General Examination

General Surgery
1. Starts with Golden 6 Rule
i. Introduction- Introduce Yourself
ii. Procedure- Explain What You are Going to Do?
iii. Consent- If said no then try to convince the patient.
(For General Examination- Oral Consent is sufficient).
iv. Privacy- Should be given to the pt. (Attendant according to gender should have to be
present).
v. Posture- Should be mentioned during procedure.
vi. Exposure- As much is required for general examination

2. Inspection
I. Consciousness- Conscious/Not-Conscious
II. Orientation- Orientated/Not-Orientated
III. Cooperative/Not-Cooperative
IV. Built Of Patient- Mild/Moderate/Obese.
V. Nutrition- Poor/Good
VI. Overall Skin Appearance
 Yellow Discoloration
 Bruise- Acquired/Spontaneous
 Scratch Marks
VII. Anthropometry
 Wt. in KG
 Height(mt.)
 BMI

3.Check For Vitals

i. Pulse Rate.
ii. Blood Pressure
iii. Respiratory Rate (Should be checked when pt. is unaware like while checking for
pulse).
iv. Body Temperature.
 4. Head to Toe Examination
I. We will start with hands
Dorsal Aspect Palmar Aspect
 Pallor- In nail bed (Pink- normal)  Jaundice- Yellowish appearance of palm
 Cyanosis- In nail bed (only in Occlusive Arterial  Palmar Erythema- At periphery Of Palm
Lesion)  Thenar & Hypothenar Muscle Wasting- Seen in
 Clubbing- Angle Seen in index finger(45°) / Arterial and Nervous Problem
Diamond Shaped (Schamroth Sign)  Dupuytren's Contracture
 Local Changes in Nail- Fungal Infection, Shape of  Fine Tremors- especially in Toxic Goitre. (Eyes
Nail. Closed).
 Capillary Refill Time- <2sec Normal, if takes  Flapping Tremor- especially in hepatic failure
more-Arterial problem (Eyes not to be closed).

II. Scalp
 Look for local loss of hair- Common in Hypothyroidism and Chemotherapy
 Palpate entire scalp and look for any swelling.
III. Eyebrows
 Look for lateral loss of hair. (B/C it grows from medial to lateral)- Seen in
Hypothyroidism

IV. Eyes
 Pallor- At palpable conjunctiva.
 Sclera- Upper Sclera for Jaundice
 Pupil- Check For Light and Accommodation Reflexes.
 Pontine hemorrhage– Pinpoint Pupil,
 Brain Stem death- Dilated and Fixed Bilaterally.
{PERLA (+VE)- Pupils Equally Reactive to Light And Accommodation.}

V. Nose
 Check for Nasal Septum Deviation
 Any Discharge from nose- Colorless- In Common cold (EVEN SURGERY HAVE TO BE
CANCELLED).
(In unconscious pt. colorless discharge may be CSF)
 Epistaxis- Bleeding from nose (Commonest cause- Nose Pricking).
 Any growth inside nose.
VI. Ear
 Look for congenital deformity.
 Colorless Discharge- May be CSF – Otorrhea.
 Look Inside.

VII. Oral Cavity

Lips
 look for Dehydration, Parched & Dry.
 Cyanosis- Central Cyanosis.
 Cheilosis- White Deposition at the angles of the mouth (May go for scarring).

Tongue
 Size of Tongue
 Deviation of Tongue- Deviated in nerve damage.
 Coating Over Tongue- White Coating- In Typhoid of 10-12 days & Abdominal Pain
. In Baby- white tongue- Fungal Infection
 Fissure- Gap in b/w
 Cyanosis- On tip of Tongue
 Ulcer/Growth
 Fine Tremors- Mostly in Thyrotoxicosis
 Also look at sublingual Region
 Tonsil- Enlarged or NOT Enlarged.
 Uvula- Position & Color.
 Hard & Soft Palate- Congenital Deformity, Jaundice.
 Oral/Buccal Mucosa- Ulcer, Growth
 Dentition- Look for gums-bleeding
False dentures, Dental Hygiene.
 Overall Oral Hygiene.

VIII. Neck Examination

a. Inspection
 Position Of Trachea.
 Observe for any obvious Swelling.
 Scar, Sinus, Fistula, Ulcer.
 Visible pulsation, Dilated Veins.
 Juglar Venous Pressure (Make patient sit in 45° position).

b. Palpation
 Confirm position of trachea-
 Trail’s Sign (3 finger)
 Invagination Method (1 finger invagination, do not press trachea)
  If there is swelling, Talk about Swelling, Proceed further with swelling.
 Cervical Lymph Nodes {7 levels}- Stand Behind pt. Put hand on head, Neck Slightly
Flexed.
o Level I - a- Submental
b- Submandibular
o Level II – Upper Juglar
o Level III – Middle Juglar
o Level IV – Lower Juglar
o Level V – Posterior Triangular with Supra Clavicular (b/w two heads of
Sternocleidomastoid)- left supra clavicular also called Virchow’s Node.
o Level VI – Central
o Level VII – Anterior Mediastinal (Percuss)
o Pre-Auricular
o Post-Auricular
o Sub Occipital

IX. Axilla Examination

 Lymph Nodes {3 Levels}
Level I – Lateral to Lateral border of pectoralis Minor.
 Anterior – Anterior Axillary Fold.
 Posterior – Posterior Axillary Fold.
 Lateral – Over the Humerus in the Axillary Fossa.

Level II – Beneath Pectoralis Minor

 Central- Inside from Behind

Level III – Medial to Medial Border of Pectoralis Minor.

 Apical or Infraclavicular

X. Chest
 Congenital Chest Deformity
 Pes carinatum
 Pes excavatum
 Spider Naevi- Small Vessels in web-pattern. (Appear as red spots to naked eye)
 Female- All same, Also check for symmetry of Breast.
 Male- Gynecomastia.
XII. Lower Limb
 Look for Dilated Vein
 Pedal Edema-May be Unilateral or Bilateral. (from 5cm above Medial Malleolus, over the
Tibial Shin, Press with your thumb for 30sec & then release till then you find edema)- in pt.
with congenital heart problem.