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Physical examination or clinical examination is the process by which a health care provider investigates the body of a patient for signs of disease. A health care provider or health professional is an organization or person who delivers proper Health care in a systematic way professionally to any individual in A patient is any person who receives medical attention care or treatment. A Sign is an indication of some fact or quality and a medical sign is an objective indication of some medical fact or quality that is detected by a Physician A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient. The medical history or Anamnesis of a Patient is information gained by a Physician or other healthcare professional by asking specific questions A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Together with the medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan. Diagnosis is the identification by Process of elimination, of the nature of anything This data then becomes part of the medical record. A medical record, health record, or medical chart is a systematic documentation of a Patient 's Medical history and care.
Although providers have varying approaches as to the sequence of body parts, a systematic examination generally starts at the head and finishes at the extremities. In Anatomy, the head of an Animal is the Rostral part (from Anatomical position that usually comprises the Brain, Eyes A limb (from the Old English lim) is a jointed or Prehensile (as Octopus tentacles or new world Monkey tails Appendage of the After the main organ systems have been investigated by inspection, palpation, percussion and auscultation, specific tests may follow (such as a neurological investigation, orthopedic examination) or specific tests when a particular disease is suspected (e. In Medicine, inspection (Latin word "Inspectio" or the act of beholding is the thorough and unhurried visualization of the client Palpation used as part of a Physical examination in which an object is felt (usually with the hands of a Healthcare practitioner to determine its size shape firmness Percussion is a method of tapping on a surface to determine the underlying structure and is used in Clinical examinations to assess the condition of the Thorax or For the ancient monasterial worker see Auscultare Auscultation is the technical term for listening to the internal sounds of the body usually Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of Surgery concerned with injuries to or conditions involving the g. eliciting Trousseau's sign in hypocalcemia). In Medicine, hypocalcaemia is the presence of low serum Calcium levels in the Blood, usually taken as less than 2
With the clues obtained during the history and physical examination the healthcare provider can now formulate a differential diagnosis, a list of potential causes of the symptoms. A differential diagnosis (sometimes abbreviated DDx, ddx Specific diagnostic tests (or occasionally empirical therapy) generally confirm the cause, or shed light on other, previously overlooked, causes.
Whilst the format of examination as listed below is largely as taught and expected of students, a specialist will focus on their particular field and the nature of the problem described by the patient. Hence a cardiologist will not in routine practice undertake neurological parts of the examination other than noting that the patient is able to use all four limbs on entering the consultation room and during the consultation become aware of their hearing, eyesight and speech. Likewise an Orthopaedic surgeon will examine the affected joint, but may only briefly check the heart sounds and chest to ensure that there is not likely to be any contraindication to surgery raised by the anaesthetist. An anaesthetist ( English) or anesthesiologist ( US English) also "anaesthesiologist" is a medical doctor trained to administer Non-specialists generally examine the genitals only upon request of the patient. A sex organ, or primary sexual characteristic, as narrowly defined is any of the anatomical parts of the body which are involved in sexual reproduction and constitute
A complete physical examination includes evaluation of general patient appearance and specific organ systems. It is recorded in the medical record in a standard layout which facilitates others later reading the notes. A medical record, health record, or medical chart is a systematic documentation of a Patient 's Medical history and care. In practice the vital signs of temperature examination, pulse and blood pressure are usually measured first. Vital signs are measures of various physiological statistics often taken by Health professionals in order to assess the most basic body functions Taking a patient's Temperature is an initial part of a full Clinical examination. In Medicine, a person's pulse is the throbbing of their arteries. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories
Vital Signs
Temperature
Temperature recording gives an indication of core body temperature which is normally tightly controlled (thermoregulation) as it affects the rate of chemical reactions. Taking a patient's Temperature is an initial part of a full Clinical examination. Core temperature, also called core body temperature, is the operating Temperature of an Organism, specifically in deep structures of the body such as the Thermoregulation is the ability of an Organism to keep its body temperature within certain boundaries even when temperature surrounding is very different
The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever (temp > 38. Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris 5°C or sustained temp > 38°C). Other causes of elevated temperature include hyperthermia. Hyperthermia, in its advanced state referred to as heat stroke or sunstroke, is an acute condition which occurs when the Body produces or absorbs more Temperature depression (hypothermia) also needs to be evaluated. Hypothermia is a condition in which an organism's temperature drops below that required for normal Metabolism and bodily functions It is also noteworthy to review the trend of the patient's temperature. A patient with a fever of 38°C does not necessarily indicate an ominous sign if his previous temperature has been higher.
