General examination
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General examination is actually the first step of physical
examination
Inspection is the major method during general
examination, combining with palpation, auscultation, and
smelling
The examiner should observe the following aspects of
the patients:
general appearance
state of nutrition
body habitus（体型） symmetry（对称性）
posture(姿势）
speech
General appearance
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Sex
Age
Vital sign（生命征）
Development/habitus（发育/体型）
Nutritional status（营养状态）
Consciousness（意识状况）
Speech（tone/voice) (语调/语态）
Facial feature/expression（面容/表情）
Position/posture（体位/姿势）
Gait（步态）
Sex
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In female: estrogen and male hormone
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In male:

Sex is involved in some specific disease
female: SLE thyroid chlorosis (萎黄病)
male: haemophilia (血友病)
male hormone
Sex

Impacts of diseases on sex characters
Female patients will be masculinized in long term use of
corticosteriod（皮质类固醇） or adrenocortical tumor（肾上腺
皮质肿瘤）
Male cirrhotic patient will develop gynecomastia（男性乳房发育）
mainly because male hormone secretion was suppressed

The impacts of normal sex chromosome on the sex and sex
characters: biasexual abnormality
klinefelter syndrome
turner syndrome
Age

Age is tightly related to some diseases
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Infant and children:
rickets（佝偻病）
diphtheria（白喉）
measles（麻疹）
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Children and adolescence:
tuberculoses（结核）, rheumatopyra（风湿热）
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Elder: carcinoma and sclerosis
Vital sign
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Vital signs are physical signs that indicate an individual
is alive
body temperature
breath rate
pulse
blood pressure
heart rate

These signs can be measured/monitored to assess level of
physical functioning of an individual

Normal ranges of measurements of vital signs may
change with age, sex, weight, exercise tolerance and
condition
Body temperature
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Oral（口腔）
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Rectal（肛门）
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Axillary（腋下）
Body temperature
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Oral
Place the thermometer under the tongue and close the
mouth using the lips hold the thermometer tightly
The patient must breath through the nose
Leave the thermometer in the mouth for 5 min
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Reliable method
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Not suitable: infants
unconscious
Body temperature
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Rectal
Using a rectal thermometer
Recommended for infants/small children
Lubricate the bulb of the thermometer with a petroleum
jelly
Place the small child face down on a flat surface or lap
Spread the buttocks and insert the bulb end of the
thermometer about one-half to 1 inch into the anal canal
After 5 min, remove the thermometer and read
Body temperature
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Axillary
It is the least accurate method
Place the thermometer in the armpit(腋窝）, with the arm pressed
against the body for 5 ~10 min before reading
Read the thermometer by gripping the end opposite the bulb so
that the numbers are facing you
Roll the thermometer back and forth between your fingers until
you see a silver reflection in the column
Body temperature
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Normal value
Oral 36.30C~37.20C
Rectal 36.50C~37.70C
Axillary 360C~370C
The normal body temperature varies from person to
person, by age, and throughout day
 Being lowest in the early hours of the morning and
highest in the afternoon
 The variation may range within 10C
Rectal T >Oral T> Axillary T (each in 0.50C)
Body temperature
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It should be recorded on temperature recoding
sheet -----so called “ body temperature curve”
(体温曲线）
Fever type is referred to those febrile （发热的）
disease possessing certain characters of body
temperature curve
Vital signs
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Breath
The breath rhythm and rates should be recorded
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Pulse
The rhythm and rates should be recorded
Vital signs---pulse
60~100 /min
childhood
Emotion
Aged
Night
Vital signs---blood pressure

Blood pressure is a measurement of the force
applied against the walls of arteries as heart
pumps blood through the body
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Blood pressure readings are usually given as two
numbers: for example, 110/70
Vital signs---blood pressure
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The first number is the systolic （收缩的）
blood pressure reading, and it represents the
maximum pressure exerted when the heart
contracts
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The second number is the diastolic（舒张的）
blood pressure reading, and it represents the
pressure in the arteries when the heart is at rest.
Vital signs---blood pressure

