Hello frnds.....I wish ki last artical aapke sb k liye kaafi helpful rha hoga....
Nd now I wanna tell you all that how can we examine a patient....so please read it carefully....nd I think this artical is also going to b very helpfull to all....
                General Examination

Environment, general appearance
Hydration
Posture, weight, body shape
Vital signs
Nails, hands
Head
Examination tips
Environment

General appearance

Pre-exam checklist: WIPE:
• Wash your hands
• Introduce yourself to pt
• Position pt
• Expose the area
Always examine from the R side of the pt.
Ask pt. if tenderness anywhere, before start touching them.
Skin colors. See Skin Colors Reference.
Posture, weight, body shape

If pt. enters, examine gait. See Gait.
Posture, stature, height..
Obesity [BMI = kg/m^2. Normal <25].
Limb amputations, deformities.
Physique expected for age.
Hydration

Sunken orbits.
Mucus membrane dryness.
Axillae.
Skin turgor [pinch skin: normal returns immediately].
Postural hypotension [less BP when sit, stand].
Peripheral perfusion [press nose, time capillary return].
Examine weight loss over hours.
Vital signs

Often logged on ward chart.
See Taking Vital Signs Reference.
Nails

Clubbing.
Nail signs.
Nail fold.
See Nails Reference.
Hands

Palms:
• Palmar erythema (cirrhosis, polycythaemia, pregnancy).
• Pigmentation of crease (Addison's, but normal in asians, blacks).
• Pallor of palmar crease. Better results if hyperextend fingers, or stretch skin on either side of crease (anemia).
• Dupuytren's contracture [fibrosis, contracture of palm's fascia] (liver dz, epilepsy, trauma, elderly).
Joints:
• Herberdens, Bouchards (OA).
• Swollen PIP, distal PIP spared (RA).
Head

Hair: deficiency, excess.
Facial hallmarks (Down's, Grave's, acromegaly, Cushing's, etc).
Teeth: nicotine stains.
Examination tips

Initial examination is from the foot of the bed.
Always ask if any part tender, before touching pt.
Watch pt's head as palpate, to look for pain flinches.
Percussion is R middle finger hitting middle of middle phalynx of L middle finger.
To measure circumference of limbs, choose the bony landmark on each, measure down the correct distance, then take the circumference at that point.