General examination with grading & clinical reasoning of each is given in this PPT.

1. DR. MEGHAN PHUTANE

2. • Built
• Nourishment
• Vitals
• Temperature
• Pulse
• Respiratory Rate
• Blood pressure

3. • Pallor
• Icterus
• Cyanosis
• Clubbing
• Lymphadenopathy
• Oedema

4. Skeletal structure in relation to age & sex of individual
TALL STATURE
• Causes –
• Simple or primary gigantism
• Endocrine
• Genetic
• Metabolic
SHORT STATURE
• Dwarfism
• Causes –
• Hereditory/genetic
• Chromosomal
• Constitutional
• Nutritional
• Endocrine
• Skeletal
• Systemic disease

5. • Normal person is well nourished as regards proteins,
fats, carbohydrates, vitamins & minerals.
NUTRIENT DEFICIENCY
Proteins Rough skin, pedal edema, brittle hair
Fats Cachexia (hollowing of cheeks, loss of hip shape,
flat abdomen)
Carbohydrates Difficult to detect because of gluconeogenesis from
fats & proteins
Vitamins Different for all water soluble & fat soluble vitamins
Minerals • Iron – pallor
• Calcium - tetany

6. • Refers to temperature of viscera & tissues of body.
• Kept normal by maintaining balance between heat gain &
loss.
• Regulated by hypothalamus.
• Recorded with mercury thermometer – kept in position for
about a minute.
• Sites –
• Axilla (common)
• Oral (lot of perspiration)
• Rectal (in cholera)
• Normal temp – 36-37.5degrees
• Diurnal variations – lowest during 2-4am; highest in the
afternoon.

7. Sr.
no.
Category Temp in degree
celsius
Temp in degree
fahrenheit
1 Hypothermia 35 95
2 Subnormal 35.0 – 36.7 95 – 97
3 Normal 36.7 – 37.2 98 – 99
4 Mild fever 37.2 – 37.8 99 – 100
5 Moderate fever 37.8 – 39.4 100 – 103
6 High fever 39.4 – 40.5 103 – 105
7 Hyperpyrexia > 40.5 > 105

8. Types of fever –
• Continuous fever
• Remittent fever
• Intermittent fever
• Hectic or septic fever
• Pel ebstein type
• Low grade fever
Causes of fever –
• Infection
• Neoplasm
• Vascular
• Traumatic
• Immunological
• Endocrine
• Metabolic
• Hematological
• Physical agents
• Miscellaneous

9. • As ventricles eject blood, a
pressure wave (pulse) is
transmitted and can be felt by
fingers.

10. Pulse assessment –
• Rate (no. of beats / min) - 60-100/minute
• Tachycardia
• Bradycardia
• Rhythm-
• Regular
• Regularly irregular
• Irregularly irregular
• Force, volume, tension
• Equality
• Peripheral pulses
• Radio radial/ radio femoral delay
• Apex pulse deficit

11. Sites -
• Radial
• Brachial
• Axillary
• Carotid
• Temporal
• Femoral
• Popliteal
• Posterior tibial
• Dorsalis pedis

12. • Number of breaths per minute
• Tachypnea - > RR
• Bradypnea - < RR

13. • Systolic BP is controlled by stroke volume & arterial
vessels stiffness whereas diastolic BP by peripheral
resistance.
• BP varies with respect to respiration, emotions, exercise,
position, meals, tobacco, alcohol, bladder distention,
temperature, pain, circadian rhythm, age, race, obesity &
arrhythmias.

14. Korotkoff sounds

15. • Apparatus –
• Mercury sphygnomanometer
• Aneroid meter
• Electronic BP meter

18. • Paleness of skin & mucous membrane either as a result
of diminished circulating RBCs or diminished blood
supply.
• Sites –
• Lower palpable conjunctiva
• Tongue
• Soft palate
• Palm & nails
• Causes –
• Anemia
• Vasoconstrictions
• Cutaneous

20. • Technical term for jaundice
• Yellow coloration of body tissues

21. • Bluish discoloration of nails due to reduced Hb in
capillary blood.
• Types –
• Central
• Peripheral
• Due to abnormal pigments
• Mixed

