Introduction: Physician's Role and Efficiency Factors
The success of a general examination directly depends on the personality of the physician. Key personal qualities at this stage are extreme attentiveness and professional meticulousness.
Accumulated clinical experience is equally important. A physician needs a so-called "clinical eye"—the ability to quickly recognize visual manifestations of pathology, which can only be developed by regularly examining a large number of patients.
Patient Comfort Conditions
The objectivity of the data obtained largely depends on how comfortable the patient feels. The physician must follow several basic rules for organizing the examination process:
- Temperature regime: the examination room must be warm.
- Respect for the patient: prolonged exposure of the patient in a completely undressed state must be strictly avoided to prevent psychological and physical discomfort.
- Convenience: awkward postures that could fatigue the patient or distort the natural clinical picture must be avoided during the examination.
Technical Conditions: Lighting and Undressing
A key technical parameter is proper lighting. The office must be sufficiently lit, but one must remember the specifics of different light sources:
- Artificial or evening light: has a significant drawback as it can visually mask jaundice (icterus) of the skin and sclera.
- Side lighting: is specifically used to reveal contour changes. With this angle of incidence, contours of internal organs, pathological formations, and various pulsations are much better defined.
The second most important rule is complete undressing. The patient must be completely undressed. The risk of failing to follow this rule is gross diagnostic errors. A classic practical example: a physician may unsuccessfully search for the cause of a fever of unknown origin simply by missing erysipelas on the leg because the patient did not take off their trousers or socks.
Age Assessment and Examination Algorithm
The examination always includes a visual assessment of age. The physician compares the patient's appearance with their actual chronological age. The clinical significance of this comparison is immense: if the patient looks significantly older than their years, the specialist should immediately suspect severe chronic pathologies typical of an older age group.
The general examination algorithm itself has a strict structure and includes 7 sequential elements:
- Assessment of the state of consciousness.
- Determination of the patient's posture.
- Assessment of body constitution.
- Observation of facial expression.
- Typological assessment of higher nervous activity.
- Measurement of body temperature.
- Collection of anthropometric data.
Important note: detailed skin examination, although performed simultaneously with the general examination, is always described and separated into an independent section when writing up the medical history.
Briefly: answers to topical questions
What types of patient posture are distinguished during a general examination?
During a general examination, three types of patient posture are distinguished.
- Active — the patient changes posture voluntarily, and the position does not depend on disease symptoms (characteristic of the early stages of many diseases).
- Passive — complete immobility; the head and limbs hang down under the influence of gravity; indicates an unconscious state (e.g., uremic coma) or extreme exhaustion.
- Forced — consciously assumed to alleviate symptoms (reduce pain, dyspnea). For example, sitting with shoulder girdle fixation during an asthma attack, semi-sitting (orthopnea) in left ventricular failure, or lying on the affected side in pleurisy and perinephric abscess.
What are the main constitutional types (body types) the physician must determine?
During the examination, the physician distinguishes three main constitutional types:
- Asthenic — predominance of longitudinal dimensions, elongated thin limbs, weak musculature, narrow and flat chest, acute epigastric angle.
- Normosthenic — proportional ratio of main body dimensions, well-developed musculoskeletal system, straight epigastric angle.
- Hypersthenic — wide chest with nearly horizontal ribs, obtuse epigastric angle.
Also, according to some classifications, asthenoid, thoracic, muscular, digestive, and undefined types are distinguished.
What degrees of impaired consciousness are distinguished when assessing a patient's condition?
The following stages of altered consciousness are distinguished:
- Stupor (torpor) — the ability to answer questions is preserved, but answers are not sufficiently meaningful.
- Obnubilation (drowsiness) — the perception threshold is increased, mental processes are slowed, and orientation is impaired. Depending on severity, it can be moderate or deep.
- Soporous state — a deep stage of obtundation; no reaction to verbal address, but reactions to painful stimuli are preserved.
- Coma — complete loss of consciousness and reflexes, impairment of vital function regulation. Subdivided into moderate, deep, and beyond (or terminal) coma.
What specific parameters are measured when collecting anthropometric data?
When collecting anthropometric data, the following parameters are measured:
- Height — measured in centimeters, used to calculate ideal body weight and the proportionality index.
- Weight (body mass) — evaluated in kilograms.
- Body mass index (BMI) — calculated at each visit.
- Waist circumference — measured along with BMI.
- Chest circumference — used to calculate the proportionality index and determine body constitution type.
To remember the 7 steps of the algorithm, use the mnemonic SPT-LN-TA: Status of consciousness, Posture, Body constitution — Face, Nervous system — Temperature, Anthropometry.
Class and exam questions
Why is artificial lighting not recommended when looking for jaundice?
Evening or artificial light has a specific spectrum that masks icterus (yellowing) of the skin and sclera, which may cause a doctor to miss this important symptom.
What is the purpose of using tangential lighting?
Side lighting creates shadows, which allows for a better visualization of the body surface relief: contours of internal organs, mass lesions, and vascular pulsations.
Why is it necessary to completely undress the patient if they only complain of a fever?
Without full undressing, the risk of a diagnostic error is high. For example, erysipelas of the lower extremity, which is the true cause of the fever, may be overlooked.
In which section of the medical history is the condition of the skin described?
Although the skin is examined during the general physical examination, these data are recorded in a completely separate section of the medical history.
What else to study on this topic
- Criteria for assessing the state of consciousness
- Types of patient body position in bed
- Body types (constitutional types) and their characteristics
- Methodology for collecting anthropometric data
- Assessment of higher nervous activity during examination
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