General Examination
General Surgery
1. Starts with Golden 6 Rule
i. Introduction- Introduce Yourself
ii. Procedure- Explain What You are Going to Do?
iii. Consent- If said no then try to convince the patient.
(For General Examination- Oral Consent is sufficient).
iv. Privacy- Should be given to the pt. (Attendant according to gender should have to be
present).
v. Posture- Should be mentioned during procedure.
vi. Exposure- As much is required for general examination
2. Inspection
I. Consciousness- Conscious/Not-Conscious
II. Orientation- Orientated/Not-Orientated
III. Cooperative/Not-Cooperative
IV. Built Of Patient- Mild/Moderate/Obese.
V. Nutrition- Poor/Good
VI. Overall Skin Appearance
Yellow Discoloration
Bruise- Acquired/Spontaneous
Scratch Marks
VII. Anthropometry
Wt. in KG
Height(mt.)
BMI
3.Check For Vitals
i. Pulse Rate.
ii. Blood Pressure
iii. Respiratory Rate (Should be checked when pt. is unaware like while checking for
pulse).
iv. Body Temperature.
4. Head to Toe Examination
I. We will start with hands
Dorsal Aspect Palmar Aspect
Pallor- In nail bed (Pink- normal) Jaundice- Yellowish appearance of palm
Cyanosis- In nail bed (only in Occlusive Arterial Palmar Erythema- At periphery Of Palm
Lesion) Thenar & Hypothenar Muscle Wasting- Seen in
Clubbing- Angle Seen in index finger(45°) / Arterial and Nervous Problem
Diamond Shaped (Schamroth Sign) Dupuytren's Contracture
Local Changes in Nail- Fungal Infection, Shape of Fine Tremors- especially in Toxic Goitre. (Eyes
Nail. Closed).
Capillary Refill Time- <2sec Normal, if takes Flapping Tremor- especially in hepatic failure
more-Arterial problem (Eyes not to be closed).
II. Scalp
Look for local loss of hair- Common in Hypothyroidism and Chemotherapy
Palpate entire scalp and look for any swelling.
III. Eyebrows
Look for lateral loss of hair. (B/C it grows from medial to lateral)- Seen in
Hypothyroidism
IV. Eyes
Pallor- At palpable conjunctiva.
Sclera- Upper Sclera for Jaundice
Pupil- Check For Light and Accommodation Reflexes.
Pontine hemorrhage– Pinpoint Pupil,
Brain Stem death- Dilated and Fixed Bilaterally.
{PERLA (+VE)- Pupils Equally Reactive to Light And Accommodation.}
V. Nose
Check for Nasal Septum Deviation
Any Discharge from nose- Colorless- In Common cold (EVEN SURGERY HAVE TO BE
CANCELLED).
(In unconscious pt. colorless discharge may be CSF)
Epistaxis- Bleeding from nose (Commonest cause- Nose Pricking).
Any growth inside nose.
VI. Ear
Look for congenital deformity.
Colorless Discharge- May be CSF – Otorrhea.
Look Inside.
VII. Oral Cavity
Lips
look for Dehydration, Parched & Dry.
Cyanosis- Central Cyanosis.
Cheilosis- White Deposition at the angles of the mouth (May go for scarring).
Tongue
Size of Tongue
Deviation of Tongue- Deviated in nerve damage.
Coating Over Tongue- White Coating- In Typhoid of 10-12 days & Abdominal Pain
. In Baby- white tongue- Fungal Infection
Fissure- Gap in b/w
Cyanosis- On tip of Tongue
Ulcer/Growth
Fine Tremors- Mostly in Thyrotoxicosis
Also look at sublingual Region
Tonsil- Enlarged or NOT Enlarged.
Uvula- Position & Color.
Hard & Soft Palate- Congenital Deformity, Jaundice.
Oral/Buccal Mucosa- Ulcer, Growth
Dentition- Look for gums-bleeding
False dentures, Dental Hygiene.
Overall Oral Hygiene.
VIII. Neck Examination
a. Inspection
Position Of Trachea.
Observe for any obvious Swelling.
Scar, Sinus, Fistula, Ulcer.
Visible pulsation, Dilated Veins.
Juglar Venous Pressure (Make patient sit in 45° position).
b. Palpation
Confirm position of trachea-
Trail’s Sign (3 finger)
Invagination Method (1 finger invagination, do not press trachea)
If there is swelling, Talk about Swelling, Proceed further with swelling.
Cervical Lymph Nodes {7 levels}- Stand Behind pt. Put hand on head, Neck Slightly
Flexed.
o Level I - a- Submental
b- Submandibular
o Level II – Upper Juglar
o Level III – Middle Juglar
o Level IV – Lower Juglar
o Level V – Posterior Triangular with Supra Clavicular (b/w two heads of
Sternocleidomastoid)- left supra clavicular also called Virchow’s Node.
o Level VI – Central
o Level VII – Anterior Mediastinal (Percuss)
o Pre-Auricular
o Post-Auricular
o Sub Occipital
IX. Axilla Examination
Lymph Nodes {3 Levels}
Level I – Lateral to Lateral border of pectoralis Minor.
Anterior – Anterior Axillary Fold.
Posterior – Posterior Axillary Fold.
Lateral – Over the Humerus in the Axillary Fossa.
Level II – Beneath Pectoralis Minor
Central- Inside from Behind
Level III – Medial to Medial Border of Pectoralis Minor.
Apical or Infraclavicular
X. Chest
Congenital Chest Deformity
Pes carinatum
Pes excavatum
Spider Naevi- Small Vessels in web-pattern. (Appear as red spots to naked eye)
Female- All same, Also check for symmetry of Breast.
Male- Gynecomastia.
XII. Lower Limb
Look for Dilated Vein
Pedal Edema-May be Unilateral or Bilateral. (from 5cm above Medial Malleolus, over the
Tibial Shin, Press with your thumb for 30sec & then release till then you find edema)- in pt.
with congenital heart problem.
