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General Physical Examination

I. General Appearance & Initial Assessment:

  • Consciousness: Conscious / Not conscious (e.g., alert, drowsy, stuporous, comatose)

  • Orientation: Oriented to time, place, and person / Not oriented

  • Cooperation: Cooperative / Not cooperative

  • Built: Average / Asthenic / Sthenic / Athletic / Obese

  • Nourishment: Well-nourished / Adequately nourished / Poorly nourished / Emaciated

  • Decubitus: (e.g., orthopneic, restless, comfortable)

  • Pallor: Present / Absent (check conjunctiva, tongue, nails, skin). If present: Mild / Moderate / Severe.

  • Icterus (Jaundice): Present / Absent (check sclera, skin).

  • Cyanosis: Present / Absent

    • Central: Present / Absent (check lips, tongue, mucous membranes)

    • Peripheral: Present / Absent (check nail beds, extremities)

  • Clubbing: Present / Absent. If present:

    • Type: (e.g., Unilateral, Bilateral)

    • Grade: (e.g., Stage 1, 2, 3, 4)

  • Edema: Present / Absent. If present:

    • Site: (e.g., Pedal, Sacral, Periorbital, Generalized)

    • Pitting/Non-pitting: Pitting / Non-pitting

    • Grade: (e.g., +1, +2, +3, +4)

  • Lymphadenopathy: Present / Absent (mention site if present: cervical, supraclavicular, axillary, inguinal).

II. Vital Parameters:

  • Pulse:

    • Rate: ___ beats/min

    • Rhythm: Regular / Irregularly regular / Irregularly irregular

    • Volume: Good / Normal / Weak / Thready / Bounding

    • Character: (e.g., Pulsus alternans, Collapsing pulse, Pulsus paradoxus, Dicrotic pulse)

    • All Peripheral Pulses: Palpable / Not palpable (mention specific pulses: radial, brachial, femoral, popliteal, dorsalis pedis, posterior tibial – presence and symmetry)

  • Blood Pressure (BP):

    • Right Arm (Supine): ___ / ___ mmHg

    • Left Arm (Supine): ___ / ___ mmHg

    • (If indicated): Right Arm (Standing) ___ / ___ mmHg, Left Arm (Standing) ___ / ___ mmHg (check for orthostatic hypotension)

    • Pulse Pressure: ___ mmHg

    • Auscultatory Gap: Present / Absent

  • Respiration Rate: ___ breaths/min

    • Rhythm: Regular / Irregular (e.g., Cheyne-Stokes, Kussmaul, Biot's)

    • Type: Abdomino-thoracic / Thoraco-abdominal

    • Use of Accessory Muscles: Present / Absent

  • Temperature: ___ °F / °C

III. General Examination Relevant to CVS

Signs of Infective Endocarditis

  • Fever and malaise

  • Heart murmur: new or changing

  • Splinter hemorrhages: linear reddish-brown marks under the nails

  • Osler’s nodes: painful, tender, red or purple nodules found on fingers and toes

  • Janeway lesions: painless, erythematous macules on palms and soles

  • Roth spots: pale-centered retinal hemorrhages on fundoscopic exam

  • Clubbing: late sign

  • Petechiae: on conjunctiva, palate, or skin

  • Mild splenomegaly

  • Signs of embolic phenomena: neurological deficits, hematuria, etc.

Signs of Rheumatic Fever

  • Fever

  • Migratory polyarthritis: tender, swollen joints, especially large joints (knees, ankles, elbows, wrists)

  • Carditis: tachycardia, new murmur, pericardial rub, signs of heart failure

  • Chorea (Sydenham’s chorea): rapid involuntary movements

  • Erythema marginatum: pink, non-pruritic, serpiginous rash on trunk and limbs

  • Subcutaneous nodules: firm, painless nodules over extensor surfaces

  • Other: abdominal pain, epistaxis, malaise

Signs of Cardiac Failure

  • General: Breathlessness, fatigue, orthopnea, paroxysmal nocturnal dyspnea

  • Inspection: Cyanosis (central and/or peripheral), cachexia, restlessness or confusion (in severe cases)

  • Palpation: Laterally displaced and diffuse apex beat

  • Auscultation:

    • Third heart sound (S3)

    • Fourth heart sound (S4)

    • Gallop rhythm

    • Accentuated pulmonary component of S2 if pulmonary hypertension present

  • Neck veins: Raised jugular venous pressure (JVP)

  • Peripheral edema: Ankles, sacrum

  • Hepatomegaly: Sometimes tender, due to hepatic congestion

  • Crepitations: Basal lung crackles from pulmonary congestion

  • Pleural effusion (especially bilateral)

Signs of Congenital Heart Disease

  • Cyanosis: Bluish discoloration of skin, lips, nail beds

  • Clubbing of fingers/toes (in longstanding cyanotic diseases)

  • Pulse: Abnormalities such as bounding or weak pulses, discrepancy between upper and lower limb pulses

  • Heart sounds: Presence of murmurs, clicks, or abnormal heart sounds

  • Growth retardation: Failure to thrive in infants, poor weight gain, or stunted growth in children

  • Other: Signs of heart failure (edema, hepatomegaly, tachypnea), excessive sweating, particularly during feeding in infants

Signs of Marfan's Syndrome

  • Body habitus: Tall, thin stature, arm span greater than height

  • Arachnodactyly: Long, slender fingers and toes

  • Chest deformities: Pectus excavatum (sunken chest) or pectus carinatum (protruding chest)

  • Scoliosis or abnormal spinal curvature

  • High-arched palate, crowded teeth

  • Joint hypermobility

  • Ectopia lentis: Dislocated eye lens (on ophthalmological exam)

  • Cardiac features: Mitral valve prolapse (mid-systolic click), aortic regurgitation or dilation

Signs of Thyroid Dysfunction

Thyrotoxicosis (Hyperthyroidism):

  • General: Weight loss, fine tremor, warm and moist skin, palmar erythema, anxiety

  • Eyes: Lid lag, staring appearance, exophthalmos (in Graves’ disease)

  • Pulse: Tachycardia, atrial fibrillation

  • Hyperdynamic circulation: Bounding pulse

  • Goiter: Diffuse or nodular thyroid swelling

Hypothyroidism:

  • General: Weight gain, dry/coarse skin and hair, myxedema (periorbital puffiness)

  • Bradycardia

  • Delayed reflexes

  • Non-pitting edema

  • Cold intolerance