General Examinations

So now that I'm done with medical school, I thought I'd post something useful for other medical students.

It's not a full list of the general examination but this is what I used for my exams and modified it depending on the case scenario.

Remember, there's always the relevant general examination and vitals. I start with vitals first, it helps me remember the general and calm down.

In a 15 minutes examination: Leave 7 minutes for questions and so try and finish Vitals, General Examination and Systemic Exam in 8 minutes. Sounds hard but the one thing I've learnt and I guarantee will come handy is PRACTICE. It is so important. Observing someone once is fine but any number of time more than that is utterly USELESS. Do it yourself.

Relevant General Examination for Each System:

CVS relevant general examination:

·         Appearance

·         Patient’s surrounding (IV cannula, oxygen mask, etc.)

·         Pallor

·         Clubbing

·         Splinter haemorrhage in the nail bed

·         Cyanosis (central and peripheral)

·         Edema

·         Xanthelasma

·         HR (rate, rhythm, volume, character) with peripheral pulses, radio-radial delay, radio-femoral delay, carotid pulse. *collapsing pulse only done if pulse volume is high.

·         RR (Inspiratory rise in JVP)

·         Temperature

·         BP (in both arms to check for co-arctation of the aorta, and other heart diseases)

·         JVP

·         Flapping tremor

·         Poor oral hygiene for IE

After completion of the CVS examination:

·         Auscultate base of lung to hear basal crepitations (only if there are signs or symptoms of pulmonary congestion/edema and heart failure)

·         Palpate and check for tender hepatomegaly (only if there are signs of RHF)

·         Tell the examiner that you would like to check the patient’s chest X-ray

Respiratory system relevant general examination:

·         Appearance

·         Patient’s surrounding (IV cannula, oxygen mask, MDIs etc.)

·         Pallor

·         Icterus (seen in CF)

·         Clubbing

·         Cyanosis

·         Lymph nodes (supraclavicular, cervical nodes are the most important for Lung Ca)

·         Edema (cor pulmonale leads to RHF which will lead to edema)

·         Tar stains on the fingers

·         Any nicotine stains in the teeth

·         HR (rate, regularity and volume)

·         RR

·         Temperature

·         BP

·         JVP

·         Flapping tremor

·         Check arms for wasting, tingling, numbness or pain in the shoulder and inner aspect of the arm (Pancoast’s syndrome is tumor of the apex of the lung compressing on the brachial plexus)

·          

      Check for symptoms of Horner’s syndrome (ipsilateral partial ptosis, small pupil, hypohydrosis of the face)

At the end of the examination:

·         Tell the examiner that you would like to check the patient’s chest X-ray

·         Tell the examiner that you would like to check the patient’s spirometry

Abdominal system relevant general examination:

*Expose patient from nipple to mid-thigh* or at least mention it..

·         Appearance

·         Patient’s surrounding (IV cannula, oxygen mask, etc.)

·         Pallor

·         Icterus (if this is present you suspect liver disease. So when there is icterus, check for palmer erythema, Dupytrene’s contracture, sparse axillary hair, gynecomastia, spider nevi, caput madusae, bruising, xanthelasma, and parotid swelling)

·         Clubbing

·         LN

·         Edema

·         HR

·         RR

·         Temperature

·         JVP (only if there are signs of heart failure such as edema and tender hepatomegaly)

·         BP

·         Flapping tremor

After completion of abdominal examination:

·         Tell examiner that you must check for the external genitalia (atrophy) and perform a PR.

CNS relevant general examination:

·         Appearance and higher mental functions and posture and dysmorphic features (e.g. ptosis, deviation of mouth, etc.)

·         Skin check for (xanthelasma, rashes and limb ischemia from DVT)

·         Eyes for arcus senilis, diabetic and hypertensive changes

·         Vitals in order of importance: pulse, peripheral pulses for rate, rhythm and volume ESPECIALLY the carotid pulse, BP, temperature, RR

Extra steps

·         In motor system of upper limb, the extra reflexes are finger jerk and Hoffmann’s sign. ALWAYS tell the examiner that you would like to check the sensation after completing the motor system examination.

·         In cerebellar system, extra steps are pronator drift, rebound phenomenon and pendulum movement.

After completing the examination:

·         Check for neck stiffness

·         Check for Kernig’s sign and Brudzinski’s sign

I hope this helps.

Anything you want to add do so and let me know too.

Best of luck.