Blood pressure
The blood pressure is recorded as two readings, a high systolic pressure which is the maximal contraction of the heart and the lower diastolic or resting pressure. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Systole (ˈsɪstɒli rhymes with "fiscally" is the contraction of Heart chambers driving blood out of the chambers Diastole is the period of time when the heart fills with blood after systole (contraction Usually the blood pressure is taken in the right arm unless there is some damage to the arm. The difference between the systolic and diastolic pressure is called the pulse pressure. Pulse pressure is the change in Blood pressure seen during a contraction of the Heart. The measurement of these pressures is now usually done with an aneroid or electronic sphygmomanometer. A sphygmomanometer ( or blood pressure meter is a device used to measure Blood pressure, comprising an inflatable Cuff to restrict blood flow and a The classic measurement device is a mercury sphygmomanometer, using a column of mercury measured off in millimeters. Mercury (ˈmɜrkjʊri also called quicksilver or hydrargyrum, is a Chemical element with the symbol Hg ( Latinized hydrargyrum The metre or meter is a unit of Length. It is the basic unit of Length in the Metric system and in the International In the United States and UK, the common form is millimeters of mercury, whilst elsewhere SI units of pressure are used. There is no natural 'normal' value for blood pressure, but rather a range of values that on increasing are associated with increased risks. The guideline acceptable reading also takes into account other co-factors for disease. Elevated blood pressure hypertension therefore is variously defined when the systolic number is persistently over 140-160 mmHg. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Low blood pressure is hypotension. In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. Blood pressures are also taken at other portions of the extremities. These pressures are called segmental blood pressures and are used to evaluate blockage or arterial occlusion in a limb (see Ankle brachial pressure index). Segmental blood pressure is used to measure actual limb pressures A limb (from the Old English lim) is a jointed or Prehensile (as Octopus tentacles or new world Monkey tails Appendage of the The Ankle Brachial Pressure Index ( ABPI) is a measure of the reduction in arterial blood pressure of the legs and as such is used to detect evidence of blockages ( Peripheral
Pulse
The pulse is the physical expansion of the artery Its rate is usually measured either at the wrist or the ankle and is recorded as beats per minute. In Medicine, a person's pulse is the throbbing of their arteries. The pulse commonly is taken is the radial artery at the wrist. In Human anatomy, the radial artery is the main Blood vessel, with oxygenated Blood, of the lateral aspect of the Forearm. Sometimes the pulse cannot be taken at the wrist and is taken at the elbow (brachial artery), at the neck against the carotid artery (carotid pulse), behind the knee (popliteal artery), or in the foot dorsalis pedis or posterior tibial arteries. The brachial artery is the major Blood vessel of the upper arm In Human anatomy, the common carotid artery is an Artery that supplies the head and neck with Oxygenated blood; it divides in the neck to form the In Human anatomy, the popliteal artery is defined as the extension of the "superficial" Femoral artery after passing through the Adductor canal In Human anatomy, the dorsalis pedis artery ( dorsal artery of foot) is a Blood vessel of the Lower limb that carries oxygenated blood to the The posterior tibial artery of the Lower limb carries blood to the Posterior compartment of the leg and Plantar surface of the Foot, from the The pulse rate can also be measured by listening directly to the heartbeat using a stethoscope. The stethoscope (from Greek στηθοσκόπιο, of στήθος stéthos - chest and σκοπή skopé - examination) is an acoustic The pulse varies with age. A newborn or infant can have a heart rate of about 130-150 beats per minute. A toddler's heart will beat about 100-120 times per minute, an older child's heartbeat is around 90-110 beats per minute, adolescents around 80-100 beats per minute, and adults pulse rate is anywhere between 50 and 80 beats per minute. Toddler is a common term for a young Child who is learning to walk or "toddle", generally considered to be the second stage of development after infancy The Adolescents are a Hardcore punk band formed in 1980 in Fullerton, California.
Respiratory rate
Varies with age, but the normal reference range is 16-20 breaths/minute.
Basic biometrics
Height
Height is the anthropometric longitudinal growth of an individual. Anthropometry ( Greek άνθρωπος man and μέτρον measure literally meaning "measurement of humans" in Physical anthropology, refers to the A statiometer is the device used to measure height although often a height stick is more frequently used for vertical measurement of adults or children older than 2. In Astronomy, Geography, Geometry and related sciences and contexts a direction passing by a given point is said to be vertical if The patient is asked to stand barefoot. For people with the name Barefoot see Barefoot (surname Going barefoot (also barefoot ed) means for a person not to use or Height declines during the day because of compression of the intervertebral discs. Intervertebral discs (or intervertebral fibrocartilage) lie between adjacent vertebrae in the spine. Children under age 2 are measured lying horizontally.