22. SR.
NO.
CENTRAL PERIPHERAL
1 Mechanism Diminished arterial
O2 saturation
Diminished flow of
blood to the local
part
2 Sites On skin & mucous
membrane (tongue,
lips, cheeks)
On skin only
3 Temperature of limb Warm Cold
4 Clubbing & polycythemia Usually associated Not associated
5 Local heat Cyanosis remains Cyanosis abolished
6 Breathing pure O2 Cyanosis decreases Cyanosis persists

23. Causes
• Central
• Cardiac (congenital cyanotic heart disease, congestive cardiac
failure)
• Pulmonary (COPD, collapse or fibrosis of lungs, pulmonary AV
fistula)
• Abdominal hepato pulmonary syndrome
• High altitude
• Peripheral (Cold, Shock, Increased blood viscosity,
reynod’s phenomenon )
• Mixed (acute left ventricular failure, mitral stenosis)
• Due to abnormal pigments (methemoglobinemia,
sulfhemoglobin)

24. • It is inflammatory or non inflammatory enlargement of
lymph nodes.
• Examination –
• Sites
• Number
• Tender/Non-tender
• Discrete/matted
• Consistency
• Fixed/Mobile
• Overlying skin
• Sinus

25. • Sites –
• Neck (submental, submandibular, tonsilar, cervical, posterior
auricular, occipital)
• Supraclavicular fossa
• Axillary glands (apical, anterior, posterior, medial & lateral group)
• Supratrochlear
• Inguinal
• Scalene nodes

26. Causes-
• Inflammatory
• Neoplastic
• Hematological
• immunological
• Generalised in cases of –
• TB
• HIV
• Secondary syphilis
• Lymphatic leukemia
• sarcoidosis

27. • Bulbous enlargement of soft parts of terminal phalanges
with both transverse & longitudinal curving of nails.
• Occurs due to interstitial oedema & dilation of arterioles &
capillaries.
• Causes –
• Pulmonary (bronchiectasis, lung abscess, TB)
• Cardiac (infective endocarditis, atrial myxoma)
• Alimentary (ulcerative colitis, biliary cirrhosis)
• Endocrine (thyroid acropachy, acromegaly)
• Miscellaneous (hereditary, idiopathic)

28. Grade Description
Grade 1 Softening of nail beds
Grade 2 Obliteration of the angle between the nail and the nail bed
Grade 3 Swelling of subcutaneous tissues over the base of nail causing
overlying skin to be tense, shiny & wet; increasing nail curvature;
resulting in Drumstick appearance or Parrot beak appearance
Grade 4 Swelling of fingers in all directions associated with Hypertrophic
pulmonary osteoarthropathy causing pain & swelling of hand &
wrist

30. • Collection of fluids in interstitial spaces or serous cavities.
• Becomes evident only when 5-6lits of fluid is
accumulated.
• Types –
• Pitting
• Non-pitting
• Sites –
• Common in lower limbs (dependant area)
• Mechanism –
• Increased capillary permeability
• Increased capillary pressure
• Decreased osmotic pressure
• Damaged lymphatic drainage

31. Bilateral edema
• Cardiac (CCF,LVF)
• Renal (nephrotic
syndrome)
• Hepatic (liver cirrhosis)
• Venous (IVC obstruction)
• Endocrine (myxedema)
• Allergic (angioneurotic)
• Toxic (epidemic)
• Nutritional (anemia,
beriberi)
Unilateral edema
• Lymphatic (filariasis,
radiations, metastasis)
• Traumatic
• Infectious
• Metabolic
• Venous
• Hereditary

32. Based on Pitting depth and Duration:
1+ : ≤ 2mm pitting that disappears rapidly
2+ : 2-4 mm pitting that disappears in 10-15 seconds
3+ : 4-6 mm pitting that may last more than 1 minute;
dependent extremity looks fuller
4+ : 6-8 mm pitting that may last more than 2 minute;
dependent extremity is grossly distorted

33. Based on Pitting depth and Rebound time:
1+ : 2 mm pit that rebounds immediately
2+ : 4 mm pit that rebounds after few seconds
3+ : 6 mm pit that rebounds after 10-12 seconds
4+ : 8 mm pit that rebounds after > 20 seconds

34. Severity of Bilateral pitting edema:
1+ (mild): Both feet/ankles
2+ (moderate): Both feet + lower legs, hands or lower
arms
3+ (severe): Generalized bilateral pitting edema, including
both feet, legs, arms and face