General Examination and History Taking

Jul 20, 2024

General Examination and History Taking Lecture Notes

Introduction

  • Importance: Critical parts of a physical examination are history taking and a general examination, which can help arrive at a probable diagnosis.

Prerequisites

  • Comfortable Position: Ensure the patient is in a comfortable position.
  • Surroundings: Examination should be performed in a quiet place and under proper natural light to appreciate skin changes better.
  • Exposure: Proper exposure of the body part being examined.
  • Attendant: A female attendant or nurse must be present when a male doctor examines a female patient.
  • Positioning: Stand on the right side of the patient for optimal examination.
  • Severity Consideration: Address acute conditions before proceeding with a general examination.

Obtaining Consent

  • Always take the patient's consent before starting the general examination.

Initial Observations

  • Arrival Observation: Observe the way the patient walks or their position in bed (decubitus) for initial assessment.

Examination from Head to Toe

Head

  • Pediatric Significance: Size and shape are crucial in pediatric patients (e.g., microcephalus, macrocephalus).
  • Mental Condition: Assess orientation, speech, cooperation, educational qualification, and occupation.

Build

  • Height and Weight: Ensure compatibility with age and gender.
  • Nourishment: Look for signs of malnourishment or obesity.

Six Important Parameters (PICKLE)

  • Pallor: Paleness of the skin due to low hemoglobin or blood volume.
  • Icterus (Jaundice): Yellowish discoloration due to high bilirubin levels.
  • Cyanosis: Bluish discoloration due to high reduced hemoglobin.
  • Clubbing: Bulbous enlargement of soft tissues of the fingernails.
  • Lymphadenopathy: Enlarged and palpable lymph nodes.
  • Edema: Fluid collection in interstitial spaces.

Examination Details

Pallor

  • Locations: Lower palpebral conjunctiva, tongue, soft palate, palms, and nails.
  • Grading: 0 (No anemia) to 3 (Severe anemia).

Icterus

  • Locations: Sclera, skin, and mucous membranes.
  • Bilirubin Levels: Normal - 0.2 to 0.8 mg/dL; clinical jaundice above 2 mg/dL.
  • Causes: Hemolytic, hepatic, and post-hepatic jaundice.

Cyanosis

  • Types: Peripheral (e.g. nail beds, ear lobes) and central (e.g. lips, tongue).
  • Causes: Cardiac failure, high altitude, lung abnormalities, AV shunt.

Clubbing

  • Tests: Fluctuation test, angle observation, Schamroth's sign.
  • Causes: Bronchitis, lung abscess, cardiac diseases, endocrine disorders, liver diseases.

Lymphadenopathy

  • Locations: Submental, submandibular, preauricular, posterior auricular, cervical, occipital, axillary (anterior, posterior, inferior, central, apical, lateral).
  • Indicators: Size (>1 cm), consistency (hard, firm), mobility, tenderness.
  • Causes: Neoplastic, inflammatory, drug-related.

Edema

  • Types: Pitting (e.g. cardiac, renal, liver disease, anemia) and non-pitting (e.g. hypothyroidism).
  • Examination: Apply pressure above medial malleolus.
  • Causes and Differentiation:
    • Cardiac: Dyspnea
    • Renal: Puffiness of face
    • Hepatic: Ascitis
    • Anemic: Generalized edema

Four Vital Signs (TPR BP)

  • Temperature: Normal - 98 to 99 °F; Types of fever – intermittent, continuous, remittent.
  • Pulse: Normal - 70 to 80 bpm; check radial artery.
  • Respiration: Normal - 12 to 16 per minute.
  • Blood Pressure: Normal - 120/80 mm Hg.

Practical Sessions

  • Separate practical sessions on measuring temperature, pulse, respiration, and blood pressure will be provided.

Conclusion

  • Complete and methodical general examination and history taking are essential for effective diagnosis and patient care.