Weight
Weight is the anthropometric mass of an individual. In the Physical sciences weight is a Measurement of the gravitational Force acting on an object Mass is a fundamental concept in Physics, roughly corresponding to the Intuitive idea of how much Matter there is in an object A scale is used to measure weight. A weighing scale (usually just "scale" in common usage except in Australian English where "scales" is more common is a Measuring instrument for
Body mass index, or BMI, is used to calculate the relationship between healthy height and weight and obesity or being overweight or underweight. The body mass index ( BMI) or Quetelet index, is a statistical measurement which compares a person's weight and height Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected
Medical professionals generally prefer to use the SI unit of kilograms, and many medical facilities have ready-reckoner conversion charts available for professionals to use, when patients describe their weight in non-SI units. (In the US, pounds and ounces are common, while in the UK stones and pounds are frequently used; in most other countries the metric system predominates. The pound or pound-mass (abbreviation lb, lbm, or sometimes in the United States #) is a unit of Mass This article is about the unit of mass For the unit of force see Pound-force. The stone is a unit of Weight. It is part of the Imperial system of weights and measures used in the British Isles, and formerly used in most The pound or pound-mass (abbreviation lb, lbm, or sometimes in the United States #) is a unit of Mass The metric system is a decimalised system of measurement. It exists in several variations with different choices of base units, though the choice of base units does )
Pain
Because of the importance of pain to the overall wellness of the patient, subjective measurement is considered to be a vital sign. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm Subjectivity refers to a subject's perspective particularly feelings beliefs and desires Clinically pain is measured using a FACES scale which is a series of faces from '0' (no pain at all showing a normal happy face) to '5' (the worst pain ever experienced by the patient). There is also an analog scale from '0' to maximum '10'. It is important to allow patients to make their own choices on a pain scale. Physicians and health care workers frequently understate patient pain.
Structure of the written examination record
General appearance
Obvious apparent features as the patient enters the consulting room and in the course of taking the history (e. g. mobility problem or deafness)
- JACCOL, a mnemonic for jaundice, suggestion of anaemia (pale colour of skin or conjunctiva), cyanosis (blue coloration of lips or extremities), clubbing of fingernails, edema of ankles, lymph nodes of neck, armpits, groins. A mnemonic device (nəˈmɒnɪk is a Memory aid Commonly met mnemonics are often verbal something such as a very short poem or a special word used to help a person remember Jaundice, also known as icterus (attributive adjective "icteric" is yellowish discoloration of the Skin, sclerae (whites of the eyes Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative The conjunctiva is a clear membrane that covers the Sclera (white part of the Eye) and lines the inside of the Eyelids It is made of lymphoid tissue Cyanosis is a blue coloration of the Skin and mucous membranes due to the presence of deoxygenated Hemoglobin in Blood vessels near the skin surface In Medicine, clubbing, finger clubbing, or digital clubbing is a deformity of the Fingers and fingernails that is associated with a Oedema (or Edema in American English formerly known as dropsy or hydropsy, is the increase of Interstitial fluid in any organ &mdash swelling A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system.
Organ systems
- Cardiovascular system
- Blood pressure, pulse rate and rhythm. This is an article about the rock music band "Circulatory System"
- Jugular venous pressure (JVP), peripheral oedema and evidence for pulmonary oedema. The jugular venous pressure (JVP sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system.
- Precordial exam (cardiac exam)
- Lungs
- 4 parts: examination, auscultation, palpation, percussion
- Examination involves observing the respiratory rate which should be in a ratio of 1:2 inspiration:expiration. In Medicine, the precordial exam, also cardiac exam, is performed as part of a Physical examination, or when a patient presents with Chest pain lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive An acidotic patient will have more rapid breathing to compensate known as Kussmaul breathing. Kussmaul breathing is the very deep and labored Breathing with normal or reduced frequency found among people with severe Acidosis; it is a form of Hyperventilation Another type of breathing is Cheyne-Stokes respiration, which is alternating breathing in high frequency and low frequency from brain stem injury. Cheyne-Stokes respiration (also known as periodic breathing) is an abnormal pattern of Breathing characterized by oscillation of ventilation between Apnea Also observe for retractions seen in asthmatics. Observe for barrel-chest (increased AP diameter) seen in COPD. Observe for shifted trachea or one sided chest expansion, which can hint pneumothorax.
- Lung auscultation is listening to the lungs bilaterally at the anterior chest and posterior chest. Wheezing is described as a musical sound on expiration or inspiration. It is the result of narrowed airways. Rhonchi are bubbly sounds similar to blowing bubbles through a straw into a sundae. They are heard on expiration and inspiration. It is the result of viscous fluid in the airays. Crackles or rales are similar to rhonchi except they are only heard during inspiration. It is the result of alveoli popping open from increased air pressure.
