OUTLINE

I. General Survey C. Height determination

A. Opening Portion D. Weight determination
B. General Survey E. Tanhauser;s Equation
C. Components of a for IBW
General Survey F. Body Mass Index
II. Skin G.Mid-arm
III. Anthropometric circumference Figure 1. Clutching of the Chest (Chest Pain)
H. Waist circumference
A. Assessment
I. Wait-hip
B. Evaluation of weight
circumference
loss
IV. References

Legend
Remember Lecturer Book Prev.Trans Presentation

Figure 2.Universal Sign of Choking

I. GENERAL SURVEY (Patient is usually cyanotic and it is sudden)
A. Opening Portion
● Greet the patient
● Address the patient appropriately by using Mr., or Ms. Or his/her NICE TO KNOW
title
● Introduce himself/herself Signs of distress are almost all the same in adults, except in
● Provide a clear statement of the purpose of the examination the extremes of infants are different.
● Ensure privacy
Example: Patient with epiglottitis, patient is dyspneic in tripod
● Ensure patient was comfortable
position, mouth open, neck and chin extended, trunk leaning
● Express how long it will take and what is to be done
forward. This will give the trunk more space to expand.
● Explain the need to take notes and ask if this is acceptable
● Get informed consent (at least verbal) from the patient Makakakita ka din dito ng alar flaring, retractions, kung
nakahiga pasyente seesaw breathing or paradoxical
B. General Survey breathing. Check for other signs and symptoms to come up
● Goal is to describe the distinguishing features of the patient so with a successful diagnosis.
clearly that colleagues can spot the patient in a crowd of
strangers
● To avoid cliches like “middle-aged gentleman” & the
uninformative “in no acute distress”

C. Components of a General Survey

APPARENT STATE OF HEALTH
● Check if the patient looks healthy or unhealthy
○ If unhealthy, check mo unang una distress.
LEVEL OF COMFORT
● Signs of distress (is there something that makes the patient
uncomfortable? ) Figure 3.Patient in Tripod Position
○ Pain
■ Chest Pain (life threatening, there’s clutching of the ches -
can be a sign of MI. Pwede din may pallor, diaphoresis LEVEL OF CONSCIOUSNESS
) ● NORMAL is when the patient is alert and responds to questions
■ also related to pain is wincing, sweating, protectiveness of spontaneously and oriented to time, place. Patient is easily
the painful area like abdominal pain due to gastroenteritis awakened from sleep.
or pwede din ruptured appendicitis, facial grimacing, ● CONFUSION patient is disoriented,m slow, impaired thinking, cant
unusual posture follow commands, maybe oriented with time but not in place
○ Dyspnea (labored breathing, wheezing, coughing ) ● LETHARGY is when a patient is drowsy but can be aroused by
■ Speaks in sentences, phrases, words, silent minimal stimuli
● OBTUNDED increase sleeping time, patient sleeps more than usual
and doesn’t responds to verbal stimuli

