Topic 2

Chapter 5: Fundamentals of Physical Examination

1. Overview of Physical Examination

  • Process of examining the patient for physical signs of disease.

  • Four basic components:

    • Inspection

    • Palpation

    • Percussion

    • Auscultation

2. Examination Procedures

  • Initial examination: performed by attending physician for diagnosis.

  • Subsequent examinations by healthcare team to monitor progress.

3. Recording the Physical Examination

Typical Format

  • Initial Impression: Age, height, weight, appearance, gender.

  • Vital Signs: Pulse, respiratory rate, temperature, blood pressure.

  • HEENT: Head, Ears, Eyes, Nose, Throat examination findings.

  • Neck, Thorax, Abdomen, Extremities: Detailed findings using inspection, palpation, percussion, and auscultation.

4. Specific Areas of Examination

Head and Neck

  • Observe facial expressions for mental status clues.

  • Signs: nasal flaring, cyanosis, diaphoresis.

Eyes

  • Pupillary reflexes: should be PERRLA (pupils equal, round, reactive to light and accommodation).

  • Abnormal signs include dilated pupils and ptosis.

Neck

  • Jugular venous distention may indicate right-sided heart failure.

  • Assess tracheal position and lymphadenopathy.

Thoracic Cavity

  • Examining Lung Topography:

    • Use imaginary lines to assess anatomy (e.g., midclavicular, axillary lines).

  • Inspection: Evaluate chest configuration and breathing effort.

    • Abnormalities include pectus carinatum, scoliosis, barrel chest.

5. Auscultation Techniques

  • Assessing breath sounds using a stethoscope (diaphragm and bell).

  • Types of sounds:

    • Normal: Vesicular, bronchial.

    • Abnormal: Diminished, crackles, wheezes, stridor.

6. Interpretation of Breath Sounds

  • Determine conditions based on breath sounds.

  • Example: Diminished sounds indicate shallow breathing or hyperinflation (e.g., emphysema).

7. Examination of the Precordium

  • Inspect for pulsations: normal PMI typically in the 5th intercostal space.

  • Heart sounds:

    • S1 (LUBB): Closure of AV valves.

    • S2 (DUPP): Closure of semilunar valves.

8. Examination of Abdomen and Extremities

  • Abdomen: Inspect for tenderness, distension, or fluid accumulation (ascites).

  • Extremities: Look for signs like clubbing, cyanosis, and edema.

9. Summary of Physical Examination

  • PE yields reliable evidence of clinical condition.

  • Importance of assessing multiple parameters to evaluate effects of treatments.