BP is continually changing depending on the
activity, temperature, diet, emotional state,
posture, physical state and drugs
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Ideal BP <120/<80 mmHg
normal <130/<85 mmHg
hypertension >140/90 mmHg
Vital signs---blood pressure
Development & habitus
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Development status is evaluated according to the age,
intelligence（智力), body weight and sexual characters
In normal adult, they are almost comparable
During adolescent stage, the body experienced a rapid
growth periods
It is influenced by some factors
race(种族) inheritance(遗传) endocrinology(内分泌)
nutrition
living condition
physical exercise
Types of habitus
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Asthenic type: slender, weak and lightweight
（无力型）
Sthenic type: average height and muscled
（矮胖型）
Ortho-sthenic type: normal proportions with
（匀称型）
normal stature (身材)
Abnormal habitus
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Gigantism(巨人症)
It refers to the excessive liner growth that occurs with growth
hormone (GH) excess when epiphyseal(骺的) growth plates are
open during childhood
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Acromegaly(肢端肥大症)
It indicates the disorder of GH excess in adulthood
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Pituitary dwarfism(垂体性侏儒症)
It may be due to dysfunction of the pituitary causing
underproduction of growth hormone
small stature normal proportions
Gigantism
Development & habitus
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Cretinism(呆小症)
It is characterized by arrested physical and mental development
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Eunuchism(无睾症)
Sex hormone control the formation/development of sex characters
it may also affect the body development. If the secretion of sex
hormone was severely suppressed, eunuchism may occur
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Rachitis(佝偻病)
Malnutrition during childhood may affect the development, for
instance, vitamin D deficiency may lead to rachitis
Nutritional status
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One of the most important factors impacting an
individual’s health and disease because it affects almost
every system
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It can be evaluated mainly by skin, hair, muscle and
subcutaneous fat in particular
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Chronic wasting(消瘦) associated with loss of
subcutaneous fat from calorie or protein deficiency
Nutritional status
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Changes in hair and nails are also common in
nutritional deficiency
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Blindness may result from vitamin A deficiency
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The tongue may be large in iodine(碘) or
niacin(烟酸) deficiency
Nutritional status
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In general the abnormal nutritional status can be
described as obesity(肥胖） and emaciation（消
瘦)
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Parameters:
body weight (体重)
Body mass index (BMI) (体重指数)
Arm circumference (上臂周径)
Skinfold thickness (皮褶厚度)
Skinfold thickness
Malnutrition
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It is the condition that develops when the body
does not get the right amount of the vitamin,
minerals, and other nutrients it needs to maintain
healthy tissue and organ function
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It is caused by inadequate intake or inadequate
digestion of nutrients
Malnutrition
Malnutrition may be mild enough to show no
symptoms or so severe that the damage it has
done is irreversible even though the individual
may be kept alive (cachexia)(恶病质)
Overnutrition
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Overnutrition results from eating too much that exceed
the normal consumption, not exercising enough, genetic
factors, endocrinology, life habits
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The nutritional status of patient based on height and
weight is interpreted by the body mass index (BMI)
(体重指数)
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BMI is an international digestion of relative weight for
stature
BMI=weight (kg)/height (meter)2
Overnutrition
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BMI
<18.5
underweight
18.5~25.0
healthy weight
25.1~29.9
overweight
>30
obsess
WHO classification
male >27
female>25 obesity
Consciousness
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It is a psychological and physiological state in which we are aware
of our sensations, perceptions, feelings, thoughts etc
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Disturbance of consciousness
memory deficit
language disturbance
disorientation
reduced clarity
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During interview, the examiner has already gained much insight
into the mental status of the patient
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The examiner could evaluate the thought, response, emotion,
calculation ability and orientation
Consciousness
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Sommolence (嗜睡)
Confusion (意识模糊)
Stupor
(昏睡)
Coma
(昏迷)
Delirium (谵妄)
Tone & Speech
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Dysarthria (构音障碍) is difficulty in articulation
(分节发音)
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Dysphonia (发声困难) is difficult in phonation
（发声）
Facial feature & expression
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The appearance of the head and face, their contours(轮廓)
and texture(特征), often provides the first insight into the
nature of illness.
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Some facial appearances are pathognomonic (特定的)of
disease
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The appearance of the patient’s face may also provide
information regarding psychological makeup: is the
person happy, sad, angry or anxious
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Some typical facial features are listed in textbook
Position
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It refers to patient’s body status
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Divided into:
Active (自主)
Passive (被动)
Compulsive (强迫)
Position
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Active position
