Physical diagnosis

THE COMPREHENSIVE
PHYSICAL
EXAMINATION
Dr. Samir Lamichhane, MD Clinical Pharmacology
 Steps proper of GPE

1. General survey

2. Vitals
➢ Pulse, temperature, BP, RR, SPO2
3. Height, weight, BMI

4. PILCCOD

5. Head to toe examination

Physical examination
 General survey
 General appearance  Posture, gait
 General state of health  Personal hygiene
 Orientation  Odor

 Height, weight  Facial expressions

 Build  Speech

 Sexual development  Level of consciousness

Physical examination
 General survey
 Facies

◼ Appearance of the face

➢ Mask face: Parkinsonism
➢ Startled look: Hyperthyroidism
➢ Moon Face: Cushing syndrome
Mask face
Hyperthyroid facies
Cushingoid facies
Physical examination
 General survey
 Gait

◼ The way the patient walks

➢ Ataxic gait (drunkard gait): cerebellar lesions

➢ Festinating gait: parkinsonism

➢ Waddling gait: proximal myopathies

Physical examination
 General survey

 Mental state

 Mood

 Intelligence

 Any difficulty in vision, hearing, movement

Physical examination
 General survey

 Built
◼ Skeletal structure in relation to age and sex of the
individual as compared to a normal person

 Decubitus
◼ Posture adopted by the patient when lying in bed

 Tremor or abnormal movements

Physical examination
 General survey
 Deformities

◼ Funnel chest (pectus excavatum)

◼ Pigeon chest (pectus carinatum)
◼ Kyphosis

◼ Scoliosis

 Congenital abnormalities
◼ Down’s Syndrome, Marfan’s syndrome, cretinism
Pectus excavatum Vs carinatum
Scoliosis
Kyphosis
Kyphosis
Kyphosis
Down’s syndrome
Down’s syndrome
Down’s syndrome
Down’s syndrome
Down’s syndrome
Marfan syndrome
Marfan syndrome
Marfan syndrome
Physical examination
 Vital signs

 Pulse rate

 Blood pressure

 Respiratory rate

 Body temperature
“Medicine is learned at the bedside
and not in the classroom”.
➢ (Sir William Osler 1849 – 1919)

THANK YOU
 Physical diagnosis

THE COMPREHENSIVE
PHYSICAL
EXAMINATION
Dr. Samir Lamichhane, MD Clinical Pharmacology
 Steps proper of GPE

1. General survey

2. Vitals
➢ Pulse, temperature, BP, RR, SPO2
3. Height, weight, BMI

4. PILCCOD

5. Head to toe examination

Physical examination
Head to toe
Physical examination: head to toe

 Skin
 Skin moisture or dryness
 Temperature

 Identify any lesions

◼ Location, distribution, arrangement
◼ Type

◼ Color

 Hair and nails

Skin lesions

Fig. A macule
Skin lesions

Fig. macules
Skin lesions

Fig. papules
Skin lesions

Fig. blister
Skin lesions

Fig. nevus
Fig. giant congenital
melanocytic nevus
Physical examination: head to toe

 Head

 Hair

 Scalp

 Skull

 Face
Physical examination: head to toe

 Eyes
 Eyelids

 Sclera, conjunctiva

 Visual acuity

 Visual fields: perimetry/visual field test

 Position and alignment of eyes: proptosis, squint

 Cornea, iris and lens

Ptosis
Proptosis
Strabismus/squint
Strabismus/squint
Strabismus/squint
Physical examination: head to toe

 Eyes
 Look for pallor

 Look for jaundice/icterus

 Compare the pupils

 Pupillary reaction to light

 Extraocular movements

 Ocular fundi with ophthalmoscope

Physical examination: head to toe

 Eyes
 Extraocular movements
Physical examination: head to toe

 Eyes
 Extraocular movements
“Medicine is learned at the bedside
and not in the classroom”.
➢ (Sir William Osler 1849 – 1919)

THANK YOU
 Physical diagnosis

THE COMPREHENSIVE
PHYSICAL
EXAMINATION
Dr. Samir Lamichhane, MD Clinical Pharmacology
 Steps proper of GPE

1. General survey

2. Vitals
➢ Pulse, temperature, BP, RR, SPO2
3. Height, weight, BMI

4. PILCCOD

5. Head to toe examination

Physical examination
Head to toe
Physical examination: head to toe

 Ears

 Inspect the auricles, canals, drums

 Auditory acuity, if diminished

◼ Weber test (lateralization)

