Physical Exam Study Guides
Physical Exam Study Guides
A doctor gives a physical examination either yearly or in preparation for a surgical procedure. The physical exam generally consists of four parts: inspection, or looking at the body; palpation, or feeling the body; auscultation, listening to bodily sounds with a stethoscope; and percussion, producing sounds to hear the resulting or percussion sounds in a cavity of a body. A screening physical examination is an integral part of maintaining one’s health and well-being. It is imperative that a physician is able to identify a problem with a patient well before that problem exacerbates and worsens. Some diseases, such as high blood pressure and high cholesterol, are noted only when tests are performed, and these are usually done on a When a patient meets with his doctor on a regular basis, the physician is also able to encourage a healthy lifestyle and maintain a good and familiar relationship with the patient. Physical examination recommendations are different for varying age groups, as some diseases are more likely to develop as one matures.
v Physical exam frequency - Overview
v Yale Medicine Winter 2009: The lost art of the physical exam
v Physical examination: MedlinePlus
v Screening Physical Exam
v Your Child's Physical Examination
Vital Signs
Physicians or other health care providers take vital signs as a basis for assessing the most basic body functions. Vital signs usually include: body temperature, pulse or heart rate, blood pressure, and respiratory rate. A temperature is usually taken by using a thermometer. The reason for taking a person’s temperature is to determine whether or not a patient has a fever, an indication of inflammation in the body. Pulse is measured at the wrist either with a stethoscope or by feeling a person’s radial artery and counting the number of beats while watching a timer. An adult’s normal heart rate is 50-80 beats per minute. Blood pressure is recorded with two readings, systolic and diastolic pressure; the difference between the two is called the pulse pressure. Blood pressure is taken with a mercury sphygmomanometer, generally in the right arm. High blood pressure is defined when the systolic number is over 140-160 mmHg. Respiratory rate is measured by using a stethoscope to listen to a patient’s breathing rate. The normal respiration rate is 12-20 breaths per minute.
v Vital Signs
v Vital Signs - Med Info
v Vital Signs, Robert Wood Johnson University Hospital
Back and Extremity Exam
The back and extremity exam has much to do with the patient’s range of motion. However, first the physician will inspect the extremities for any rashes or lesions. Another consideration is the asymmetry of the extremities, so the physician will compare the limbs to one another to assess for any swelling or atrophy. The medical examiner will then palpate the limbs and muscles to evaluate for any area of tenderness or deformity. He will then begin to move each of the joints and muscles through a range of motion examination to determine whether there has been any damage in any area of the extremities or back. There is an active examination as well as a passive examination. During the active examination, the patient will be asked to move the extremity to determine the range of motion capable for the patient. The physician will move the patient’s extremity during the passive examination to determine the range of motion before sensitivity or pain is sensed.
v Virginia Health System Back Workshop
v Low Back Pain
v Physical Exam: Extremities - IME Video Library
Chest and Lung Exam
The inspection of the patient begins with observation of effort and rate of breathing. The physician will note the depth and rhythm of the breathing as well and will observe any abnormal sounds such as wheezing or coughing. The physician may assess the expansion of the chest and the asymmetry by placing his hands on the back and asking the patient to breathe deeply. He will check percussion of the chest, using a pattern along the posterior and anterior of the chest; the physician will categorize the sound as normal, dull, or hyper resonant. In order to assess auscultation, the physician must use a stethoscope to identify crackles, wheezes, and rhonchi.
v Ohio State University Lung Exam
v Posterior Lung Fields - Examination of the Chest
v Anterior Lung Fields - Examination of the Chest
v A Practical Guide to Clinical Medicine - Lung
v Screening Exam Pulmonary steps/Chest expansion
Cardiovascular Exam
Before beginning an examination, the physician may observe the patient for general signs of cardiovascular disease such as cyanosis, finger clubbing, and edema. The physician will need the room to be quiet for the examination. He will check the pulse manually at the wrist to check for rate and rhythm to rule out tachycardia and bradycardia. He can check the amplitude of the pulse and the contour of the pulse wave by checking carotid pulsations; he will place his fingers on the carotid artery at the neck to check for variations in pulse and variations in pulse with respiration. Blood pressure will be taken using a sphygmomanometer.
v Physical Exam - Proper Cardiovascular Assessment
v South Carolina University - Cardiovascular Screening
v Cardiovascular examination -- Cardiology Explained -- NCBI Bookshelf
Head and Neck Exam
The head is made of many different parts that must be examined as their own entity. First the physician will examine the head itself with inspection for rash and asymmetry, hair loss, lesions, and scars. He may physically palpate the head for areas of edema and tenderness. He will need to examine the ears using an otoscope for any redness, deformity, fluid, or drainage, to indicate an infection. He may use an otoscope as well to examine the nostrils for redness, swelling, or deformity of the sinus canals. Using a light and tongue depressor, the physician will examine the patient’s mouth and throat. He will note any ulcers, white patches, redness, or ulcers. He will probably ask the patient to say “ahhh” in order to see more clearly down the throat. The physician will palpate the exterior of the neck for swelling and deformity. He may also evaluate the lymph nodes in and around the head and neck.