The patient can move his/her body freely, without any
restriction
It can be seen in normal adult, patients with mild
diseases or at earlier stage of the diseases
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Passive position
The patient can’t adjust or move his/her body
It occurs in extremely sick or patients with
unconsciousness
Compulsive position
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Compulsive supine position (仰卧位）
The patient lie down on the beck, with two legs bending.
Acute peritonitis
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Compulsive prostrate position（俯卧位）
in order to relief the tenderness of back muscles.
Rachis disease（脊柱病变）
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Compulsive side down position（侧卧位）
in patients with one sided pleurisy or pleurorrhea(胸腔积液)
Compulsive position
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Orthopnea（端坐呼吸）
An abnormal condition in which a person must keep the
head elevated (sit or stand) to breathe deeply or
comfortably (orthopnea) or wakes up suddenly in the
middle of the night short of breath (paroxysmal nocturnal
dyspena)（阵发性夜间呼吸困难）. It can be seen in
patients with lung or heart disease
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Squar down position（蹲位）
It has been seen in patients with congenital heart disease
Compulsive position
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Compulsive rest position
When patient suffers an angina attack it will force
them to rest. The heart is then able to return to it’s
normal working level
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Toss & turn position (alternative position)
辗转体位
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Opisthotonos (角弓反张）
It is an abnormal posturing condition characterized by
rigidity and severe arching of the back, with head thrown
backwards
Posture & gait
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Posture: the general way of holding the body
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Gait : a way or manner of walking
Gait abnormalities describe unusual and uncontrollable problem
with walking
Gait disturbances may occur for a variety of reasons
Gait may be changed by local pain in the foot, joint, claudication
（跛行） of the hip（臀） or leg, bone disease etc
Gait
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Waddling gait （蹒跚步态）
Characterized by a distinctive duck-like walk that may appear in
childhood or later in life
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Scissor gait（剪刀式步态）
Characterized by legs flexed slightly at the hips and knees, giving
the appearance of crouching（卷缩）, with the knees and thighs
（大腿） hitting or crossing in a scissors-like movement
Gait
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Steppage gait（跨阈步态）
Characterized by foot drop where the foot hangs with the toes
pointing down, causing the toes to scrape the ground while
walking
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Propulsive (Festinating) gait（慌张步态）
Characterized by stooped, rigid posture with head and neck bent
forward
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Drunken man gait（醉酒步态）
Characterized by unbalanced trunk, as drunken man like walking
Gait
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Ataxic gait（共济失调步态）
Characterized by an abnormality of muscle control or an inability
to finely coordinate movements, resulting in a jerky “to-and-fro”
unsteady motion
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Intermittent claudication（间隙性跛行）
It is leg pain (most often in the calves) that does not clear up after
walking and is relieved by rest
It is a symptom of peripheral artery disease (PAD)
Skin
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The skin is the largest organ of the body
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One of the best indicators of general health
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The examination of the skin is dependent on
inspection, but palpation of a skin lesion must
also be performed
Skin color
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Skin coloration is determined by the amount of pigment
in the skin and the blood flowing through it
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The distribution of capillary, the thickness of the
subcutaneous fat （皮下脂肪）may also affect it
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The color changes include
Pallor （苍白）
Cyanosis（发绀）
Yellow skin（黄染）
Redness（发红）
Pigmentation（色素沉着）Discoloration（色素脱失）
Pallor
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Paleness may be the result of decreased blood supply to
the skin (cold, fainting, shock, hypoglycemia) or
decreased number of red blood cells (anemia)
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Fingers that turn paller when exposed to cold or stress
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Raynaud’s syndrome may cause sudden change in the
finger color
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It is almost apparent on the face, lining of the eyes, inner
mouth and nails
Cyanosis
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It is a bluish discoloration of the skin and mouth membranes from
lack of oxygen
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Blood that is saturated with oxygen is bright red
Blood that has lost its oxygen is dark bluish-red
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Person who has a large quantity of their blood which is deficient in
oxygen tend to take on a bluish discoloration -----called “cyanosis”
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Cyanosis is more obvious in the mucous membranes and nail beds,
particularly for dark-skinned people
It may also appear on the feet, nose and ears
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Cyanosis
Yellow skin
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A yellow discoloring the skin, mucous
membranes and eyes, caused by too much
bilirubin in the blood
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With the exception of physiologic jaundice in the
newborn, all other jaundice indicates overload or
damage to the liver or inability to move bilirubin
from the liver through the biliary tract to the gut
Yellow skin
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A yellow to orange color may be imparted to the skin by
excessive intake of beta carotene

