Physical Exam

General Inspection

also known as General survey, General appearance

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Video coming September 2026

How to Perform

Step back and observe the patient as a whole. Note the apparent state of health, level of distress, body habitus and nutritional state, level of consciousness and alertness, posture, and any abnormal movements, along with personal hygiene and grooming and the color and condition of the skin. Note any obvious odors and the patient's behavior, mood, and interaction during the encounter.

How to Interpret

Aspiration

Drowsiness in a patient with acute stroke

Rule in

HelpfulDerived CI

Rule out

Minimally helpfulDerived CI

Evidence:Limited

Bowel Obstruction

Visible peristalsis

Rule in

Very helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Limited

Hepatopulmonary Syndrome

Cyanosis

Rule in

Somewhat helpfulDerived CI

Rule out

HelpfulDerived CI

Evidence:Limited

Hypothyroidism

Slow movements

Rule in

Not helpful

Rule out

Not helpful

Evidence:Limited

Multiple System Atrophy

Absence of tremor

Rule in

InconclusiveWide CI

Rule out

Not helpfulDerived CI

Evidence:Limited

Myocardial Infarction

Diaphoresis

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Strong

Pulmonary Embolism

Diaphoresis

Rule in

Not helpfulNo CI

Rule out

Minimally helpfulNo CI

Evidence:Limited

Cyanosis

Rule in

InconclusiveWide CI

Rule out

Not helpfulDerived CI

Evidence:Limited

Serious Infection

Clinician's "gut feeling" that the child is more unwell than the examination suggests

Rule in

Very helpfulDerived CI

Rule out

InconclusiveWide CI

Evidence:Limited

References

Research in progress on one or more findings above; ratings may change.

Van den Bruel A, Thompson M, Buntinx F, Mant D. Clinicians' gut feeling about serious infections in children: observational study. BMJ. 2012;345:e6144. doi:10.1136/bmj.e6144. PMID: 23015034.
Bruyninckx R, Aertgeerts B, Bruyninckx P, Buntinx F. Signs and symptoms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis. Br J Gen Pract. 2008;58(547):e1-e8. PMID: 18307844.
Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med. 2007;120(10):871-9. PMID: 17904458.
Alizadeh AH, Fatemi SR, Mirzaee V, Khoshbaten M, Talebipour B, Sharifian A, Khoram Z, Haj-sheikh-oleslami F, Gholamreza-shirazi M, Zali MR. Clinical features of hepatopulmonary syndrome in cirrhotic patients. World J Gastroenterol. 2006;12(12):1954-1956. PMID: 16610006.
O'Connor KW, Snodgrass PJ, Swonder JE, Mahoney S, Burt R, Cockerill EM, Lumeng L. A blinded prospective study comparing four current noninvasive approaches in the differential diagnosis of medical versus surgical jaundice. Gastroenterology. 1983;84(6):1498-1504. PMID: 6840479.
Leibovici L, Greenshtain S, Cohen O, Mor F, Wysenbeek AJ. Bacteremia in febrile patients: a clinical model for diagnosis. Arch Intern Med. 1991;151(9):1801-1806. PMID: 1888246.
Indra R, Patil SS, Joshi R, Pai M, Kalantri SP. Accuracy of physical examination in the diagnosis of hypothyroidism: a cross-sectional, double-blind study. J Postgrad Med. 2004;50(1):7-11. PMID: 15047991.
Nugent CA, Warner HR, Dunn JT, Tyler FH. Probability theory in the diagnosis of Cushing's syndrome. J Clin Endocrinol Metab. 1964;24:621-630. PMID: 14212081.
León-Justel A, Madrazo-Atutxa A, Alvarez-Rios AI, et al. A probabilistic model for Cushing's syndrome screening in at-risk populations: a prospective multicenter study. J Clin Endocrinol Metab. 2016;101(10):3747-3754. doi:10.1210/jc.2016-1673. PMID: 27490917.
Smithard DG, O'Neill PA, England RE, et al. Can bedside assessment reliably exclude aspiration following acute stroke? Age Ageing. 1998;27(2):99-106. PMID: 16296668.
Böhner H, Yang Z, Franke C, Verreet PR, Ohmann C. Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. Eur J Surg. 1998;164(10):777-784. PMID: 9840308.
Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20(6):528-544. doi:10.1111/acem.12150. PMID: 23758299.
Wenning GK, Ben-Shlomo Y, Hughes A, Daniel SE, Lees A, Quinn NP. What clinical features are most useful to distinguish definite multiple system atrophy from Parkinson's disease? J Neurol Neurosurg Psychiatry. 2000;68(4):434-440. doi:10.1136/jnnp.68.4.434. PMID: 10727478; PMCID: PMC1736862.
Diehr P, Wood RW, Bushyhead J, Krueger L, Wolcott B, Tompkins RK. Prediction of pneumonia in outpatients with acute cough - a statistical approach. J Chronic Dis. 1984;37(3):215-225. doi:10.1016/0021-9681(84)90149-8. PMID: 6699126.
Litaker D, Pioro M, El Bilbeisi H, Brems J. Returning to the bedside: using the history and physical examination to identify rotator cuff tears. J Am Geriatr Soc. 2000;48(12):1633-1637. PMID: 11129754.
Gravelyn TR, Weg JG. Respiratory rate as an indicator of acute respiratory dysfunction. JAMA. 1980;244(10):1123-1125. PMID: 7411767.
Geetadevi Y, Joshi R, Pai M, Kalantri SP. Simple clinical predictors of brain lesions in patients with impaired consciousness: a cross sectional study from a rural, tertiary hospital in central India. Clin Neurol Neurosurg. 2005;108(1):25-31. doi:10.1016/j.clineuro.2004.12.018. PMID: 16311141.
Medd WE, French EB, Wyllie VM. Cyanosis as a guide to arterial oxygen desaturation. Thorax. 1959;14(3):247-250. PMC1018507.
Hung OL, Kwon NS, Cole AE, et al. Evaluation of the physician's ability to recognize the presence or absence of anemia, fever, and jaundice. Acad Emerg Med. 2000;7(2):146-156. PMID: 10691073.
Huo Z, et al. Diagnostic Criteria for Cancer-Associated Cachexia: Insights from a Multicentre Cohort Study. J Cachexia Sarcopenia Muscle. 2025. PMID: 39949111.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.