General Patient Examination in Propaedeutics

Basic Principles of Clinical Examination

Physical examination is grounded in two fundamental logical principles that ensure comprehensive data collection.

The first premise is the "general to specific" principle. The clinician begins by evaluating the patient's overall clinical status, and only then proceeds to a targeted examination of individual organs and systems.

The second premise is the "simple to complex" principle. It governs a strict sequence of physical examination techniques when evaluating a patient:

1. History taking and visual inspection (visus).
2. Palpation of tissues and organs (palpatio).
3. Percussion (percussio).
4. Auscultation of acoustic phenomena (auscultatio).

These methods can be combined as clinically indicated. For instance, if abnormalities are identified during inspection of the neck, the physician can immediately ask clarifying questions regarding dysphagia or epistaxis.

History Taking as the Initial Stage

Patient assessment invariably begins with a medical interview. The initial historical data provide the basis for formulating a provisional diagnosis and outlining an action plan. Information gathering comprises three main components:

• Chief complaints — the patient's subjective symptoms at presentation.
• History of presenting illness (anamnesis morbi) — the chronological development of the current condition.
• Past medical history (anamnesis vitae) — past illnesses, comorbidities, and allergic history.

When taking a past medical history, it is crucial not merely to compile a list of past events, but to understand the clinical course of prior illnesses. This helps identify chronic processes pathogenetically linked to the current decompensation (for example, recognizing that hypertensive nephropathy has progressed to uremic syndrome).

During the interview, the physician achieves multiple objectives: establishes rapport, strictly adheres to medical ethics and deontology, asks guided questions, and assesses the patient's cognitive capacity to determine how reliably they can describe their symptoms.

Components of the General Examination

The general physical examination directly aims to evaluate baseline physiological and somatic parameters. This stage includes:

• Assessment of the level of consciousness.
• Evaluation of current body position and posture.
• Determination of body habitus (physique).
• Observation of facial expression.
• Body temperature measurement.
• Anthropometric assessment.

In clinical practice, the general examination based on propaedeutic principles always precedes specialized regional examinations (e.g., a bimanual pelvic examination when gynecological pathology is suspected).

An essential part of anthropometry is calculating the Body Mass Index (BMI). This parameter is necessary for objectively identifying overweight status or obesity. The formula is straightforward: body weight in kilograms divided by height in meters squared.

Role and Hierarchy of Diagnostic Modalities

History taking and physical examination occupy the top tier of the diagnostic hierarchy — this primary stage often enables a clinician to establish a diagnosis without further workup. However, when pathology is detected, laboratory and instrumental investigations are employed.

The diagnostic workup is always structured from simple, non-invasive procedures to complex, invasive interventions. The key algorithmic principle is to stop at any stage as soon as the definitive diagnosis is established.

Objectives of diagnostic modalities:

• Diagnosis and monitoring — confirming the disease and assessing treatment efficacy (e.g., routine self-monitoring of blood glucose with a glucometer in diabetes mellitus).
• Functional assessment — determining the functional capacity of organ systems.
• Screening — incidental findings in apparently healthy individuals. For example, a chest radiograph may reveal a pulmonary infiltrate (raising suspicion for malignancy), microhematuria on urinalysis may indicate occult glomerulonephritis, and severe leukocytosis on complete blood count may point to lymphocytic leukemia.

In challenging cases requiring anatomical or histological confirmation, a biopsy is performed. Several techniques are available: endoscopic biopsy, fine-needle or core aspiration biopsy, surgical incisional biopsy, and bone marrow sampling (sternal puncture or trephine bone marrow biopsy) to diagnose hematologic disorders.

Class and exam questions

What else to study on this topic

• Clinical Assessment of Renal Function: Creatinine Clearance, GFR, and Hyposthenuria
• Pathogenetic Interrelationships Among Arterial Hypertension, Nephropathy, and Uremic Syndrome
• Detailed History Taking in Abnormal Uterine Bleeding
• Indications and Techniques for Tissue Biopsy: From Endoscopy to Trephine Biopsy
• Disorders of Calcium-Phosphate Metabolism in Secondary Hyperparathyroidism

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.