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● STUPOR only responsive to pain or vigorous stimuli, kailangan mo
saktan para magrespond siya. Respond can be a grimace or
withdrawal but DTR are still intact
● COMA, here kahit saktan mo walang respond talaga. No intrinsic
reflexes such as gag, corneal and DTR
○ Decorticate - flexion response; nakaflex yung upper arm and
extend yung lower arm
○ Decerebrate - extension response to pain; naka-extend yung
upper arm and extended din yung lower arm
Figure 4. Glasgow Coma Scale
GCS-Mn-Vn-En Score:
● 14-15 fully awake (14 mEdyo confused pa pero yung 15
fully awake na )
● 11-13 drowsy
● 6-10 stuporous
● 4-5 semi coma
● 3 comatose
CONCEPT CHECKPOINT
What is the patient’s GCS?
A 65 year old woman was rushed to the emergency room for
progressive dyspnea and confusion. She is a known diabetic,
hypertensive, and she is poorly adherent to her maintenance
medications. Her symptoms started 4 days prior to admission
with high grade fever, productive cough, and pleuritic chest
pain. On the day of admission, she was noted by her family
members to be confused and breathing heavily. At the ER, she
has eye opening to light tapping, but was confused, disoriented
but can follow commands. Her vital signs are as follows; BP:
80/60, HR: 112, RR: 29, O2 Sats: 85% on room air. Actual
weight is 65kg, Ideal weight is 50kg. The rest of the physical
examination was unremarkable except for crackles heard in
the right lung field.
Answer: 13 E3V4M6
At the ER, she has eye opening to light tapping (E3), but
was confused, disoriented (V4) but can follow commands
(M6). Total is 13.
AMBULATORY STATUS
● This is where you look for the patient if they are able to stand or
walk as they come in your clinic
● Also check for ambulation with assistance using different mobility
equipment devices is seen in patients with problems with balance or
walking.
● It gives us physician the functional capacity of the patient
● Motor Activity
○ Diplegia
■ e.g. Both lower extremities are not moving
■ e.g. cerebral palsy
○ Hemiplegia
■ e.g. the right side of the patient is not moving
■ e.g. massive right sided stroke that will cause left sided deficit
○ Quadriplegia
■ usually wheelchair-borne
■ e.g. motor accident that causes damage to the spinal cord
■ it will cause all extremities to be paralyzed
● Abnormal Movement
○ Postural tremors
■ this occurs when your muscle try to hold parts of your body
against gravity
■ e.g. patient is just watching tv, the hands will move
unintentionally
○ Intention tremor
■ it occurs when you try to reach something and your hands
starts shaking
■ there is a disturbance with the fine tuning of movement
■ the test for this is finger to nose test
POSTURE
● Look also for the patient if they have preferences in their position
and even if they change their position frequently
● Example: In patients with ruptured appendicitis and peritonitis, they
tend not to move in the stretcher because the pain will increase if
they move.
GAIT
● It is the manner how the patient will walk
● Musculoskeletal and neurological problems are the most common
cause of abnormalities in gait and stance
● It generally arise due to any pain, joint immobility,weak muscle or
abnormal regulation of the extremity (spasticity, rigidity,
proprioception problem, cerebellar, or cerebral lesion)
● Antalgic Gait:
○ In the painful hip conditions, patients walk with reduced stance
phase on the affected side
○ Increase swing time in the normal leg, and decreased stance time
in the painful leg.
○ Pa “ika-ika” maglakad ang pasyente
○ Example: Patient with sprain
● Spastic Hemiparesis
○ Upper motor neuron lesion
○ The muscle tone increases more on rapid movements, the spastic
limb is weak and there is unequal tone in the flexor and extensor
muscles resulting in a characteristic posture.
○ Seen in patient who suffered from stroke
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 ○ The upper extremity is in constant flexion and the lower extremity
cannot move. Patient usually drag by circumduction the affected
lower extremity because of poor flexor control during swing phase

● Scissoring Gait
○ Seen in spinal cord disease which causes bilateral lower
extremity spasticity, including adductor spasm, and abnormal
proprioception
○ Seen in patients with cerebral palsy
○ Both lower extremities are flexed and stiff which causes the thighs
to cross forward to each other causing a scissoring motion on
every step. Figure 5.Body habitus in men and women
● Steppage Gait
○ Seen in foot drop, usually secondary to peripheral motor unit BODY HABITUS SYMMETRY
disease. ● Hypersthenic
○ Patients either drag the feet or lift them high, with knees flexed, ○ Massive
and bring them down with a slap on the floor, thus appearing to be ○ Endomorph
walking on their heels ○ large body
○ No dorsiflexion during walking due to foot drop ○ short arms and legs
● Parkinsonian Gait ○ neck is short
○ Seen in the basal ganglia defects of Parkinson’s disease ○ face is square
○ Posture is scooped, with flexion of hand, arms, hips, and knees. ○ subcostal angle is obtuse
○ Patients are slow getting started and their steps are short and ● Sthenic
shuffling with involuntary hastening. ○ Mesomorph
○ athletic types
○ They do not have any control in their movement ○ good musculature
● Cerebellar Ataxia ○ broad shoulder
○ Seen in disease of cerebellum or associated tracts. ○ flat abdomen
○ There is staggering, unsteadily, and wide based with exaggerating ○ subcostal angle is the right angle
difficulty on turns. ○ face is ovoid
○ Patients can’t stand steadily with their feet together, whether their ● Hyposthenic
eyes are open or closed. ○ tall and thin
● Sensory Ataxia ○ large skin and bone compartment
○ Similar to cerebellar ataxia. However, the patient can’t stand only ○ neck is long
if their eyes are closed ○ slender delicate bone structure
○ Loss of position sense ● Asthenic
○ exaggerated
○ super thin
HEIGHT, BUILT, AND WEIGHT ○ might have ongoing nutritional problem
● Somatotypes ○ might have disease
○ Mesomorph
■ good muscular development
■ sthenic physique
○ Ectomorph
■ poor muscular development
■ hyposthenic
○ Endomorph
■ prominent fat tissue
■ hypersthenic
■ may have a good or poor muscle development

