General: Examination
  1. Environment, general appearance
  2. Hydration
  3. Posture, weight, body shape
  4. Vital signs
  5. Nails, hands
  6. Head
  7. Examination tips
Environment
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.
  • Skin colors. See Skin Colors Reference.
Posture, weight, body shape
  • If pt. enters, examine gait. See 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.
Vital signs
Nails
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.