Approach to conducting General Clinical Examination on a patient

1. GENERAL CLINICAL PHYSICAL
EXAMINATION
J. A OTEGBAYO

2. OBJECTIVES OF GCE
• TO EXPLAIN THE PURPOSE AND CLASSIFY
CLINICAL EXAMINATION
• DEFINE GCE
• TO FAMILIARISE PARTICIPANTS WITH SYSTEMATIC
CONDUCT OF GCE
• TO EXPLAIN THE SIGNIFICANCE OF GCE IN
PATIENT EXAMINATION.
AT THE END OF THE LECTURE, PARTICIPANTS
SHOULD BE ABLE TO :
1, EXPLAIN THE PURPOSE OF GCE AND DEFINE IT,
2,KNOW HOW TO SYSTEMATICALLY CONDUCT GCE,
3, MAKE REASONABLE CLINICAL JUDGEMENTS
FROM GCE

3. INTRODUCTION
• WHY CLINICAL EXAMINATION?
- Care
- -Diagnose
- Treat
- Cure
• ROUND UP THE CULPRITS
• SINGLE OUT THE OFFENDER

4. DEFINITIONS
• Very efficient direct observation of a PATIENT
• Carried out with a high degree of precision
• Usually involves the following steps:
A. Inspection
B. Palpation
C. Percussion
D. Auscultation

5. TYPES OF CLINICAL EXAMINATION
1. Local.
2. Regional
3. Loco-regional
4. Systemic
5. General

6. PURPOSE
• To gather the information/signs of manifestation of
diseases
• Critically analyse the signs
• Relate the signs to specific disease(s)
• Come up with an assessment or differential
diagnosis
• Chart the next line of action eg laboratory tests
• Make a final diagnosis
• Then treatment

7. SIGNIFICANCE of GCE
• Though non-specific for any organ-system,
information gathered is useful in tracking down the
disease or at least make differential diagnosis.
• It gives a clue to the area(s) of the body to pay
particular or more attention to while conducting
systemic or regional examination.

8. HOW TO CONDUCT GCE
• Self-Comportment
• Greet and introduce yourself (Courtesies)
• Explain your mission
• Obtain permission or consent
• Chaperone if necessary
• Re-assure patient of privacy, comfort and
gentleness.
• Before GCE- ?Gloves and other requirements. Cold
palms

9. HOW TO CONDUCT GCE contd.
• Positioning of patient – Anatomical
• Positioning of examiner
• A cursory scan of the patient (Head to foot).
• General appearance of the patient: Dressing;
Anxious? Conscious? Alert? Drowsy? Ill-
looking? Acute or chronic; Healthy-looking?
Restless? Aggressive? Calm? In distress?
• Feel for temperature (Thermometer)

10. Head
• Scalp infection, swellings
• Hair – colour, distribution (alopecia), feel.
• Face – colour, expression, rash (distribution),
puffiness etc
• Eyes – colour, pallor, icterus, haemorrhage,
discharge, size (proptosis/exophthalmos) etcetera
• Nose – size, discharge, flaring
• Mouth – odour/fetor, colour (tongue, mucosa),
hydration, tongue, central cyanosis, gum etc
• Salivary glands eg parotid fullness
• Neck – swellings, medical alert necklace

11. Hands
• Palms- colour/pigmentation,
thenar/hypothenar eminences, wasting,
deformed, contractures, moist, cold, warm,
sweaty, velvety etc
• Dorsum
• nail (colour, shape, capillary refill) etc;
• Compare with yours.
• medical alert bracelet

12. Lymph nodes
• – various regions: List

13. Feet
• oedema
• Check if one sided or vary in size
• if oedema is present or lying down, check
sacrum) etc.
• demonstrate pitting

14. SUMMARY
Present findings on GCE