Figure 6. Body habitus

FACIES
● Hyperthyroid state
■ Graves ophthalmopathy
■ Thyroid stare

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 ● Appearance of the patient that staring due to the forward
protrusion of the eyeball
● Whitish sclera is seen from the upper and lower limbus of
the cornea

Figure 10. Acromegaly

● Malar Rash
○ Photosensitivity
○ Seen in patients with Systemic Lupus Erythematosus (SLE)

Figure 7. Thyroid stare

○ Myxedema facies
■ Coarse hair
■ Sparse hair
■ Puffy face
■ Puffy eyelids

Figure 11. Malar rash

● Bell's palsy
○ Affects one side of the patient’s face
■ Loss of smile line
■ Smaller eye opening
■ Unable to raise eyebrows
Figure 8. Patient before and after treatment for primary hyperthyroidism

● Cushing’s Disease
○ Moon facies
■ Increased fat at the side of the face
■ Hirsutism
● Presence of facial hair

Figure 12. Bell’s palsy signs and symptoms

● Stroke
○ More common
Figure 9. Cushing’s syndrome ○ Life threatening
○ Only one quadrant of the face
● Acromegaly ■ Loss of smile line
○ Enlarged hand ■ But when the patient tries to raise the eyebrows, its intact
○ Prominent jaw
○ Enlargement of the nose
○ Increased frontal bossing

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 Figure 16. (A) State after the patient looks up for a prolonged
period of time. Right eye drooping is more severe than the left.
(B) normal state

ODOR
Figure 13. Stroke signs and symptoms
● Odors can be important diagnostic clues, like the fruity odor of
● Tetanus diabetes or the scent of alcohol
○ Sardonic smile of tetanus (risus sardonicus) ○ Presence of alcohol in a comatose patient
■ Thick sarcastic grinning, ○ Ketoacidosis / DM → acetone / fruity
■ With anxious expression ○ Pulmonary infections
■ Raise eyebrow ■ TB → stale beer
■ Bronchiectasis / aspiration pneumonia → persistent bad
breath
○ Uremia (uremic fetor) → ammoniacal fish breath
○ Liver failure → rotten egg smell breath
○ Melena → fishy foul smell (because of the blood in the stool)

GROOMING AND PERSONAL HYGIENE

● Hypothyroid patient
○ Patient will low thyroid hormone
○ “lamigin” so they use all cloth covering

Figure 14. Sardonic smile in a tetanus patient

● Parkinsonism
○ Hypomimia or mask-like facies
■ Loss or reduction of facial expression
■ Patient can’t move his face

Figure 17. Patient without thyroid gland or hypothyroid patient often feel
cold

● Stroke patient
○ Especially with parietal involvement
○ They have hemineglect
■ The unawareness or unresponsiveness to objects, people,
and other stimuli in the left side of space

Figure 15. Hypomimia in a parkinsonian patient

● Myasthenia gravis
○ A neuromuscular disease that causes weakness in the skeletal
muscle that worsen after periods of activity and improves after
period of rest
■ Sleepy appearance caused of the ptosis of the eyes

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 Table 1. Thought process and content of patients.
Examples
Stream of thought Appropriate
Inappropriate
Form Logical or illogical
Relevant and pertinent or irrelevant and
unimportant
Concise or verbose
Circumstantial
Tangential or derailed
Realistic
Rate of thought Normal or rapid/accelerated
processing Slowed, hesitant, interrupted or blocked
Figure 18. Hemineglect in a stroke patient
Language Ironical
Rhyming or with neologisms
● Psychiatric patient
○ Illicit drug use Hallucinations Auditory, visual, gustatory, olfactory,
■ Most common kinesthetic, or tactile
■ They’re facies really do change
Paranoia, depersonalization or derealization
● Messier hair
● Unkempt appearance Others Hypochondriacal ideas, obsessions,
compulsions, phobias, illusions, delusions

