Introduction

General examination can reveal abnormalities in a number of systems which may assist in making an accurate diagnosis.

Disorders of gait, speech and mood should be apparent on first meeting the patient and during the consultation process. Dyspnoea may be observed and abnormal movements, including tremor or paucity of facial expression, should be noted.

During the general examination, obvious features of systemic disease in one site should be correlated with signs elsewhere.

Hands

Note

joint disorders – arthritis, gout, deformity
neuromuscular changes – muscle wasting, loss of function
skin temperature

warm, cyanosed hands with bounding pulse in CO₂ retention

cold pale hands with arterial disease

fingers

Raynaud’s phenomenon, other signs of systemic sclerosis

nicotine staining

Osler’s nodes (endocarditis, vasculitis)

nails

anaemia (pallor, koilonychia)

peripheral cyanosis

splinter haemorrhages

clubbing – swelling of the ends of the fingers with increased curvature of the nails and loss of the angle at the nail beds
palmar erythema
Dupuytren’s contracture
tremor

fine tremor may be exaggerated by placing a piece of paper over the patient’s outstretched hands