The general visual inspection

1. General condition of the patient - satisfactory, moderately severe, grave, critical.

2. Level of consciousness - clear, depressed (stupor, spoor, coma), excited (irritative disorder, delirium).

3. Posture and motor behavior - active, passive, forced (describe what). Restlessness, agitation, bizarre postures, immobility, involuntary movements.

4. Type of constitution - normosthenic (athletic), asthenic, or hypersthenic.

5. Weight in kgs and height in centimeters. Body temperature.

6. Gait - firm, free, and straight (healthy); pathologic: spastic, paretic, hemiplegic, puppet, peroneal, cerebellar, “proud”.

7. Skin: Inspect for color changes: brown, gray, bronze, blue, reddish blue, red, icteric, hypopigmentation (vitiligo) or hyperpigmentation. Palpate the skin to determine its moisture, temperature, texture, and turgor.

Inspect and palpate the nails to determine their texture, color and shape.

Look for scab.

Inspect and palpate the hair: its quantity, quality, texture and distribution.

Look for pediculosis.

Degree of humidity: normal, increased, dry skin, skin peeling

Primary skin lesions include: macule, patch, papule, plaque, nodule, tumor, wheal, vesicle, bulla, and pustule.

Secondary skin lesions include: erosion, ulcer, fissure, crust, scale, lichenification, atrophy, scar, keloid.

Subcutaneous layer development.

8. Face of the patient: shape, expression, symmetry, color of skin, eyes, ears, nose, lips, hear.

9. Cavity of the mouth: color of the mucosa, gum, gingival, tongue: shape and size, fur, surface.

10. Neck: shape, size, symmetry, skin color, scars, visible pulsation.

11. Palpation of Lymph Nodes

Systematically palpate with the pads of your index and middle fingers to examine various lymph node groups.

Preauricular - In front of the ear

Postauricular - Behind the ear

Occipital - At the base of the skull

Tonsillar - At the angle of the jaw

Submandibular - Under the jaw on the side

Submental - Under the jaw in the midline

Superficial (Anterior) Cervical - Over and in front of the sternornastoid muscle.

Supraclavicular - In the angle of the sternornastoid muscle and the clavicle inguinal lymph nodes.

Note the size and location of every palpable node and whether it was soft or hard, non-tender or tender, and mobile or fixed.

12. Thyroid Gland

Inspect the neck looking for the thyroid gland. Note whether it is visible and symmetrical. A visibly enlarged thyroid gland is called a goiter.

Move to a position behind the patient.

Identify the cricoid cartilage with the fingers of both hands.

Move downward two or three tracheal rings while palpating for the isthmus.

Move laterally from the midline while palpating the lobes of the thyroid.

Note the size, symmetry, and position of the lobes, as well as the presence of any nodules. Normal gland is often not palpable.

13. Muscular system: the level of development, sex and age correspondence, tenderness, muscular tonus, cramps, nodules in muscles.

14. Joints are investigated to reveal:

Symmetry of joints, shape;

Configuration (normal, deformed, swelled);

Hyperemia of skin and local increase of temperature in a joint area;

Movements (active, passive, free or limited);

Palpable tenderness related to passive movements (indicate joints);

Crackles, fluctuation.

15. Bones are examined for:
deformation, curvature, periostitis; acromegaly (excessive size of feet, hands, upper and lower jaw or all skeleton); drumstick (clubbed, Hippocratic) fingers; revealed by tapping or palpation tenderness of sternum, ribs, tubular and plane bones, vertebrae); form of spine, its mobility.

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