Clinical Methods

Common Steps
1.Greetings
2.Self-introduction
3.Explain procedure/method
4.Consent
5.Proper position and exposure
6.Always from right side
7.Always wash hands before and after examining
the patient
8.Cover after completion
9.Thanks to patient
General Physical Examination
1. General appearance
a.Weight, height and built
b.Severity of illness/distress
c. Posture
d.Typical
face,
hygiene
and
odor
body/breath
e.Consciousness (GCS)
2. Hands
a.Shake hand, grip/strength
b.Shape and size
c. Sweating and temperature
d.Tremors and flaps
e.Muscle wasting and palmer erythema
f. Pallor and jaundice
g.Janeway lesions
3. Fingers
of
a.Shape, length and deformities (swan neck

etc..)
b.Oslers, heberdens and bouchards nodes
c. Joint swelling and subluxation
4. Nails
a.Pallor and cyanosis
b.Clubbing and its grade
c. Koilonychia, splinter hemorrhages etc..
5. Pulse and respiratory rate
a.Rate and rhythm
b.Respiratory rate and pattern
6. Arms
a.Epitrochlear lymph nodes
b.I/V injection marks
7. BP and temperature
a.Thermometer in left axilla
b.BP on right side
8. Axillary lymph nodes
9. Face
a.Hair
b.Typical face (Acromagally, Parkinsonism,
Cushings, CRF)
c. Eyes (Proptosis, lid retraction etc.)
d.Sclera (pallor, jaundice)
e.Malar rash/flush
f. Parotids
g.Lips (cyanosis)
h.Tongue (size, dryness, pallor, cyanosis and
jaundice)
i. Palate and oral hygiene
10.
Neck
a.Neck veins
b.JVP
c. Lymph nodes
11.
12.
13.
14.
15.
Thyroid
a.Inspection (Extend the neck and swallow)
b.Palpation (size, tender, consistency and
number of nodules)
c. Pembertons sign
d.Auscultation (bruit)
Gross inspection of chest and abdomen
a.Pattern of respiration
b.Abdominal distension
Inguinal lymph nodes
Legs and feet
a.Clubbing
b.Loss of hair and shiny skin (Peripheral
vascular Disease)
c. Edema
Back
a.Spine tenderness and deformities
b.Sacral edema
Cardiovascular System
Examination of pulses
1.Rate
2.Rhythm
3.Volume
4.Character
5.Comparison with other side
6.Radio-radial and femoral delays
7.Condition of vessel wall
8.All peripheral pulses and comparison
Blood Pressure
1.Palpatory
2.Auscultatory
3.Postural drop if necessary
Neck veins
JVP
1.Inspection
2.Palpation
3.Abdomino-jugular reflex
4.Measurement
Examination of Precordium
Position and exposure

1.45 degrees
2.Expose up to umbilicus
Inspection (inspect from foot end and then near at

level of chest)
1.Shape and chest deformity
2.Bulging, scar marks and prominent veins
3.Pulsations
Palpation
1.Ask for pain on chest & rub hands
2.Look at patients face for tenderness
3.Site and character of apex beat (Left later
or sitting if impalpable)
4.Palpable heart sounds, thrill or rub (Make
Z)
5.Left parasternal heave
6.Tenderness or crepitus
Auscultation
1.Locate apex if not yet done
2.Start from apex (palpate carotid
simultaneously)
3.Make Z with diaphragm then with bell
4.Sitting and lean forward for base of heart
(Hold in Inspiration for P2 and Expiration
for A2)
5.Heart sounds, murmur and rub

6.Murmur (Timing, intensity, SOMI,
Radiation, character, effect of respiration
and posture)
General Physical Examination relevant to CVS

a.Cardiac cachexia
b.Propped-up posture
c. Typical face (Marfan, Turner and Downs)
2. Hands
a.Sweating,
temperature
and
tremors
(hyperthyroidism)
b.Pallor
c. Janeway lesions
3. Fingers
a.Oslers nodes
4. Nails
c. Splinter hemorrhages
a.Rate and rhythm
6. Arms
a.I/V injection marks (Infective endocarditis)
b.BP on right side
8. Face
a.Typical face (Marfan, Turner and Downs)
b.Proptosis,
lid
lag
and
retraction
(Hyperthyroidism)
c. Pallor
d.Jaundice (cardiac cirrhosis)
e.Xanthelesma
f. Malar flush (mitral stenosis)
g.Lips (cyanosis)
h.Palate (Marfan)
i. Teeth hygiene (infective endocarditis)
j. Petechial
spots
in
mouth
(infective
endocarditis)
9. Neck
a.Neck veins & JVP
b.Carotid bruit
10.
Thyroid
11.
Abdomen
a.Hepatomagaly (Cardiac failure)
b.Splenomegaly (infective endocarditis)
c. Abdominal aorta pulsations
12.
Legs and feet
a.Clubbing
b.Loss of hair and shiny skin (Peripheral
vascular Disease)
c. Edema (Heart failure, DVT)
d.Tendon xanthomata
13.
Back
a.Auscultation of lung bases
b.Sacral edema
Respiratory System
1.Supine with arms abducted (front and
lateral chest)
2.Sitting with hands on opposite shoulders
(back of chest)
3.Expose up to umbilicus
Inspection (inspect from foot end and then near at
level of chest)
1.Shape and symmetry

