General Examination

Symptoms and signs elicited from the general aspects of the history and physical examination are the first signals that alert clinicians toward specific findings that help make diagnoses.

Weight Change

Significant involuntary weight loss usually means a decrease in body weight of 5 to 7% over 6 months or less. Weight loss due to malignancy is almost always associated with anorexia, whereas weight loss due to hyperthyroidism occurs despite an enormous appetite. Weight changes of 1.5 to 3.5 kg are not infrequent after starting or discontinuing diuretic therapy.

Fever, Chills, and Night Sweats

Most abrupt changes in body temperature are associated with sweating and a sensation of chilliness. Hard, teeth-rattling, shaking chills, however, usually occur only with bacterial, rickettsial, or malarial infections.

Dizziness

Most patients with dizziness or vertigo have either inner ear disease, orthostatic hypotension, or no definable cause. Cardiac arrhythmias and transient ischemic attacks involving the posterior circulation are much less frequent causes.

Weakness and Fatigue 

Weakness and fatigue, like dizziness, are two of the most common patient complaints. Unfortunately, these symptoms are very nonspecific and can be caused by conditions that range from anxiety or depression to metastatic cancer.

A complaint of weakness becomes much more specific when it is either localized or has a temporal profile. For example, weakness in one arm or leg or weakness that is localized specifically to the proximal musculature (brushing hair, getting out of a chair, etc.) almost always has a neurologic cause. In contrast, weakness that occurs postprandially is often a clue to reactive hypoglycemia, postprandial hypotension, or familial periodic paralysis.

Allergic Drug Reactions

Allergies to penicillins and sulfa-containing drugs are common. Clarify the nature of the reaction (e.g., anaphylaxis, rash, vomiting) and define whether the supposed allergy is a “history of …” or an unequivocal reaction.

General Appearance

Often the most informative part of the entire clinical examination is the general appearance of the patient. An astute clinician uses the overall patient appearance, gleaned in the first 60 seconds of the interview, to catalog his or her first set of diagnostic possibilities.