Components of the Basic Physical Exam

history

cardinal techniques

physical evaluation

patient assessment consists of

chief complaint

history of present illness

past medical history

• med list

• allergy

family history

social history

review of systems

history includes

inspection

auscultation

palpation

percussion

Cardinal Is A Proper Priest

cardinal techniques include

general survey

extraoral

intraoral

physical evaluation includes

inspection

• Observing what people are doing (through eyes and nose)

• Learn as much as you can

  • ie. If someone is anxious, you can tell quickly

  • ie. Color and moisture of skin

palpation

• use hands and fingers to gather info through sense of touch

• determine position, texture size, consistency, masses, fluid, crepitus

• can be light (1cm) or deep (4cm)

• always start w light touch

palmar surfaces

__ of fingers and hands are more sensitive than tips (better for info)

crepitus

velcro on joints

ulnar

these surfaces for vibration

dorsal (back of hand)

these surfaces for temperature estimation

laying of hands

therapeutic touch where we begin PE on pt

percussion

• Striking one object against another, producing vibration and sound

• Use dental instrument to tap against hard surface like tooth

• Use one finger as a hammer

• Sound waves heard as percussion tones (resonance) arising 4-6cm deep

tympany

hyperresonance

resonance

dullness

flatness

classifications of sounds

tympany

hollow drum-like sound heard over air filled structure during abdominal exam

hyperresonance (pneumothorax)

• sounds similar to percussion of “puffed up”cheeks”

• lower, louder and longer pitch sound

resonance

• percussing normal chest

• low pitched and short

dullness

percussion of a mass like liver

auscultation

• Listening through stethoscope to augment sounds produced by body

• Stethoscopes placed on bare skin

• Listen for intensity, pitch, duration, quality

• Close eyes

• In general, leave this technique for last

auscultation

taking vital signs

general survey

• General appearance

• Apparent state of health → acute or chronically ill, frail

• Level of consciousness → awake, alert, responsive, lethargic, obtunded, comatose

• Signs of distress → cardiac or respiratory, pain, anxiety/depression

• Inspection/observation of lesions, behavior

  • Skin color and obvious lesions

  • Dress, grooming, personal hygiene

  • Facial expression → eye contact, change in facial expression

  • Odors of body and breath

    • ie. sweet → ketone in diabetics

    • ie. alcoholic → metabolized alc

  • Posture, gait, motor activity

• Height and Weight

dental exam

oral mucosal exams

intraoral exam includes

facial inspection exam

• Facial asymmetry, loss of sensation, swelling

• Skin of the face

  • ie. ulcer

  • ie. Pinched purpura or ecchymosis (black and blue) → blood cancer

• Lips

facial inspection exam

head and neck evaluation

temporal mandibular exam

cranial nerve exam

extraoral exam includes

lymph nodes

salivary gland

thyroid exam

head and neck evaluation include

temporomandibular exam

evaluation of joint

review of systems (not intraoral exam)

swallowing is associated with