What should be included in a general medical exam for a patient with an unknown medical history and presentation?

General Physical Examination Components

The general physical examination should systematically assess vital signs, overall appearance, skin integrity, cardiovascular and respiratory systems, neurological status, and signs of trauma or systemic illness, with specific attention to findings that may indicate serious underlying pathology or guide immediate management decisions. 1

Vital Signs Assessment

All patients require comprehensive vital sign measurement as the foundation of the general examination:

• Measure blood pressure in both arms to identify potential subclavian artery stenosis or asymmetry that may indicate vascular disease 2
• Record heart rate, respiratory rate, temperature, and oxygen saturation as these are essential indicators of physiological status and risk stratification 1, 3
• Assess orthostatic blood pressure changes (supine and standing measurements) when indicated, particularly in older adults, those with diabetes, or patients with symptoms suggesting volume depletion 1, 2
• Document pain level as an additional vital parameter in appropriate clinical contexts 4

General Appearance and Mental Status

• Evaluate age-appropriate responsiveness to environment and overall level of alertness 1
• Assess orientation to person, place, and time to screen for delirium or altered mental status 1, 2
• Observe for signs of acute distress, respiratory effort, or abnormal positioning 1
• Note any craniofacial abnormalities affecting mandible, maxilla, or nasal structures 1

Skin and Integumentary Examination

• Inspect skin color and perfusion status to identify cyanosis, pallor, or mottling 1
• Look for evidence of injury including bruising, erythema, or other trauma 1
• Examine for stigmata of coagulopathies or platelet disorders such as petechiae or purpura 1
• Identify embolic lesions (Janeway lesions, Osler nodes) that may indicate endocarditis 1
• Check for acanthosis nigricans as a marker of insulin resistance 1

Head, Eyes, Ears, Nose, and Throat

• Examine head shape and fontanelles (in infants), looking for signs of trauma 1
• Assess pupillary response to light and extraocular movements 1
• Look for conjunctival hemorrhage which may indicate trauma or coagulopathy 1
• Inspect tympanic membranes for infection or perforation 1
• Examine nasal passages and oropharynx for blood, trauma, or obstruction 1
• Check for torn frenulum which may indicate trauma or abuse 1

Neck Examination

• Assess neck mobility and range of motion 1
• Auscultate for carotid bruits which may indicate cerebrovascular disease 1
• Palpate thyroid gland for enlargement or nodules 1

Cardiovascular Examination

• Auscultate heart for rhythm, rate, murmurs, and extra sounds to identify arrhythmias or valvular disease 1
• Assess peripheral pulses in all extremities, including pedal pulses 1, 2
• Palpate and auscultate for signs of congestive heart failure including jugular venous distention 1
• Perform ankle-brachial index when peripheral arterial disease is suspected 1, 2

Respiratory Examination

• Auscultate lungs bilaterally for breath sounds, wheezes, rales, or rhonchi 1
• Palpate chest wall for rib tenderness, crepitus, or irregularities suggesting fracture 1
• Observe respiratory pattern and effort including use of accessory muscles 1

Abdominal Examination

• Inspect for distention and visible masses 1
• Palpate for organomegaly, masses, and tenderness 1
• Assess for peritoneal signs when abdominal pathology is suspected 1

Musculoskeletal and Extremities

• Examine for limb deformities consistent with fractures 1
• Assess muscle tone and strength symmetrically 1
• Look for joint swelling, erythema, or limitation of movement 1

Neurological Examination

• Test symmetry of reflexes bilaterally 1
• Assess symmetry of movement, tone, and strength in all extremities 1
• Evaluate response to sound and visual stimuli 1
• Perform sensory testing including vibration, pinprick, and 10-gram monofilament (when diabetic neuropathy is a concern) 1

Growth Parameters (When Applicable)

• Measure height, weight, and calculate BMI 1, 2
• Measure waist circumference in adults with metabolic concerns 2
• Assess occipitofrontal circumference in infants and young children 1
• Evaluate growth and pubertal development in children and adolescents 1

Common Pitfalls to Avoid

Do not rely on incomplete vital sign assessment - missing respiratory rate or oxygen saturation measurements can result in failure to identify deteriorating patients 3, 4. Avoid measuring blood pressure in only one arm - bilateral measurements are necessary to detect vascular asymmetry 2. Do not skip orthostatic vital signs in high-risk populations (elderly, diabetic, volume-depleted) as this may miss significant postural hypotension 1, 2. Ensure proper blood pressure technique - use appropriate cuff size, position arm at heart level, and allow adequate rest before measurement to avoid inaccurate readings 5.