◼ Rinne test (compare AC and BC)

Weber test
Rinne test
Rinne test
Physical examination: head to toe

 Nose and sinuses

 External nose

 Nasal mucosa, septum, turbinates

 Tenderness of sinuses
Deviated nasal septum
Deviated nasal septum
Physical examination: head to toe

 Tongue
 Pallor

 Cyanosis

 Dryness

 Coating

 Ulcers
Coated tongue
Oral candidiasis
Tongue ulcer
Geographic tongue
Fissured tongue
Strawberry tongue
Strawberry tongue
Physical examination: head to toe

 Mouth and throat (mouth and pharynx)

 Lips

 Oral mucosa

 Gums, teeth

 Palate, tonsils

 Pharynx
Enlarged tonsils
Enlarged tonsils
“Medicine is learned at the bedside
and not in the classroom”.
➢ (Sir William Osler 1849 – 1919)

THANK YOU
 Physical diagnosis

THE COMPREHENSIVE
PHYSICAL
EXAMINATION
Dr. Samir Lamichhane, MD Clinical Pharmacology
 Steps proper of GPE

1. General survey

2. Vitals
➢ Pulse, temperature, BP, RR, SPO2
3. Height, weight, BMI

4. PILCCOD

5. Head to toe examination

Physical examination
Head to toe
Physical examination: head to toe

 Neck
 Inspect and palpate cervical lymph nodes

 Masses, pulsations

 Deviation of trachea

 Sound and effort of breathing

 Thyroid gland
Tracheal deviation
Goiter (enlarged thyroid gland)
Goiter (enlarged thyroid gland)
Physical examination: head to toe

 Neck

 Salivary glands

 Jugular venous pressure/pulsation

 Carotid pulse
Physical examination: head to toe

 Back

 Inspect and palpate

◼ The spine

◼ Muscles of the back

 Observe shoulder height for symmetry

Physical examination: head to toe

 Breast
 Inspect

 Palpate for any lumps, tenderness

 Axilla
 Inspect the axilla

 Palpate for the axillary nodes

Physical examination: head to toe

 Thorax and lungs

 Inspection

 Palpation

 Percussion

 Auscultation
Physical examination: head to toe

 Cardiovascular system
 Observe the jugular venous pulsation

 Inspect and palpate the carotid pulsation

 Examine the precordium

◼ Inspection

◼ Palpation

◼ Percussion

◼ Auscultation
Physical examination: head to toe

 Abdomen

 Inspection

 Palpation: abdominal organs

 Percussion

 Auscultation
Physical examination: head to toe

 Upper extremities
 Deformity

 Swelling

 Arthritis

 Muscle wasting

 Palms: erythema e.g. in liver disease

 Tremor
Swan neck deformity
Palmar erythema
Palmar erythema
Physical examination: head to toe

 Upper extremities
 Finger nails
◼ Finger clubbing
◼ Deformity, e.g. koilonychia
◼ Anaemia, leukonychia, lines
◼ Haemorrhages
Koilonychia
Leuconychia
Physical examination: head to toe

 Lower extremities
 Examine the legs, inspect for any findings
◼ Alignments, motion

◼ Edema

◼ Discolorations, ulcers, varicose veins

 Femoral and popliteal pulsations

 Examine joints, their range of motion

Edema (pedal edema)
Edema (pedal edema)
Edema (pedal edema)
Varicose vein
Varicose vein
Varicose vein
Physical examination: head to toe

 Lower extremities
 Assess the muscles: tone, power, reflexes

 Palpate inguinal lymph nodes

 Check for hernias

 Genitalia and rectal examination

Hernia
Physical examination: head to toe

 Nervous system
 Mental status

 Cranial nerves

 Motor system

 Sensory system

 Reflexes
 Steps proper of GPE

1. General survey

2. Vitals
➢ Pulse, temperature, BP, RR, SPO2
3. Height, weight, BMI

4. PILCCOD

5. Head to toe examination

“Medicine is learned at the bedside
and not in the classroom”.
➢ (Sir William Osler 1849 – 1919)

THANK YOU
“Medicine is learned at the bedside
and not in the classroom”.
➢ (Sir William Osler 1849 – 1919)
“Patients are the best
teachers in medicine”
THANK YOU