Clinical Skill In Medicine

& Sugery

Mukhdoom BaharAli
Services Hospital
M.B.B.S Lhr. Pk

Physical Examination
The 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 patient
guessing his mental state, general health & degree of illness.

General Physical Examination

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 assessment
2.Random examination
3.Regional examination

1. Examination by assessment
General Appearance
We make a quick assessment of the age of the patient whether he is a child, young or
old (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

Posture
We should note all the aspects & things related with the posture of the patient like, whether he is lying on
the 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.

Consciousness
Access 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 the
degree of consciousness & give the results in numbers or digits format).

Physique
Make 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 Examination
Random examination is mainly for measuring the vitals of body;
Pulse
72 pulses/min
Respiratory rate
12-14 respirations / min
Temperature
98.6 oF
Blood pressure
120/80
(Pulse & respiratory rate is measured while performing regional examination & temperature along with
blood pressure are measured separately for consuming time).

a. Temperature monitoring
Put 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).

b. Blood pressure monitoring

Set 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).

3. Regional Examination
General physical examination proper starts from here. In it, we examine the following;
a. Hands
b. Face
c. Neck
d. Foot

a. Hand
In hand, we examine the signs for nails, finger & palm.
a) Nails
b) Fingers
c) Palm

a) Nails
We 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;

Pallor
Yellowish in color reflects;
Anemia
Nails become pale

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

Koilonychias
Nails 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

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

 Clubbing
The loss of angle b/w the nail & nail base.

Method
Examine 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 fingers
The 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.

Causes
Respiratory Diseases
Chronic Suppurative conditions
Empyema
Bronchiectasis
Lung abscess
Carcinoma lung
Fibrosing alveolitis

Cardiovascular Diseases