GENERAL SURVEY

Part 1: Physical Appearance 

  1. Age → the person should appear in accordance with its age. 

ABN findings: 

  • Chronic Illnesses 

  • Metabolic Endocrine Problems

  • Chronic Alcoholism

  1. Sex → refers to biological aspect (gender)

Take note: if the patient is transgender, note the transitioning phase

(M to F or F to M)

ABN findings:

  • Delayed puberty

  1. L.O.C (level of consciousness) - the patient is alert and oriented, attends to your questions and responds appropriately.

  • Person

  • Time

  • Place

  • Situation

ABN findings: Delirium (Acute Confusional State)

- Confused

- Drowsy

- Lethargic (semi-coma)

  1. Skin Color - color tone is even, pigmentation varying with genetic background, skin is intact with no obvious lesions.

ABN findings

  • Pallor (maputla)

  • Cyanosis (bluish)

  • Coldplay (jaundice) (yellowish)

  • Erythema

  • Any lesions (abnormality of skin)

  1. Facial Features - are symmetric with the environment. 

Common facial deformities: 

  • Stroke → Cerebrovascular Accident → Paralysis

  • Bell’s palsy 

ABN findings:

  • Immobile

  • Masklike

  • Asymmetric

  • Drooping

No signs of acute distress are present

ABN findings:

Respiratory signs - shortness of breath. Wheezing

Pain, indicated by facial grimacing, holding body part

Part 2: Body Structure

  1. Stature - the height appears within normal range for age, genetic heritage.

ABN findings: 

  • Excessively short or tall

Gigantism vs Acromegaly

Gigantism (vertical growth)

High Growth Hormone - open epiphyseal plate (>7ft.)

Acromegaly (horizontal growth)

High Growth Hormone - closed epiphyseal plate

Low Growth Hormone - Dwarfism 

  1. Nutrition - the weight appears within normal range for height and body fat distrbution is even. 

  • Ectomorph - tall, long, lean limbs

  • Endomorph - stock build, prominent abdomen

  • Mesomorph - muscular build

ABN findings:

- cachectic, emaciated

- simple obesity, with even fat distribution 

- centripetal (truncal) obesity - fat concentrated in face, neck, trunk, with thin extremities, as in Cushing’s syndrome (hyperadrenalism)

  1. Symmetry - body parts look equal bilaterally and are in relative proportion to each other.

ABN findings:

- unilateral atrophy or hypertrophy

- asymmetric location of a body part

  1. Posture - the person stand comfortably erect at appropriate for age 

Common problems:

  • Scoliosis

  • Lordosis

  • Kyphosis

  1. Patient Positioning - sits comfortable with arms at sides

ABN findings:

- tripod

  1. Body Build, contour - proportions are

  1. Arm span (fingertip to fingertip) equals height

  2. Body Length from crown to pubis roughly equal to length from pubis to sole

Obvious physical deformities - note any congenital or acquired deformities/defects.

ABN findings:

- Marfan’s syndrome (arm span greater than height)

- Missing extremities or digits; webbed digits; shortened limbs

Part 3: Mobility 

  1. Gait - normally, the base is as wide as the shoulder width; foot placement is accurate; the walk is smooth, even and well-balanced; and associated movements, such as symmetric arm swing, are present. 

ABN findings:

  • Exceptionally wide base

  • Nonfunctional leg 

  • Limping with injury

  • Propulsion → difficulty stopping

  1. Range of motion - note full mobility for each joint, and that movement is deliberate, accurate, smooth, and coordinated. No involuntary movement.

ABN findings:

  • Limited joint range of motion

  • Paralysis - absent movement

  • Movement jerky, uncoordinated

  • Tic, tremors, seizures

Part 4: Behavior 

  1. Facial Expression - expressions that are appropriate to the situation or should match with the event. 

ABN findings:

  • Flat, depressed, angry, sad, anxious

  • However, note that anxiety is common in ill people. Also, some people smile when they are anxious.

  1. Mood and affect - the person is comfortable and cooperative with the examiner and interacts pleasantly. 

ABN findings:

  • Hostile

  • Distrustful

  • Suspicious

  • Crying

  1. Speech - articulation (the ability to form words) is clear and understandable.

Brocha’s Aphasia - can’t speak but can understand

Wernick’s Aphasia - can speak but can’t understand

  1. Dress - clothing is appropriate to the climate, looks clean, and fits the body, and is appropriate to the person’s culture and age group.

ABN findings:

  • Trousers too large and held up by the belt suggest weight loss, as does the addition of new holes in the belt. If the belt is moved to a looser fit, it may indicate ascites or obesity.

  1. Personal Hygiene - the person appears clean and groomed appropriately for his or her age, occupation and socioeconomic group. Note that a wide variation of dress and hygiene is “normal”. Many cultures do not include use of deodorant or women shaving legs. Hair is groomed, brushed. Women’s make-up is appropriate for age and culture.

ABN findings:

  • In an previously carefully, groomed woman, unkempt hair and absent makeup may indicate or illness.