The Comprehensive Physical Examination

General Survey. Observe the patient's general state of health, height, build, and sexual development. Obtain the patient's weight. Note posture, motor activity, and gait; dress, grooming, and personal hygiene; and any odors of the body or breath. Watch the patient's facial expressions and note manner, affect, and reactions to persons and things in the environment. Listen to the patient's manner of speaking and note the state of awareness or level of consciousness.

The survey continues throughout the history and examination.

Vital Signs. Measure height and weight. Measure the blood pressure. Count the pulse and respiratory rate. If indicated, measure the body temperature.

Skin. Observe the skin of the face and its characteristics. Identify any lesions, noting their location, distribution, arrangement, type, and color. Inspect and palpate the hair and nails. Study the patient's hands. Continue your assessment of the skin as you examine the other body regions.

Head, Eyes, Ears, Nose, Throat (HEENT). Head: Examine the hair, scalp, skull, and face. Eyes: Check visual acuity and screen the visual fields. Note the position and alignment of the eyes. Observe the eyelids and inspect the sclera and conjunctiva of each eye. With oblique lighting, inspect each cornea, iris, and lens. Compare the pupils, and test their reactions to light. Assess the extraocular movements. With an ophthalmoscope, inspect the ocular fundi. Ears: Inspect the auricles, canals, and drums. Check auditory acuity. If acuity is diminished, check lateralization (Weber test) and compare air and bone conduction (Rinne test). Nose and sinuses: Examine the external nose; using a light and a nasal speculum, inspect the nasal mucosa, septum, and turbinates. Palpate for tenderness of the frontal and maxillary sinuses. {Throat (or mouth and pharynx): Inspect the lips, oral mucosa, gums, teeth, tongue, palate, tonsils, and pharynx. (You may wish to assess the cranial nerves during this portion of the examination.)

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