2.Type of respiration and movement of chest
3.Deformity, scar, veins, pulsations etc.
Palpation
1.Ask for pain on chest & rub hands
3.Position of apex beat and trachea
4.Tenderness and crepitus
5.Palpable sounds or rub
6.Vocal fremitus
7.Movements of chest
8.Chest expansion
Percussion
1.Upper border of liver
2.Supraclavicular fossa, clavicles (front)
3.2nd to 6th intercostal space (front), 4th to 7th
(lateral)
4.Apex and up to 11th space (back)
Auscultation
1.Breath sounds
2.Added sounds (ronchi, crackles or rub)
3.Vocal resonance
General Physical Examination relevant to

respiratory system
a.Cachexia
b.Respiratory distress & coughing
c. Posture (resting on arms)
d.Accessory muscles
e.Consciousness (GCS)
f. Sputum mug
2. Hands
a.Flaps
b.Muscle wasting (Tumor compression of C8
& T1)
3. Fingers
a.Nicotine staining
4. Nails
a.Rate and rhythm (pulsus paradoxus)
b.BP on right side
7. Axillary lymph nodes
8. Face
a.Horner syndrome (Apical lung CA)
b.Lips (cyanosis)
c. Tongue (cyanosis)
d.Nose (DNS, polyps & turbinates)
e.Oral hygiene and breath (lung abcess)
f. Facial plethora/cyanosis (SVCO)
9. Neck
a.Neck veins
b.JVP (cor-pulmonale)
c. Lymph nodes
10.
Thyroid
11.
Chest
a.Auscultation of P2
12.
Abdomen
a.Liver span
13.
Legs and feet
a.Clubbing & cyanosis
b.Edema & DVT
Gastrointestinal system

1.Supine with arms by side of body
2.Exposed xiphisternum to pubic symphysis
Inspection
1.Shape & movements of abdomen
2.Umbilicus
3.Pulsations, peristalsis, scars, striae, veins
etc.
4.Pubic hair and hernia orifices
Palpation
1.Ask for pain & rub hands

3.Light palpation (tone, guarding, rigidity,
tenderness)
4.Deep palpation (nine quadrants,
tenderness/mass)
5.Palpation for liver, gall bladder, spleen,
kidneys, urinary bladder, abdominal LN
6.Renal punch from back
Percussion
1.Percussion for liver, spleen, urinary
bladder
2.Shifting dullness and fluid thrill
Auscultation
1.Bowel sounds
2.Aortic, renal and hepatic bruit and splenic
rub
Groin and genitalia
1.Genitalia
2.Per-rectal examination
General Physical Examination relevant to GIT
a.Weight, height and built
b.Consciousness (GCS)
2. Hands
a.Flaps
b.Pallor, jaundice and palmer erythema (CLD)
c. Dupuytrens contracture
3. Nails
c. Leuconychia
d.Blue nails (wilsons)
a.Rate and rhythm
5. Arms
a.Skin pigmentations (peutz-jeghar)
b.Scratch marks
c. Bruises
d.Spider nevi
b.BP on right side
7. Axillary LN
8. Face
a.Jaundice
b.Pallor
c. KF ring in eyes
d.Xanthelesmas
e.Parotids (alcoholics)
f. Oral cavity
9. Neck
a.Lymph nodes
10.
Chest
a.Spider nevi
b.Gynecomastia
11.
Inguinal lymph nodes
12.
Legs and feet
a.Clubbing
b.bruises
c. Edema
13.
Back
a. Sacral edema

Clinical Methods

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Clinical Methods

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Common Steps

General Physical Examination

a.Shape, length and deformities (swan neck

Position and exposure

Inspection (inspect from foot end and then near at

5.Heart sounds, murmur and rub

General Physical Examination relevant to CVS

1.Shape and symmetry

General Physical Examination relevant to

Position and exposure

1.Ask for pain & rub hands

General Physical Examination relevant to GIT

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