THE GENERAL SURVEY

Physical Appearance
Criteria Normal Findings Abnormal Findings

Age  The person appears  Appears older than

his or her stated age. stated age, as with
chronic illness and
chronic alcoholism.

Sex  Sexual development  Delayed or

is appropriate for precocious puberty.
gender and age.

Level of Consciousness  The person is alert  Confused, drowsy,

and oriented, attends lethargic
to your questions
and responds
appropriately.

Skin Colour  Colour tone is even,  Pallor, cyanosis,

pigmentation varying jaundice, erythema,
with genetic any lesions.
background, skin is
intact with no
obvious lesions.

Facial Features  Facial features are  Immobile, masklike,

symmetrical with asymmetric,
movement. drooping.

Pain  No signs of acute  Facial grimace and

distress present. holding body part or
respiratory
symptoms, such as
shortness of breath
and wheezing.
 Body Structure
Criteria Normal Findings Abnormal Findings

Stature  The height appears within normal  Excessively short or tall.

range for age, genetic heritage.

Nutrition  The weight appears within normal  Cachectic and emaciated or

range for height and body build; simple obesity, with even fat
body fat distribution is even. distribution.
 Centripetal (truncal) Obesity:
Fat concentrated in face, neck,
trunk, with thin extremities, as in
Cushing's syndrome
(hyperadrenalism).

Symmetry  Body parts look equal bilaterally and  Unilateral atrophy or

are in relative proportion to each hypertrophy and asymmetrical
other. location of a body part.

Posture  The person stands comfortably erect  Rigid spine and neck; moves as
as appropriate for age. Note the one unit (e.g., arthritis).
normal “plumb line” through anterior  Stiff and tense, ready to spring
ear, shoulder, hip, patella, ankle. from chair, fidgety movements.
Exceptions are the standing toddler  Shoulders slumped; looks
who has a normally protuberant deflated (e.g., depression).
abdomen (“toddler lordosis”) and the
aging person who may be stooped
with kyphosis.

Position  The person sits comfortably in a  Tripod - leaning forward with

chair or on the bed or examination arms braced on chair arms;
table, arms relaxed at sides, head occurs with chronic pulmonary
turned to examiner. disease.
 Sitting straight up and resists
lying down (e.g., congestive
heart failure).
 Curled up in fetal position (e.g.,
acute abdominal pain).

Body Build and Proportions are:  Obvious physical deformities

Contour  1. Arm span (fingertip to fingertip) Note: Any congenital or
equals height. acquired defects.
 2. Body length from crown to pubis
 roughly equal to length from pubis to
sole.

Mobility
Criteria Normal Findings Abnormal Findings

Gait  Normally, the base is  Exceptionally wide

as wide as the base.
shoulder width; foot  Staggered,
placement is stumbling.
accurate; the walk is  Shuffling, dragging,
smooth, even, and nonfunctional leg.
well-balanced; and  Limping with injury.
associated  Propulsion - difficulty
movements, such as stopping.
symmetrical arm
swing, are present.

Range of Motion  Note full mobility for  Limited joint range of

each joint, and that motion.
movement is  Paralysis—absent
deliberate, accurate, movement.
smooth, and  Movement jerky,
coordinated. (Refer uncoordinated.
to Chapter 22 for  No involuntary
information on more movement.
detailed testing of  Tics, tremors,
joint range of seizures (Refer to
motion.) Chapter 23 for
Neurological
disorders that affect
ROM)
 Behaviour
Criteria Normal Findings Abnormal Findings

Facial Expression  The person maintains eye  Flat, depressed, angry, sad, anxious.
contact (unless a cultural taboo However, note that anxiety is
exists), expressions are common in ill people. Also, some
appropriate to the situation; e.g., people smile when they are anxious.
thoughtful, serious, or smiling.
(Note: Expressions both while
the face is at rest and while the
person is talking.)

Mood and Affect  The person is comfortable and  Hostile, distrustful, suspicious,
co-operative with the examiner crying.
and interacts pleasantly.

Speech  Articulation (the ability to form  Dysarthria and dysphagia. Speech

words) is clear and defect, monotone, garbled speech.
understandable.  The stream of talking is fluent, with
an even pace.
 The person conveys ideas clearly.
 Word choice is appropriate to culture
and education.
 The person communicates in native
language easily by himself or herself
or with an interpreter.
 Extremes of few words or of constant
talking.

Dress  Clothing is appropriate to the  Trousers too large and held up by

climate, looks clean and fits the belt suggests weight loss, as does
body, and is appropriate to the the addition of new holes in belt. If
person's culture and age group; the belt is moved to a looser fit, it
for example, Amish women may may indicate obesity or ascites.
wear nineteenth century–style  Consistent wear of certain clothing
clothing, and Indian women may may provide clues: long sleeves may
wear saris. Culturally conceal needle marks of drug abuse;
determined dress should not be broad-brimmed hats may reveal sun
labelled as bizarre by Western intolerance; Velcro fasteners instead
standards or by adult of buttons may indicate chronic
expectations. motor dysfunction.

Personal Hygiene  The person appears clean and  In a previously carefully groomed
groomed appropriately for his for woman, unkempt hair and absent
her age, occupation and makeup may indicate malaise or
socioeconomic group. (Note: A illness.
wide variation of dress and
hygiene is “normal”).
 Hair: Groomed, brushed.
Women's makeup is appropriate
for age and culture.