4. general physical examination
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8/12/2019 4. General Physical Examination
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General Physical Examination
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General Examination
Build of the patient◦ Slender or muscular or stocky
HeightWeightH/WBMI
24-hour dietary recall
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General Examination
Appearance of the patient◦ Apparent state of health
Acutely or chronically ill
Frail/Feeble/robust/vigorousLevel of Consciousness◦ Awake/Alert/Responsive/Oriented X 3Signs of distress◦ Cardiac or respiratory distress◦ Pain/anxiety or depression
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General Examination
Posture, Gait, & motor activityObvious skin changes◦ Pallor/Cyanosis/Jaundice/rashes/bruises
Dress, Grooming, & Personal HygieneFacial ExpressionOdors of body & breath
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General Examination – head to toe
Ears◦ Discharge/ lesions
Teeth◦ Hygiene/ implants/ dental problems
Gums◦ Any bleeding/ Color
Tongue◦ Moist or dry/ pink or not/ appearance/ any
lesions
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General Examination – head to toe
Face◦ Symmetry
Neck◦ Visible pulsations/masses
Hands◦ Tremors/ muscle mass
Nails◦ Clubbing/ Cyanosis/ pallor/ grooming
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General Examination – head to toe
Chest◦ Usage of intercostal muscles/ visible pulsations
Abdomen◦ Masses/ distension/ dilated veins/ visible
movements
Legs◦ Swollen or not/ If swollen – Pitting or not◦ Masses/ ulcers
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Vital signs
BPRRHRTemperature
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BP – Korotkoff sounds
Systolic BP – Pressure at which thesounds startDiastolic BP – Pressure at which thesounds become muffled or totally absent◦ Total absence point gives best estimate of the
true diastolic BP◦
Gap between muffling and absence should besmall
If more, then note both the values
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HR
RateRhythmVolumeContour
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RR
RateRhythmDepthEffort of breathing
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Temperature
Oral temp.Rectal temp.Axillary temp.Tympanic membrane temp.
Glass vs. Electronic thermometers