v Core Curriculum Syllabus: Examination of the Head and Neck
v University of California - Head and Neck Examination
v Examination of the Head and Neck
Eye Exam
It is recommended that the physician always check visual acuity before proceeding with the examination. This is done with a Snellen eye chart approximately 20 feet from the patient, or with a Rosenbaum pocket card. He will ask the patient to read the smallest line possible and record the vision acuity. The physician will then begin the physical examination by looking for ptosis of the eyelids, lesions, asymmetry of the eyes, or exophthalmos. He will ask the patient to look up and down and will pull down the eyelids to examine the sclera and conjunctiva. The physician will need to make sure that the pupils react normally to light, so he will ask the patient to look into the distance while he shines a light into the eye to note the reaction of the pupil to the light source. If a patient were to see an optometrist or an ophthalmologist, he would receive a much more thorough eye examination, focused more intensely on visual acuity.
v Screening Physical Exam -- Eye Exam
v Eye Examination
Abdominal Exam
When examining the abdomen, the physician will divide the abdomen into quarters: the right upper quadrant, the left upper quadrant, the right lower quadrant, and the left lower quadrant. This will allow easier identification when noting pain and findings on a patient’s medical chart. On inspection, the physician will look for rashes, lesions, evidence of a hernia, scars, and striae. He may also be able to identify movement related to peristalsis or pulsations. He will describe the abdomen as flat, schapphoid, or protuberant. The physician will use a stethoscope on the abdomen to listen for bowel sounds to identify any abnormality and to listen for any bruits over the renal arteries and aorta. The physician will palpate the abdomen to examine the span and size of the spleen and the liver. By pressing on different areas of the abdomen, he will check areas for pain and tenderness. Rebound tenderness is noted if a patient has more severe pain after the abdomen is pressed and released.
v Abdominal Assessment
v Arch Intern Med -- The Accuracy of Physical Examination
Breast Exam
A breast exam can be performed either sitting or lying down on the examining table. Patient should remove the gown from one breast and place her arm behind her head. The physician will begin to palpate the breast with the pads of the index, middle, and ring fingers starting at the junction of the clavicle and sternum. He should examine the breast tissue by pressing in on the breast and traveling around the breast in circular motions until all areas of the breast have been examined. He should press the nipple gently to note any discharge. The patient’s arm should be lowered, and the physician will palpate axillary lymph nodes. The examination will be repeated on the other side. A patient will generally undergo a breast examination each year during her gynecological visit, but it is important that she perform monthly self-examinations as well.
v What to Expect During a Clinical Breast Exam
v Examination of the Breast
v Related Health Topics: Guidelines for Performing Breast and Pelvic Exam
Pelvic Exam
The patient should be lying down, and she will need to have her legs in stirrups. Her hips will slide down to the edge of the table, and she should relax her knees to the side. The physician will inspect the exterior of the vagina first, including the labia and clitoris for redness, swelling, and lesions. The physician will then insert a speculum into the vagina to open the walls of the vagina in order to examine the cervix. He will insert his fingers into the vagina and use his other hand on the outside of the abdomen to check for swelling or abnormalities. Once the fingers are removed, a cotton swab will be used to take a Pap smear to be sent for biopsy.
v Pelvic Exam and Pap Smear
v Pelvic Examination
v smithSEX.ED - The Pelvic Exam
Neurologic Exam
There are several different phases to a neurologic examination, many things a physician needs to evaluate in order to get a proper diagnosis. A few of the things that a physician can observe immediate is the articulation of a person’s speech, ptosis a person’s eyes that was not present previously, a droop or asymmetry of the face, abnormal eye position, or abnormal pupils. The physician may test visual acuity if he thinks that vision may have been affected by a neurological episode, and he will check pupil reactivity to light. The physician can test a patient’s face for muscular change by asking them to open their mouth and then clench their teeth. He will also use a semi-sharp object to touch various areas of their face to check for pain sensation. Accordingly, he will do the same with a piece of cotton and a cool and hot tuning fork to assess for sensation to light touch and to temperatures. The physician will screen the patient’s hearing and listen to the patient’s voice to note any changes. The muscles throughout the rest of the body will also need to be evaluated, and the physician will do this by asking the patient to squeeze his finger and pull and push on him. He will assess the gait by asking the patient to walk across the floor. The physician may perform other tests as necessary.
v Screening Physical Exam -- Central Nervous System Exam
v Neurologic Examination
v Essential Neurologic Examination
Mental Status Exam
During a mental status examination, the physician or psychiatrist observes a patient’s state of mind through the appearance, behavior, speech, thought process, actions, judgment, affect, and mood. Much of this is done by observation; some is done by taking historical information from the patient. The physician may administer some mental health tests as well while he is evaluating the patient. He may also question the patient to elicit particular responses.
v UIC, Dept. of Psychiatry
v Mental Status Examination Measures
v Neurology
v Cognitive Mental Status and Mental Disorders