COGNITIVE FUNCTIONS [2024]

● Orientation as to time, places and person
● Immediate, recent and remote memories
● Recall and retention are also tested
○ Patient is asked to repeat previously given objects, his
breakfast and birthday
● Mini-Mental Status Exam (MMSE)
○ Easily administered
○ 11-part 30-point test of cognitive function
○ Tests five cognitive areas:
■ Orientation
■ Registration
■ Attention and calculation
■ Recall and language comprehension
■ Naming and copying
○ Screening test for cognitive impairment in the elderly,
Figure 19. Changes in facies for psychiatric patient hospitalized or institutionalized
MOOD AND AFFECT OTHERS
● Facial expression ● Manner of speech
○ During conversation of specific topics
○ During the physical examinations, interaction, etc
● Attitude towards the examiner NICE TO KNOW
○ REGARD
● Appropriateness of the mood / affect GENERAL SURVEY
● Describes the patient at a glance from afar
○ Anxious
● How can you set the patient apart from different
○ Fidgety
patient
○ Flat affect ● For psychiatric patient, it's the odd, bizarre
○ Poor eye contact presentation
PSYCHOMOTOR ACTIVITY [2024] ● For ambulatory patient, it's more challenging
● Manner of speech: especially the outpatient setting
○ Normal slurred, with inappropriate use of words
○ May speak in phrases, nod or use gestures
II. SKIN
● Abnormal movements:
● Should pursue the following
○ Grimacing, tics, tremors or certain mannerisms
○ Pallor
THOUGHT PROCESS AND CONTENT [2024] ○ Cyanosis
○ Jaundice
● Responds to questions reflects thought process and content
○ Rashes
○ Bruises

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● Access any changes in
○ Skin color (perfusion of hypoventilated alveoli)
■ Impaired oxygen diffusion
○ Scars
○ Anatomic shunt
○ Plaques ■ Certain type of congenital heart disease
○ Nevi ■ Pulmonary arteriovenous fistulas
CYANOSIS ■ Multiple small intrapulmonary shunts
○ Hemoglobin with low affinity for oxygen
● Central cyanosis ● Hemoglobin abnormalities
○ Disturbance of oxygenation ■ Methemoglobinemia - acquired, hereditary
○ Reduced Hgb of greater than 40 g/L → absolute quantity ■ sulfhemoglobinemia - acquired
○ Bluish / purplish discoloration of mucous membranes / mouth ■ Carboxyhemoglobinemia (not true cyanosis)
○ Causes
■ Impaired pulmonary function Peripheral cyanosis
● Persistent hypoxemia, for severe - hindi nalagyan ng
oxygen ● Reduced cardiac output
■ Hemoglobin abnormalities ● Cold exposure
● Methemoglobinemia ● Redistribution of blood flow from extremities
● Sulfhemoglobinemia ● Arterial obstruction
● Carboxyhemoglobinemia - not a true cyanosis ● Venous Obstruction
■ Heart disease
● Congenital heart disease for patients with shunts
● Left to right shunting and there is a mixing involved - for JAUNDICE
pedia ● Yellowish discoloration
● Peripheral cyanosis ● Deposition of bilirubin
○ Bluish discoloration of nails / fingers ● Earliest sites of Jaundice
○ Problem of distribution of blood to the extremities ○ Scleral icterus → 51 umol/L or 3mg/dL, best examined in
○ Causes fluorescent lighting
■ Cold exposure ○ Underneath the tongue
■ Redistribution of blood flow from extremities ○ Other sites: skin, palms, and soles (usually areas of the skin
■ Arterial obstruction which are lighter)
■ Venous obstruction ● Differentiate from carotenemia
■ Reduced cardiac output - generalized ○ Limited to the palm and soles
● Refer to the diagram below: Jaundice can be due to (1) isolated
elevation of bilirubin or (2) increased bilirubin and other liver
function tests are elevated
○ Isolated elevation of bilirubin = hematologic condition
○ Increased bilirubin and other liver function tests are elevated =
Diseases of biliary tract (i.e., cholestatic pattern [elevated ALT]
or hepatocellular pattern, viral hepatitis, toxic hepatitis,
autoimmune hepatitis)
Figure 20. Bluish discoloration of the tongue and mouth

