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Medical Students and Doctors in Libya

General Examination
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                   General examination             

Initial Encounter:

o        Introduce self

o        Wash hands

o        Observe general appearance, including nutritional status, hygiene & comfort level

Vital Signs:

o        Measure BP (one arm)

o        Measure radial pulse bilaterally (rate & rhythm)

o        Measure respirations

Head:

o        Inspect hair & scalp

o        Palpate cranium

o        Inspect facial symmetry

Eyes:

o        Inspect lids & palpebral fissure

o        Inspect conjunctivae

o        Inspect sclera & cornea

o        Test extraocular movements

o        Test visual fields to confrontation

o        Test visual acuity (pocket screener)

o        Inspect pupils (PERRLA) & cornea

o        Ophthalmoscopic exam: Inspect retina -
optic disc and vessels

Ears:

o        Inspect external ear

o        Otoscopic exam: Inspect auditory canal &
tympanic membrane

o        Test hearing (gross test) eg. watch tick

Nose:

o        Inspect septum

o        Inspect turbinates & mucosa

Mouth/ Throat:

o        Inspect lips

o        Inspect buccal mucosa

o        Inspect gums & teeth

o        Inspect tongue & tongue protrusion

o        Inspect hard & soft palates

o        Inspect movement of palate ( with phonation)

o        Inspect tonsils & tonsillar fossae

o        Inspect pharynx

o        Test facial muscles eg. show teeth, wrinkle forehead

o        Test jaw clench

Neck:

o        Inspect neck & jugular veins

o        Test ROM (flexion, extension & rotation)

o        Test shoulder shrug

o        Palpate trachea

o        Palpate carotid pulses

o        Auscultate carotids

o        Palpate cervical, submandibular & supraclavicular nodes

o        Palpate thyroid

Back and Lungs:

o        Inspect shape

o        Inspect spine

o        Palpate spine for tenderness

o        Evaluate chest excursion

o        Palpate for posterior fremitus

o        Percuss posterior lung fields

o        Auscultate apices

o        Auscultate posterior lung fields

o        Palpate axillary nodes

Heart and Lungs:

o        Inspect precordium (PMI, symmetry)

o        Palpate precordium (PMI, heaves, thrills)

o        Auscultate base (aortic & pulmonic area)

o        Auscultate left sternal border & apex

o        Auscultate anterior lung fields

Abdomen:

o        Inspect shape & scars

o        Auscultate bowel sounds, aorta, and renal arteries

o        Percuss liver & spleen

o        Light palpation of abdomen in all four quadrants

o        Deep palpation of abdomen in all four quadrants

o        Palpate liver

o        Palpate spleen

o        Palpate inguinal nodes

o        Palpate femoral arteries

o        Palpate aorta

Lower Extremities:

o        Inspect thighs & legs

o        Inspect knees & feet

o        Palpate calves for tenderness

o        Inspect ankles for edema

o        Palpate ankles for edema

o        Palpate dorsalis pedis pulses

o        Palpate posterior tibial pulses

o        Test ROM - hips & knees

o        Test strength - hips & knees

Upper Extremities:

o        Inspect hands, incl. nails

o        Inspect arms & shoulders

o        Test ROM - shoulders, elbows, wrists & hands

o        Test strength - shoulders, elbows, wrists & hands

Mental Status Examination:

o        Assess orientation to person, place and time

o        Assess short term memory

o        Assess ability to calculate

Neuromuscular Exam & Reflexes:

o        Test biceps reflexes

o        Test triceps reflexes

o        Test brachioradialis reflex

o        Test vibration sense in hands

o        Test position sense in hands

o        Test knee reflexes

o        Test ankle reflexes

o        Test plantar reflex

o        Test coordination with finger to nose

o        Test coordination with heel to shin

o        Test vibration sense in toes

o        Test position sense in toes

o        Test touch sensation on fingers and toes

o        Test pain sensation on fingers and toes

o        Test gait (unless already observed)

o        Observe posture

o        Test ROM of spine

EXAMINATION OF BREASTS, GENITALIA, HERNIASAND RECTUM DEFERRED WITH THIS EXERCISE   

 

by Dr. Younis Ejwalli  

 

 

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