Physical examination is the second essential part of evaluating a patient. By this stage, some observations would already have been made regarding the patient’s speech, general appearance, and mental condition. The next step is to collect further information by observing definite physical signs of disease. To perform a proper examination, it is necessary to have a clock or watch with a second hand, a blood pressure apparatus, a stethoscope, a thermometer, and a quiet room.

Vital signs

Vital signs must be checked by measuring the patient’s blood pressure, pulse rate, and body temperature. These provide important basic information about the patient’s condition.

General appearance

The patient’s overall appearance should be observed carefully. The position of the body and facial expression must be noted. It should be assessed whether the patient appears tense, restless, or in an unusual posture. The examiner should also observe the patient’s general ability to move and respond.

Skin

The skin should be examined thoroughly for any abnormalities. The location of rashes or sores should be noted, and their characteristics should be carefully observed. It should be determined whether the rash is red, whether it consists of small or large spots, and whether the spots are separate or merging together. The examiner should also check whether the rash is itchy, raised, or flat. The condition of the skin should be assessed to see if it is hot and dry or cold and wet. The colour of the skin is important, especially for identifying jaundice, which causes yellowing. The lips and nail beds should also be observed to see whether they appear bluish (dusky) or pale and white.

Head

The head should be examined for any evidence of trauma such as cuts, bruises, or swelling.

Eyes

The eyes should be checked for signs of jaundice or inflammation in the sclera, which is the white part of the eye. It is best to check for jaundice in sunlight, as artificial light may sometimes give a slightly yellow appearance even in normal individuals. The examiner should check whether both eyes move together in all directions, including up, down, and sideways. The pupils should also be examined to see if they are equal in size and whether they react normally to light by becoming smaller.

Ears

The ears should be carefully examined for any blood in the ear canal, especially if there is a known or suspected head injury.

Nose

The nose should be checked for any bleeding or abnormal discharge.

Mouth and throat

The mouth and throat should be examined thoroughly. The gums should be checked for swelling or extreme redness. The colour and movement of the tongue should be observed for any abnormalities. The throat should be inspected for redness, swelling, or ulcerated patches. The patient should be observed while swallowing to detect any difficulty. Any abnormal odour of the breath should also be noted.

Neck

The patient should be asked to lie down, and the examiner should place hands behind the patient’s head. When the patient is relaxed, the head should be gently lifted forward so that the chin touches the chest. This helps identify abnormal stiffness or discomfort. The examiner should also observe whether there is pain when the patient’s legs are lifted with the knees straight. The sides of the neck should be checked for enlarged glands, noting whether they are tender, movable, soft, or hard.

Chest

The patient’s breathing should be observed carefully. The examiner should note whether breathing is painful and whether both sides of the chest move equally.

Nervous system

The nervous system should be evaluated by observing the patient’s mental state and behaviour. It should be noted whether the patient shows abnormal concern about the illness. The examiner should assess whether the patient is rational, whether behaviour is normal, and whether the patient can remember simple details such as the current date and perform basic arithmetic. Coordination and walking ability should also be tested by asking the patient to walk a few steps and pick up objects with each hand. If the patient is too ill to walk, the examiner should observe how the patient moves, turns, and handles objects while in bed.