Physical Examination

GP clinical examination reference

General Examination Overview

Systematic approach to physical examination — vital signs, end-of-bed assessment, hands, face, and presentation-guided exam selection. Follow IPPA: Inspect → Palpate → Percuss → Auscultate.

Vital SignsHands ExamFace SignsPresentation Guide

Before You Start — 3 Ps

P

Position

Patient at 45° for cardiovascular; lying flat for abdominal; sitting for respiratory.

P

Permission

Introduce yourself, explain examination, gain consent. Chaperone for intimate exams.

P

Pain

Ask if the patient has any pain before you begin. Examine painful areas last.

IPPA Sequence

I

Inspect

From end of bed first — colour, distress, posture, equipment in use, cachexia.

P

Palpate

Light palpation first, then deep. Watch face for pain. Warm hands.

P

Percuss

Systematic — compare sides. Dullness = solid or fluid. Resonance = air.

A

Auscultate

Listen methodically. Compare sides. Use diaphragm for high-pitched, bell for low-pitched sounds.

Vital Signs Quick Reference

Heart Rate

Normal60–100 bpm
Low<60 → bradycardia
High>100 → tachycardia

Resting athlete: 40–60 bpm normal. Irregularly irregular → AF.

Blood Pressure

Normal<130/80 mmHg
Low<90/60 → hypotension
High≥140/90 → hypertension

Measure both arms. >10 mmHg difference → subclavian stenosis or aortic dissection.

Respiratory Rate

Normal12–20 breaths/min
Low<12 → bradypnoea (opioids, metabolic)
High>20 → tachypnoea (sepsis, PE, heart failure)

Most sensitive early sign of deterioration. Count for a full 60 seconds.

SpO₂ (Oxygen Sat)

Normal95–100%
Low<94% → supplemental O₂ indicated; <90% → emergency
HighNot clinically significant

COPD target: 88–92%. Unreliable with nail polish, peripheral vasoconstriction, or carbon monoxide poisoning.

Temperature

Normal36.1–37.2°C
Low<36°C → hypothermia (sepsis, exposure)
High>37.5°C → fever; >38°C → pyrexia; >40°C → hyperpyrexia

Oral temperature most common in GP. Axillary reads 0.5°C lower. Elderly may not mount fever.

BMI

Normal18.5–24.9 kg/m²
Low<18.5 → underweight
High≥25 overweight; ≥30 obese; ≥40 morbidly obese

Waist circumference >88 cm (F) / >102 cm (M) = metabolic risk, independent of BMI.

Hands Examination — Key Signs

Face & Head Examination Signs

Presentation → Examination Priority Guide

Chest pain

Examine: Cardiovascular → Respiratory → Abdominal (epigastric)

Breathlessness

Examine: Respiratory → Cardiovascular (heart failure) → Abdominal (ascites)

Abdominal pain

Examine: Abdominal (full) → consider Respiratory (referred) → PR if indicated

Headache

Examine: Neurological (full cranial nerves) → Cardiovascular (BP, carotids) → Eye (fundi)

Joint pain

Examine: MSK (affected joint + surrounding joints) → Systemic (hands, skin, eyes for RA/PsA)

Dizziness/collapse

Examine: Cardiovascular (postural BP, pulse) → Neurological (cerebellar, cranial nerves)

Swollen leg

Examine: Cardiovascular (JVP, heart failure) → Abdominal (pelvic mass, lymph nodes) → consider DVT

Weight loss

Examine: Systematic exam of all systems — hands, lymph nodes, abdominal (organomegaly/mass), thyroid