4/30/2012
Objectives
Physical Examination
Stevie Morrison
Lecturer / Practitioner
SM GCU M3B712923
First steps
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Approach patient with confidence
Introduce yourself
Ensure good lighting
Ensure the patient is comfortable and safe
BE SYSTEMATIC!
Always examine from the right hand side
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An overview of physical examination
Outline the types of examination
Consider the techniques
Practice
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2 Types of Examination
• Full Examination – more thorough
Nurse practitioners in training/medical students
• Focused Examination – Brief
Experienced practitioners in physical examination:
• Although remember ABCDE approach if patient is
acutely unwell
SM GCU M3B712923
SM GCU M3B712923
4 Main Techniques
2 Others
• Inspection - Look
• Palpation - Feel
• Range of Motion – normal/abnormal
• Percussion - Tap
• Special manoeuvres – position, technique
• Auscultation - Listen
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4/30/2012
Inspection
• Begins as soon as you meet the patient
• General appearance –age, sex, race, body
build, alert , orientated, anxious, in pain
• Distressed cardiac or respiratory
• Deformities – compare sides
• Obvious distinguishing characteristics
Inspection cont
• Ensure good light
• Ensure proper exposure of area to be examined
• May need instruments to enhance view
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SM GCU M3B712923
Feel for
Palpation
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Use of different areas of the hand
Light
Deep
May be used to confirm something you have
noticed on inspection
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Temperature
Texture
Size
Shape
Firmness – soft, hard, spongy (fluid filled)
Organ span
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Percussion
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Used to illicit sounds
Identify location of organs or mass
Identify air/fluid/solid filled areas
Needs practice! – technique & sound identification
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Percussion sounds / notes
• Resonant = normal chest
• Hyper resonant = hyper inflated chest
• Tympanic = normal abdomen
• Dull = liver or plueral effusion
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Auscultation
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TAKES TIME & PRACTICE!
Not as difficult people think
Main points are : Normal/Abnormal
How important are the abnormal?
Use stethoscope properly
– high pitched = diaphragm
– Low pitched= bell
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Remember
• We said 70% - 80% of diagnoses can be made based on
history alone.
• However, 90% plus of diagnoses can be made based on
history & physical examination!
• The expensive tests are used to confirm what has been
found during history taking & physical examination.
SM GCU M3B712923
Sources of Information
•Bickley, L.S. (2007) Bate’s pocket guide to physical examination and history taking. 5th ed.
Philadelphia: Lipincott Williams and Wilkins.
•Douglas, G., Nicol, F. & Robertson, C. (eds.) (2005) MacLeod’s clinical examination. 11th ed.
Edinburgh: Elsevier
•Longmore, M., Wilkinson, I., Turmezei, T. & Cheung, K. C. (2007) Oxford Handbook of Clinical
Medicine, 7th ed., Oxford University Press: Oxford
•Porth, C. A. & Matfin, G. (2009) Pathophysiology: Concepts of Altered Health States. 8th ed.
Lippincott, Williams & Wilkins: Philidepphia.
•Resuscitation Council UK (2006) Advanced Life Support Course Provider Manual. 5th ed.,
Resuscitation Council (UK): London.
•Singer, M. & Webb, A. (2004) Oxford Handbook of Critical Care. 2nd ed., Oxford University
Press: Oxford.
•Tortora, G. & Derrickson, B. (2006) Principles of Anatomy and physiology. 11th ed. Wiley: New
Jersey.
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