Figure 21. Bluish discoloration of the extremities, usually in the nail beds

Table 1. Causes of cyanosis

Central cyanosis

● Decreased arterial oxygen saturation

○ Decreased atmospheric pressure - high altitude
○ Alveolar hypoventilation
■ Inhomogeneity in pulmonary ventilation and perfusion

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 Figure 22. Evaluation of patient with jaundice

PALLOR
● Anemia
○ Skin and mucous membranes <80-100 Figure 23. Physical Examination to Diagnose Anemia
■ Check the color of the conjunctiva, tongue, nail beds
○ Hemoglobin <80: lighter palmar crease SKIN LESION
○ Bleeding ● Describe the skin lesion - using ABCD rule
○ Inadequate hematopoiesis ○ Asymmetry
● Inadequate perfusion ○ Borders
○ Systemic: SHOCK ○ Color
○ Localized: COMPARTMENT SYNDROME ○ Diameter
■ Patient with injury or fracture at one extremity; patient has ● Describe the shape and arrangement of the lesion
pallor with poikilothermia, pain, pulselessness, paresthesia, ○ Shape - dome-shaped, pedunculated, verrucous, umbilicated,
paralysis (Mnemonics: 6P’s of compartment syndrome: pain, flat-topped
poikilothermia, paresthesia, paralysis, pulselessness, and ○ Arrangement - discoid, annular, targetoid, linear, serpiginous,
pallor) clustered
● Vasovagal Reflex ● Define the distribution
○ Hypoglycemia ○ Symmetric vs. asymmetric
○ EMotional stress ○ Sun-exposed
○ Localized
○ Regionalized (i.e. Zosteriform)
○ Generalized

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Figure 24. ABCD rule of skin cancer
Figure 25. Shape and Arrangement of lesions
Table 2. Primary skin lesions.
Type Characteristics
Macule
● Flat, colored lesion
● <2 cm in diameter
● Not raised above the surface of the
surrounding skin
● A “freckle” or ephelid
○ Prototypical pigmented macule
● A large (> 2cm) flat lesion
● Color different from the surrounding
Patch
skin
● Differs from a macule only in size
Papule
● Small, solid lesion
● <0.5 cm in diameter
● Raised above the surface of the
surrounding skin; thus, palpable
○ E.g., a closed comedone, or
whitehead, in acne
Plaque
● Large (> 1cm)
● Flat-topped, raised lesion
● Edges may either be distinct (e.g., in
psoriasis) and gradually blend with
surrounding skin (e.g., in eczematous
dermatitis)
Vesicle
● Small, fluid-filled lesion
● <0.5 cm in diameter
● Raised above the plane of surrounding
skin
● Fluid is often visible and lesions are
translucent
○ E.g., vesicles in allergic contact
dermatitis caused by Toxicodendron
[poison ivy]
● Vesicle filled with leukocytes
● Note: presence of pustules does not
Pustule necessarily signify the existence of an
infection
● Infected vesicles
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 Table 3. Secondary skin lesions.
Type Characteristics
Lichenification
● A distinctive thickening of
Bulla the skin
● Characterized by
accentuated skin-fold
markings

● Fluid-filled, raised, often translucent Scale

lesion
● >0.5 cm in diameter
● Excessive accumulation of
stratum corneum

Nodule Crust
● Dried exudate of body
fluids that may either be
● A larger (0.5-5.0 cm), firm lesion raised yellow (i.e., serous crus) or
above the surface of the surrounding red (i.e., hemorrhagic
skin crust)
● Differs from a papule only in size
○ E.g., a large dermal Erosion
nevomelanocytic nevus
● Loss of epidermis without
an associated loss of
dermis
Tumor

● A solid, raised growth Ulcer

● >5 cm in diameter
● Loss of epidermis and at
least a portion of the
Wheal underlying dermis