- For palpation, place both palms or medial aspects of hands on the posterior lung field. Ask the patient to count 1-10. The point of this part is to feel for vibrations and compare between the right/left lung field. If the pt has a consolidation (maybe caused by pneumonia), the vibration will be louder at that part of the lung. This is because sound travels faster through denser material than air.
- On percussion, you are testing mainly for pleural effusion or pneumothorax. The sound will be more tympanic if there is a pneumothorax because air will stretch the pleural membranes like a drum. If there is fluid between the pleural membranes, the percussion will be dampened and sound muffled.
- There is always difficulty differentiating between pneumonia and pleural effusion based on just auscultation since both will have crackles or rhonchi. That is why such exams like palpation will help differentiate between the two. If there is pneumonia, palpation should reveal increased vibration and percussion should be decreased. If there is pleural effusion, palpation should reveal decreased vibration and percussion should also be decreased.
- 4 parts: examination, auscultation, palpation, percussion
- Breasts
- Abdomen
- Abdominal examination notes in particular any tenderness, bloating, organ enlargement, or aortic aneurysm. The breast is the upper Ventral region of an animal’s Torso, particularly that of Mammals including Human beings. In Vertebrates such as Mammals the abdomen (belly constitutes the part of the body between the Thorax (chest and Pelvis. The abdominal exam, in Medicine, is performed as part of a Physical examination, or when a patient presents with Abdominal pain or a history that suggests
- No abdominal examination is complete without a Rectal examination
- Genitalia
- Musculoskeletal system
- Nervous system, including mental status
- Head and neck (HEENT)
- Skin
- Check of the hair to see if the hair growth is receding (baldness) or there is loss of hair (alopecia). A rectal examination or rectal exam is an internal examination of the Rectum such as by a Physician or other healthcare professional A sex organ, or primary sexual characteristic, as narrowly defined is any of the anatomical parts of the body which are involved in sexual reproduction and constitute The human musculoskeletal system is the organ system that gives humans the ability to physically move by using the Muscles and Skeletal system. A neurological examination is the assessment of sensory neuron and motor responses especially Reflexes to determine whether the Nervous system The mental status examination (or mental state examination in the UK and Australia abbreviated MSE, is an important part of the clinical assessment process In Anatomy, the head of an Animal is the Rostral part (from Anatomical position that usually comprises the Brain, Eyes The neck is the part of the Body on many limbed Vertebrates that distinguishes the head from the Torso or trunk The skin is the outer covering of living tissue of an animal (or plant Baldness involves the state of lacking hair where it often grows especially on the head Alopecia or hair loss is the medical description of the loss of hair from the head or body sometimes to the extent of Baldness.
- Check of the skin will tell if there are marks such as hemangioma or strawberry marks or changes to the skin. A hemangioma is a Congenital Benign Tumour or Vascular malformation of endothelial cells (the cells that line blood vessels Dark spots on the skin, nevi are also places where cancerous changes can appear because the face, head and neck are most usually sun exposed. Nevus (or naevus, plural nevi, from nævus, Latin for birthmark is the medical term for sharply-circumscribed and Chronic lesions of the Specific skin conditions (e. g. pyoderma gangrenosum, erythema nodosum, acanthosis nigricans) may be associated with specific diseases (ulcerative colitis, sarcoidosis and polycystic ovary syndrome, respectively). Pyoderma gangrenosum is a disease that causes tissue to become necrotic, causing deep Ulcers that usually occur on the legs Erythema nodosum (EN ( red nodules) is an Inflammation of the fat cells under the skin ( Panniculitis) Acanthosis nigricans is a brown to black poorly defined velvety Hyperpigmentation of the Skin, usually present in the posterior and lateral folds of the Neck Ulcerative colitis ( Colitis ulcerosa, UC) is a form of Inflammatory bowel disease (IBD Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized Polycystic ovary syndrome abbreviated PCOS or PCO (also known clinically as Stein-Leventhal syndrome, Sclerocystic ovary syndrome, Hyperthecosis
See also
- Eye examination
- Heart sounds
- Human weight
- Knee examination
- Medical record
- Medical test
- Intimate examination
External links
- Connecticut Tutorials Physical Examination Video
- UCSD school of medicine - guide to writing HPI and performing complete physical exam. Excellent for medical students
- The Journal of Clinical Examination - A useful online source for evidence-based guidance on physical examination
- JAMA Rational Clinical Exam - A collection of papers reviewing the evidence base for physical examination
Dictionary
physical examination
-noun
- (medicine) The examination of the patient's body with the use of such methods as inspection, palpation, percussion and auscultation.
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