Clinical exam · General exam and vital signs

General inspection: appearance, posture, gait and consciousness !

Exam technique

The first look at the patient: how they appear, how they move and how alert they are, before any hands-on exam.

Updated 2026-11-01

What it is

General inspection is the overall observation of the patient from the first moment of contact: how ill they look, body build, posture, gait, facies, skin, level of consciousness and speech. In seconds it tells you how sick the patient is (stable or in danger?) and steers the rest of the exam. It is recorded at the start of the physical exam, together with the vital signs.

Technique, step by step

Watch the patient from the doorway before approaching: overall appearance, colour, breathing effort and position.
Greet, introduce yourself and ask permission; examine in good light, ideally daylight, with privacy.
Assess consciousness: alert, responds to voice, responds only to pain or unresponsive, and whether oriented.
Describe body build and nutrition (thin, normal, overweight or obese) and the facies.
Note the position in bed: active, passive or forced (antalgic, orthopnea, knee-chest).
If able to walk, ask for a few steps and watch gait, balance and use of aids.
Look at skin and mucosae (pallor, cyanosis, jaundice), hydration, hygiene, clothing and odours (alcohol, ketones).
Listen to speech and voice (dysarthria, aphasia, dysphonia) and record everything in objective terms.

Abnormal findings

Acutely ill look (sweating, pallor, pained face, fast breathing): suggests severity and calls for vital signs at once.
Tripod position with accessory muscle use: airway obstruction or severe bronchospasm.
Orthopnea (cannot lie flat): left heart failure and some lung diseases.
Patient lying still and avoiding movement: peritoneal irritation. Patient unable to find a comfortable position: renal or biliary colic.
'Gun-hammer' position (neck extended, hips and knees flexed): meningeal irritation.
Abnormal gait (hemiparetic, parkinsonian, ataxic, steppage): points to a neurological or musculoskeletal lesion.
Fruity breath in diabetic ketoacidosis; uremic breath in advanced kidney disease.

Common errors

Going straight to the stethoscope and skipping inspection: signs of severity visible from the door are missed.
Blaming confusion on alcohol without ruling out hypoglycemia, head injury or infection.
Using vague labels ('patient calm') instead of describing what was seen.
Examining under yellowish artificial light, which hides mild jaundice, pallor and cyanosis.

Test yourself

Think of the answer, then tap the question to see it.

What position does a patient with acute pericarditis typically adopt?

Sitting up and leaning forward, which eases the chest pain; lying flat makes it worse.

How does the behaviour of a patient with peritonitis differ from one with renal colic?

With peritonitis the patient lies still because any movement worsens the pain; with renal colic the patient is restless and keeps changing position without relief.

What is the tripod position and what does it suggest?

The patient sits leaning forward with hands on the knees to recruit the accessory muscles; it suggests airway obstruction or severe respiratory distress.

Why is daylight preferred for general inspection?

Because artificial light, especially yellowish light, can hide mild jaundice, pallor and cyanosis.

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: 15.3 Vital Signs - Clinical Nursing Skills | OpenStax (OpenStax, Rice University, 2024); Blue discoloration of the skin: MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine (MedlinePlus), 2025); National Early Warning Score (NEWS) 2 (Royal College of Physicians, 2017).

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Representative model, for educational purposes only.