Excoriation
● A raised, erythematous, edematous ● Linear angular erosions
papule or plaque that may be covered by
● Usually representing short-lived crust and are caused by
vasodilation and vasopermeability scratching

● An acquired loss of
Atrophy substance
● In the skin, this may
Telangiectasia ● A dilated, superficial, blood vessel appear as
○ Depression with intact
epidermis (i.e., loss of
dermal or subcutaneous
tissue)

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 ○ Sites of shiny, delicate, ○ linear angular erosion that cause by scratching
wrinkled lesions (i.e., ● Vascular lesions
epidermal atrophy) ○ Purpura
■ Around 8-10 mm
Scar ● A change in the skin ○ Petechiae
secondary to trauma or ■ Around less than 3mm
inflammation ○ Telangiectasia
● Sites may be ■ venous, star shape or spider-like that do not blanched
erythematous, ● Edema
hypopigmented, or ○ swollen area
hyperpigmented ○ there can be indentation
○ Depending on their age ○ Cause by an increase of hydrostatic pressure or decrease
or character of oncotic pressure
● Sites on hair-bearing areas ○ Cause
may be characterized by ■ Cardiogenic
destruction of hair follicles ■ Renal
■ Hepatic
■ Nutritional (Hypoalbuminemia)
GRADING PRESSURE SORES
● Grade 1
○ Non-blanchable erythema (redness) of intact skin
○ discolouration of the skin, warmth, oedema induration or
hardness may also be used as indicators, particularly on
individuals with darker skin

Figure 26: Grade 1

● Grade 2
○ Partial thickness skin loss involving epidermis, dermis or
both. The ulcer is superficial and presents clinically as an
abrasion or blister

Figure 27: Grade 2

● Grade 3
○ Full thickness skin loss involving damage to or necrosis of
subcutaneous tissue that may extend down to but through
underlying fascia

Figure 30. Grading of edema

Figure 28: Grade 3

● Grade 4 Table 4. Edema grading.
○ Extensive destruction, tissue necrosis or damage to Grade Degree of Pitting Rate of Recovery Leg
muscle, bone or supporting structures with or without full Appearance
thickness skin loss
+1 Slight pitting about Disappears rapidly Normal
2mm in 2-3 secs looking
+2 Somewhat deeper Disappears in No detectable
pit of 4mm 10-15 secs leg swelling
+3 Deep pit of 6mm Lasts more than a Looks full and
Figure 29: Grade 4 minute swollen

● Lichenification +4 Very deep pit of at Lasts 2-5 minutes Grossly

○ Thickening of the skin that causes skin marking least 8 mm distorted
● Excoriation

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 Table 5. Edema grading. Table 9. interpretation of %usual body weight

Grade Description Involved Area Significant Weight Loss Severe Weight loss
Absent Absent None
5% over 1 month * > 5% over 1 month
+1 Mild Both feet/ankle
+2 Moderate Both feet plus lower legs, 7% over 3 months* > 7.5% over 3 months
hands or lower arms
+3 Severe Generalized, both feet, legs 10% over 6 months* >10% over 6 months
and face (anasarca) Asterisk* = important to take not for the exam

III. ANTHROPOMETRIC C. HEIGHT DETERMINATION

A. Assessment ● Standing
● Important in determining the nutritional status ○ Remove shoes
● Baseline measurement vs average standard for age group and ○ Stand straight and place back against the measuring tape on the
gender wall where the measure tape is affixed Or stand erect, feet
● Serve as prognostication factor with chronic debilitating diseases together and with head, shoulders, buttocks, and heels touching
the measuring tape
NUTRITIONAL ASSESSMENT
○ Measure from the top of the head to the heels
● Evaluates the status of the body composition in order to determined ○ Read in centimeters
whether consumed nutrients are adequate ○ Convert to meters and record
● Supine
MALNUTRITION ○ Body fully extended
● Both undernutrition and overnutrition ○ Measure from the tip of the head to the heels with a tape measure
● Deficiency or excess of essential vitamins and minerals ○ Read in centimeters
○ Convert to meters and record
Table 6. Pattern of Deficits in Various Types of Malnutrition
Types of Body Body fat Somatic Serum Immune D. WEIGHT DETERMINATION
Deficit Weight properties protein function
● Patient to empty his bladder
● Remove shoes
Marasmus Decreased Decreased Decreased Moderate Decreased
or Normal ● Use a calibrated weighing scale Make sure that the needle is at zero
● Measure at approximately the same time of the day and wearing the
Kwashiork Decreased Normal Normal Decreased Decreased ● same amount of clothing in the previous measurement
despite fluid ● Record in kilograms
or retention

