GENERAL SURVEY/STATUS

Question 1

First, look for the obvious; then look for closer cues that might signal a
problem
* Make a mental note of any clues detected on the general survey that you may
need to follow-during the physical examination

Answer 1

General Survey

Question 1

begins with the opening moments of the patient ecounter.
* “First impression” of your patient
* Use your senses and observation skills

Answer 1

General Survey

Question 2

• Is the patient acutely or chronically ill?
• Is the patient frail?
• Is the patient fit or robust?
• Is the patient overweightor underweight?

Answer 2

Apparent State of Health

Question 3

• Is the patient awake, alert, and responsive to you and others in the environment?
• Is the patient drowsy, lethargic or stuporous?
• Is the patient unconscious?

Answer 3

Level of Consciousness

Question 4

Level of Consciousness (Arousal) Techniques

Answer 4

Alertness
Lethargy
Obtundation
Stupor
Coma

Question 5

Look for evidences of a health problem

Answer 5

Signs of Distress

Question 6

• Is there clutching of the chest?
• Is there pallor? Cyanosis? Diaphoresis?
• Is there labored breathing, wheezing, or coughing?

Answer 6

Cardiac or Respiratory Distress

Question 7

• Is there wincing, diaphoresis, protectiveness of a painful area, grimacing, or unusual posture favoring one limb or region of the body?

Answer 7

Pain

Question 8

• Are there any anxious facial expressions, fidgety movements, cold moist palms, inexpressive or flat affect, poor eye contact, or psychomotor slowing?

Answer 8

Anxiety or Depression

Question 9

• Observe facial expression at rest, during conversation and social interactions, and during the physical examination
• Ask yourself what is the patient’s face telling me?
• Do you see pain, fear, or anxiety?
• Does the patient maintain eye contact?
• Is his/her facial expression happy or sad?
• Look at the facial features. Are they symmetrical?

Answer 9

Facial Characteristics

Question 10

• drooping of the eyelid
• May suggest an underlying neurological disorder

Answer 10

Ptosis

Question 11

May indicate a transient
ischemic attack or stroke

Answer 11

Drooping on one side of the face

Question 12

• Bulging or protruding eyeballs
• May suggest hyperthyroidism

Answer 12

Exophthalmos

Question 13

Inspect for any changes in skin color, scars, plaques, or nevi

Answer 13

Skin Color and Obvious Lesions

Question 14

pale complexion or unusual lightness of skin color; may indicate anemia, malnutrition, vitamin deficiency

Answer 14

Pallor

Question 15

bluish discoloration of the skin or mucous membrane; may indicate poor oxygenation

Answer 15

Cyanosis

Question 16

yellowish discoloration of the skin or mucous membranes; may suggest an underlying hepatobiliary tract disease

Answer 16

Jaundice

Question 17

medical term for a mole; a common benign skin lesion
but some may be malignant

Answer 17

Nevus

Question 18

• Excess clothing may reflect cold intolerance of hypothyroidism, hide skin rash or needle marks, mask anorexia, or signal personal lifestyle preferences

Answer 18

Dress, Grooming, and Personal Hygiene