THE PHYSICAL EXAM

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PHYSICAL EXAM
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THE HISTORY OF THE STETHOSCOPE LAENNEC INVENTED
THE INSTRUMENT IN 1816 DE L AUSCULTATION
MEDIATE , ETC 2 VOLS 1819 ALLOWED THE FIRST REAL
AUSCULTATORY DESCRIPTIONS OF CHEST DISEASES
(BRONCHITIS, BRONCHIECSTASIS, PULMONARY EDEMA,
MITRAL STENOSIS, TB AND MANY OTHERS) SIR JOHN
FORBES TRANSLATED LAENNECS WORK INTO ENGLISH
THAT IT WILL EVER COME INTO GENERAL USE,
NOTWITHSTANDING ITS VALUE, I AM EXTREMELY
DOUBTFUL BECAUSE ITS BENEFICIAL APPLICATION
REQUIRES MUCH TIME, AND GIVES A GREAT DEAL OF
TROUBLE BOTH TO THE PATIENT AND PRACTITIONER, ...
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DR. GEORGE PHILIP CAMMAN CREDITED WITH THE
BINUARAL FORM OF THE STETHOSCOPE 1851 DR. FRANCIS
W. PEABODY OF COURSE I SHALL EXAMINE THE PATIENT
AND LISTEN TO HIS CHEST ALTHOUGH I HAVE
AUSCULTATED THOUSANDS OF LUNGS I HAVE NEVER HEARD
TWO WHICH SOUND ALIKE DR. DICKINSON RICHARDS
1962 IN ORDER FOR THE STETHOSCOPE TO FUNCTION,
TWO THINGS HAVE TO HAPPEN. THERE HAS TO BE, BY
GOD, A SICK MAN AT ONE END OF IT AND A DOCTOR AT
THE OTHER. SIR JAMES KINGSTON FOWLER THOSE
WHO ADVISE THAT ALL STETHOSCOPES SHOULD BE
SCRAPPED, MAY BE INFLUENCED BY THE FACT THEY DO
NOT KNOW HOW TO USE THEIR OWN
J OF THE ROYAL SOCIETY OF
MEDICINE 73 448-456 1980
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THE PHYSICAL EXAM

• DECRIPTION OF THE PATIENTS APPEARANCE
• VITAL SIGNS - BP-T-P-R---02
• HEENT (HEAD,EARS,EYES,NOSE,THROAT,THYROID,ORO-PHAR
  YNX)
• LYMPHATICS
• NECK (THYROID, CAROTIDS)
• CHEST
• CARDIAC (CAROTIDS,PULSES)
• ABDOMEN
• RECTAL
• GU-PELVIC
• MUSCULOSKELETAL - EXTREMITIES
• SKIN
• NEUROLOGICAL

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THE PHYSICAL EXAM

• ALWAYS DESCRIBE IN DETAIL WHAT YOU FIND ON THE
  EXAMINATION OF YOUR PATIENT
• THE PATIENT HAS A LUMP ON HER LEFT BREAST
• THE PATIENT HAS A 2X2 CM MASS WHICH IS
  NON-TENDER, NON-MOBILE, LOCATED IN THE UPPER
  OUTTER QUADRANT OF HER LEFT BREAST WITH NO SKIN
  CHANGES

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THE PHYSICAL EXAMTHE BASICS

• INSPECTION - LOOKING
• PALPATION - FEELING
• PERCUSSION - TAPPING
• AUSCULTATION - LISTENING

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THE PHYSICAL EXAMINSPECTION

• GENERAL APPEARANCE
• NUTRITIONAL STATUS
• BODY HABITUS
• SYMMETRY
• POSTURE AND GAIT
• SPEECH

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LOOK AT THE PATIENTS HANDS
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PALPATE TO FEEL
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PALPATION

• FEEL WITH THE HAND FINGERTIPS
• TEXTURES
• DIMENSIONS
• CONSISTENCY
• TEMPERATURE
• EVENTS

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PALPATION DESCRIBE THE
FEATURES OF A PARTICULAR PHYSICAL FINDING

• HARD OR SOFT
• MOVEABLE OR STATIONARY
• PAINFUL
• PULSATILE
• FLUCTUANT
• LARGE OR SMALL - SIZE

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PERCUSSION TO TAP
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PERCUSSIONTYPES OF SOUNDS

• TYMPANY OVER THE ABDOMEN
• RESONANCE HEARD OVER THE LUNG
• DULLNESS HEARD OVER THE LIVER OR THIGH

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AUSCULTATE TO LISTEN
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AUSCULTATIONDESCRIBE WHAT YOU HEAR

• QUIET
• TINKLES
• CRACKLES
• WHEEZES
• S3
• NORMAL

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THE PHYSICAL EXAMPREPERATION

• BE PREPARED
• THE EQUIPMENT REQUIRED IS LOCATED ON PAGE 117
  TABLE 6-1 IN SWARTZ
• WASH YOUR HANDS
• LAY EQUIPMENT OUT
• GOWN
• CHAPERONE
• SPEAK TO THE PATIENT
• POSITIONS
• PRECAUTIONS

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LABORATORY DATA

• WBC-HGB-HCT-PLATELETS
• NA-K-CL-HCO3-BUN-CREATNINE
• CHEST X-RAY
• URINALYSIS
• EKG

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PROBLEM LIST

• THE PURPOSE OF THIS SECTION IS TO HELP YOU.
• ORGANIZING THE PATIENTS PROBLEMS IN ORDER OF
  THEIR IMPORTANCE ALLOWS YOU TO LOOK AT THE BIG
  PICTURE. HOW DO THE PIECES FIT TOGETHER ?
• HOW DO I PLAN TO EVALUATE THE PROBLEMS.

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PROBLEM LIST MOST ACTIVE TO LEAST
ACTIVE 1.CONGESTIVE HEART FAILURE 2.COPD 3.DIABET
ES 4.PEPTIC ULCER DISEASE 5.HISTORY OF COLON
CANCER
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ASSESSMENT AND PLAN

• THIS IS WHERE YOU DISCUSS YOUR DIFFERENTIAL
  DIAGNOSIS AND MANAGEMENT PLAN.
• IT IS IMPORTANT TO BE THOROUGH AND CLEAR.