Decreased Decreased Decreased Decreased Decreased E. Tanhauser’’s Equation for IBW

Marasmus
-Kwashior ● IBW - Filipino = (height in cm - 100) - 10% of (height in cm - 100)
kor ● %IBW = (actual body weight/ideal body weight) x 100

Table 10. Interpretation of IBW.

B. Evaluation of Weight Loss
% Ideal Body Weight Interpretation
● We compare the usual weight to the weight of the patient now.
● IMPORTANT: Significant weight loss that need medical evaluation
● should be unintentional weight loss > 200% Morbidly Obese

Table 7. Weight Loss and usual weight formula. >130% Obese

%Usual weight = (actual weight / usual weight) x 100
110% - 120% Overweight
%Weight Loss = Usual body weight / actual body weight) x 100
91% - 109% Normal

Table 8. interpretation of %usual body weight 80% - 90% Mild malnutrition

% Usual body weight Interpretation
70% - 79% Moderate Malnutrition
85% to 90% Mild Malnutrition
<69% Severe Malnutrition
75% to 84% Moderate Malnutrition

<74% Severe Malnutrition

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 CONCEPT CHECKPOINT Morbid Obesity >40

DBW (kg) = (height in cm - 100) -10% DBW ● you need to be very careful ib checking the difference of BMI
between the WHO standard and the Asia Pacific standards.
Note: the deduction of 10% is only applicable for Filipinos due
to the stature
G. Mid Arm Circumference (MAC)
Given: Height 5’2” ● Encircles the muscle mass, adipose tissue and bone of the upper
DBW: ? arm
● Overall indicator of undernutrition
= (157.48 - 100) - 10% DBW ● Steps:
= 57.48 - 5.748 ○ Bend the left arm, find and mark with a pen the olecranon process
= 51.732 and acromion.
= 52 kg ○ Mark the midpoint between these two marks.
○ With the arm hanging straight down, wrap a MUAC tape around
the arm at the midpoint mark.
F. Body Mass Index (BMI)
○ Measure to the nearest 1 mm
● Useful measure of the total amount of body fat
● Calculated by dividing the weight in kg by the square of the height in
H. Waist Circumference (WC)
meters
● Established criterion for metabolic syndrome
● Not suitable for patients with famine edema or in hospitalized
● Measure between the last rib and the iliac crest, at minimal
patients with third space edema.
inspiration (WC)
● Weight changes in these conditions indicate fluid retention rather
● Measure at the widest part of the buttocks (HC)
● than body fat content
● Divide the waist circumference by the hip circumference
● Interpret based on the table

Figure 31. BMI Formula

Table 11. Interpretation of Classification of adult underweight and obesity

according to BMIe.

Classification WHO Asia-Pacific

Figure 32. Metabolic syndromes
Underweight <18.5 <18.5 I. Waist -Hip Circumference (WC)

Normal 18.5 - 24.9 18.5 - 22.9 Table 12. Acceptable Waist hip circumference

Acceptable
Overweight 25 - 29.9 23 - 24.9

Excellent Good Average

Obese 1 30 - 34.9 25 - 25.9

Male <0.85 0.85 to 0.90 0.90 to 0.95

Obese 2 35-40 >30

Female <0.75 0.75 to 0.80 0.80 to 0.85

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Table 13. Unacceptable Waist hip circumference

Unacceptable

High Extreme

Male 0.95 to 1.00 >1.00

Female 0.85 to 90 > 0.90

Figure 33: Central obesity seen in patients

● In internal medicine, Waist circumference is more important than

waist hip circumference.

IV. References
● Magalong, John Vincent. (2022). General Survey, Skin and
Anthropometric Assessment [Lecture PowerPoint].
● Bickley, L., & Szilagyi, P. G. (2012). Bates' guide to physical
examination and history-taking. Lippincott Williams & Wilkins.

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