index (BMI).
5. Mental state: Patients orientation to time, place and person,
state and abnormalities of behavior are evaluated to assess mentalhis/her emotional
state. These
features are usually obvious during history taking. Example is
delirium in fever.
6. Skin:
a) Colour - pallor indicating anaemia, bluish discoloration in cyanosis, yellowish
discoloration of jaundice,

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 b) Texture / state of hydration - wrinkled
due to fluid loss, dry coarse skin in non-elastic skin ocCurring in dehydration
myxoedema,
c) Hair distribution - hair loss with pattern of baldness, abnormal hair in women,
abnormal pigmentation,
d) Skin eruptions- e.g. those occurring in
chicken pox
exanthematous fever like measles,
e) Evidence of vitamin deficiency such as pellagra, scurvy
7 Head: The head should be examined for size and
shape. Small head
(microcephaly) is usually observed in mentally retarded person. Large head
(hydrocephalus) Occurs when there is obstruction to circulation of cerebrospinal
fluid. In children, increase in the girth of the head according to the age is useful
guide for the development of brain.
8. Nails:
a) Colour pallor indicate anaemia, cyanosis (bluish discoloration) occurs in
congenital heart iseases and respiratory diseases
b) Shape - Scaphoid shaped nails (koilonychia) indicates iron deficiency anaemia
9. Ear and Nose: For external appearance and presence of any discharge

10. Eyes:
a) Conjunctiva should be examined for - pallor due to anaemia, cyanosis which
occurs in congenital heart diseases or respiratory diseases
b) Sclera should be examined for - yellow discolouration indicating jaundice,
evidence of haemorhages indicating scurvy or a bleeding disorder
c) Cornea should be examined for xerophthalmia (a sign of Vitamin Adeficiency)
d) State of pupils provides useful information
11. Mouth: Observe the following points
a) Breath- Bad odour (halitosis) may be due to pyorrhea. Odour of acetone
indicates diabetic ketacidosis
b) Lips- pallor, cyanosis
c) Gums- bleeding tendency indicates scurvy or gingivitis, blue lines at margins
suggest lead poisoning
d) Teeth- caries
e) Buccal cavity- Ulcer due to cancer is common in our country due to the habit of
chewing tobacco or paan.
) Tongue- pallor suggest anaemia, cyanosis suggest congenital heart diseases,
dryness indicates dehydration, red angry looking tongue indicates Vitamin B12
deficiency, presence of ulceration suggest aphthous ulcer or cancer, particularly
at base of tongue,
9) Soft palate fauces, tonsils (enlargement and ulceration indicates tonsillitis)
h) Pharynx- observe for congestion
12. Neck: Neck should be examined for enlarged thyroid gland, engorgement of the
neck veins and lymphadenopathy.

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 obliteration f u
should be examined for clubbing. It is characterized by
13. Fingers
angle between the base of nail and the adjacent skin. It OCCurs in Congenital

heart diseases and respiratory diseases.

is characterized by pitting on pressure
14. Edema: swelling of subcutaneous tissue sacrum) in congestive
Edema occurs initially in dependent parts (ankles or
cardiac failure, hypoproteinemia and liver diseases.
Anasarca- generalized swelling all over the body.
supratrochlear region and
15. Lymph nodes should be examined in neck, axilla, infection or cancer
groin. Common causes of lymphadenopathy are tuberculosis,
in area drained and lymphomas.
16. Bones and Joints should be examined for swelling and deformity

17. Back and Spine:

Back - rash, bedsores
Spine should be examinedfor kyphosis, scoliosis, lordosis.
18. Genitals: check for any abnormality
19. Blood pressure: record blood pressure

Proforma for General Examination Record

Name of the patient: Amit Koulane
1. Decubitus: Normal

2. Gait: Aormal

3. Temperature, Pulse and Respiration:

4. Body constitution: Alomal BMI 9 235 ko f

5. Mental state: Alormal

6. Skin:

Colonaton t Pig mentahion - Abreut

Pallor (Palenen kin) Absnt

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 7. Head:
Nomma

8. Nails:
Colows ¢ hape Nogmal
Ear and Nose: Eterus (eell
ovolny at skin)’AbSent
Cyanosu Blus colomation) 9 Abnnt
10.Eyes: Apeanance Nomal
11. Mouth: Nor mal

12. Neck:
Normal
13. Fingers:
Ciublaing CDecneese m angle let nail)’ Abseut
14. Edema:
dsellingAbent.
15. Lymph nodes:
Lymphadenopattiy Cinglammatioy f lymph nodes) ’ Absant
16. Bones and Joints:
Nomal
17. Back and Spine:
Dtomies Abent
18. Genitals:
Normal

19.Blood pressure:
Normal Cne/s)

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