Clinical Skill In Medicine& SugeryMukhdoom BaharAliM.B.B.S Lhr. PkServices Hospital

Physical ExaminationGeneral Physical ExaminationThe ideal method of examination of a patient depends upon the style & techniques possessed by the examiner &the results recorded. Following things should be regarded;Build a routine of thorough examination without omitting any step.Impart minimum necessary disturbance to the patient.Routine must be modified regarding the state of patient & circumstances.

The examination starts on very first look of the patient. Observe for general appearance & posture of the patientguessing his mental state, general health & degree of illness.

The following scheme is reliable for a complete, swift & thorough general physical examination (GPE).

General physical examination can be divided into three steps for sake of ease;

1.Examination by assessment2.Random examination3.Regional examination

1. Examination by assessment

General AppearanceWe make a quick assessment of the age of the patient whether he is a child, young orold (may access the approximate age in years).We take a bird's eye view of the patient to access the degree of illness whether he looks; Well Mildly ill Severely ill

PostureWe should note all the aspects & things related with the posture of the patient like, whether he is lying onthe bed or just sitting, with a bernoulla on his right or left hand or not, & also he's comfortable or not.We must also consider the posture of the patient or subject which helps in understanding the diseases.E.g. In meningitis, the neck of the patient is retracted backward. Colicky pain causes the patient to become restless. The patient of heart failure is compelled to sit in upright posture due to worsening of respiration of lying flat (orthopnea). In the case of airway obstruction, the patient is compelled to sit up while bending forward which helps extra respiratory muscles to assist in respiration.

ConsciousnessAccess the level of consciousness i-e the patient looks alert or drowsy or is in unconsciousness. We describe it as; he is well oriented in time, space or person.(While performing central nervous system examination, we use Glasgow coma scale to determine thedegree of consciousness & give the results in numbers or digits format).

PhysiqueMake a general assessment about the height & weight of the patient; Normal height or not Normal weight or not(Both of these parameters should be measured properly with scales when we've to determine the dosage of a drug for that patient).

The recording of GPE by assessment should be like that;My patient is a young man of 20 years approximately looking well & lying on the bed comfortably with a bernoulla on his right hand. He is well oriented in time, space & person & is of normal height &weight in rough estimate.

2. Random ExaminationRandom examination is mainly for measuring the vitals of body; Pulse 72 pulses/min Respiratory rate 12-14 respirations / min

o Temperature 98.6 F Blood pressure 120/80

(Pulse & respiratory rate is measured while performing regional examination & temperature along withblood pressure are measured separately for consuming time).

a. Temperature monitoringPut the thermometer in the armpit of the patient for recording the body temperature.(Temperature is noted by reading the thermometer when we have performed the examination of hand. This saves time).

LeuconykiaWhite patches seen in the root of the normal nails termed as Lanula. Sometimes becomes large in sizeassociated with certain diseased conditions like;Hypoalbuminemia Leuconykia (white patches)

KoilonychiasNails achieve the shape of spoon (spoon-shaped nails) as these become thin, brittle in stuff & concave on look.Long standing Iron (Fe) deficiency AnemiaNails become spoon-shaped

CyanosisLiterary means bluish discoloration.Hypoxia Nails become cyanosed (bluish in color)Poisoning Nails become cyanosed (cyanide poisoning)

PallorYellowish in color reflects;Anemia Nails become pale

a) NailsWe should check for nails color. Nails color vary from broadly in different individuals normally. In certain diseases,the color is the characteristic for those like;

a. HandIn hand, we examine the signs for nails, finger & palm.a) Nailsb) Fingersc) Palm

3. Regional ExaminationGeneral physical examination proper starts from here. In it, we examine the following;a. Handsb. Facec. Neckd. Foot

b. Blood pressure monitoringSet the cough of sphygmomanometer on the right arm of the patient to monitor the blood pressure.(Blood pressure is noted calculated in the end to save time).

ClubbingThe loss of angle b/w the nail & nail base.

MethodExamine the finger from the side at the level of the patients finger.Check for Schamroths sign: Approximate two respective fingers &diamond shaped space is seen b/w the two fingersThe diamond space is absent in the case of clubbing.Place a card over the nail & nail base. A space or opening is left beneath it.

CausesRespiratory Diseases

Cardiovascular Diseases

Chronic Suppurative conditions

BronchiectasisLung abscess

Empyema

Carcinoma lungFibrosing alveolitis

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