People who consume large quantities of carrots or carrot
juice or take beta carotene tablets may develop a
distinctly yellow-orange cast to their skin. The condition
is called hypercarotenemia（高胡萝卜血症）

Hypercarotenemia is easily distinguished from jaundice
in that the sclera（巩膜） remain white, while people
with true jaundice have a yellow sclera
Redness

It is due to dilation of capillary, accelerating & increasing
blood stream and increment of the red blood cells
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In physiological condition, it may be seen after sports or
drinking
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In pathological condition, it may be caused by lung TB,
scarlet fever, drug intoxication
Pigmentation

Melanin（黑色素） is a pigment produced in the skin
cells that causes skin coloration
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The production of melanin may be affected by heredity,
heat, trauma, solar or ionizing radiation, heavy metals
and other factors

Changes in any of these factors can result in
hyperpigmentation, hypopigmentation or both

The changes may be temporary or permanent
It can be either primary or secondary to other disease

Discoloration
Vitiligo (白癜风）
 It is a skin condition in which there is loss of pigment
from areas of skin resulting in irregular white patches
with normal skin texture
 Associated with pernicious anemia, hyperthyroidism,
Addison’s disease
Discoloration
Leukoplakia（白斑）
 A precancerous lesion that develops on the tongue or the
inside of the cheek as a response to chronic irritation
 Occasionaly, leukoplakia pathches develop on the female
external genitalia
Discoloration
Albinismus（白化病）

It refers to a group of related conditions. These
conditions are the result of altered genes that cause a
defect of melanin production

This defect results in the partial or full absence of
pigment from the skin, hair and eyes
Moisture

The moisture of skin is tightly related with the secretion
of sweat gland

Diaphoresis（大量出汗） is a medical term for profuse
sweating

It can be normal brought on by physical activity,
emotional response, high environment temperature or a
symptom of an underlying disease
Overactive thyroid gland

Cold sweat:
hypoglycemia
shock or dehydrated patients
Moisture

Periodic sweating at night without an obvious
cause may be caused by an underlying infection
or malignancy

Sweat absent: abnormal lack of sweat in response
to heat.
neurologic disorders
skin disease
congenital disorders
some drugs
burns
dehydration
Elasticity

Skin elasticity （皮肤弹性）is related with age,
nutritional status, subcutaenous fat and the
amount of liquid in the interstitial space
Rashes

Skin rashes are frequently one of the manifestation of
systemic diseases, and hence, they are important for the
diagnosis of some special diseases

The different rashes may occur in infectious disease,
dermentological disease, drug or other allergic materials
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The rashes have some special regular patterns and sharps
Types of rashes
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Macule（斑疹）
Roseola（玫瑰疹）
Papules（丘疹）
Maculopapulae（斑丘疹）
Urticaria（荨麻疹）
Macule

A macule is small, flat, distinct colored area of skin

Does not include a change in skin texture or thickness
Rosela

Rosela is a skin lesion that is small, solid, and
raised. It may be seen in measles, drug rashes,
eczema
Papule

A papule is defined as a small (5 millimeters or
less), solid lesion slightly elevated above the
surface of the skin.
Maculopapulae


It is plate lesion with redness around the
papules
It can be seen in scarlet fever and drug-induced
rashes
Urticaria

Urticaria (hive) are raised red welts of variuos
size on the surface of the skin, often itchy, which
come and go. It is associated with allergic
reaction
Desquamation

It is the detachment of cells from the surface of an
epithelium

In physiologic condition, it’s not easy to notice the
desquamation

In pathologic condition, lots of desquamation can be seen
Subcutaneous hemorrhage


Bleeding into the skin & subcutaneous tissues
According to the size of bleeding, it may be subdivided
as follows:
petechia（瘀点） <2mm
purpura （紫癜）3~5 mm
ecchymosis （瘀斑） >5mm

A hematoma（血肿） is a large collection that forms a
lump
Spider angioma
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

Spider angioma is a group of abnormal blood vessel that
produces the appearance of a spider-web on the surface
of the skin
A spider angioma lesion typically has a red dot in the
center with reddish extensions radiating out for some
distance around it
Liver palms
Edema
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Excessive build up of fluid in the tissues
Either occurs throughout the body (generalized swelling)
or limited to a specific part of the body (localized
swelling)
It can be either pitting （凹陷性） edema or non-pitting
（非凹陷性）edema
Mild : facial edema, peripheral edema
Moderate: generalized edema
Severe: generalized severe edema
Nodules & scar & hair

Subcutaneous nodules are solid, raised bumps on the skin

Scar tissue forms as skin heals after an injury or surgery
A keloid is an abnormal scar that is thicker, different color and
texture, extends beyond the edge of the wound

Nodules & scar & hair

Pay attention to the pattern of distribution and
texture of hair over the body
Sparse/coarse: hypothyroidism
chemotherapy
Increased hair: Cushing’s disease neoplastic
condition
Lymph notes
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The lymph notes are distributed all over the body
The general physical examination can only palpate the
superficial lymph notes
The superficial lymph notes are in cluster distribution
that drainage different part of lymphoid liquid
Lymph nodes play an important part in the body’s
defense against infection
Swelling might occur even if the infection is trivial or not
apparent. Tumor may also cause its swelling
Lymph notes

Palpation is the major methods to detect the
superficial lymph notes and it should be done
sequentially
Lymph notes


Lymph note enlargement either localized or
systemically
Localized :
lymphadenitis
tuberculous ~
malignant metastasis
(gradually and painless)

Systemically: lymphadenitis
lymphoma
leukemia