Physical Examination

2nd Affiliated Hospital China Medical University

内科 郑长青

What is physical examination? Physical examination is a fundamental examining method, it is proceeded by the sense organs such as eyes, ears, nose and hands or simple tools –stethoscope and plexor.

The basic methods of physical examination 1 inspection 2 palpation 3 percussion 4 auscultation 5 smelling

1 Inspection includes a general view of the patient’s mental status development

nutrition posture body movement gait facial expression complexion

Inspection

For example pallor anemia exophthalmus hyperthyroidism cyanosis(lips) mitral face moon face cushing syndrome spider angioma liver cirrhosis barrel chest pulmonary emphysema

Inspection

Gastric type pylorus obstruction Abdomenal respiratory movement normal men children disappear acute peritonitis lower extremity edema right heart failure skeleton and joints deformity

2 Palpation

mainly used in abdominal examination mass: location size contour consistency mobility tenderness pulsation

palpation

The methods of palpation Light palpation Deep Palpation deep slipping palpation bimanual palpation deep press palpation ballottement

The methods of palpation

light palpation abdominal muscle tensity abdominal tenderness

Light palpation

Deep Palpation deep slipping palpation ---deep mass bimanual palpation ---liver spleen kidney deep press palpation ---tenderness point ballottement

bimanual palpation liver and spleen

deep press palpation tenderness point

Cholecystic point Murphy’s sign ---acute cholecystitis Appendix point McBurney point ---acute appendicitis

rebound tenderness ---acute peritonitis

ballottement ---liver enlargement ---splenomegaly with massive ascites

ballottement

Notice: patient in supine position ask patient flex his thighs and knees, tell patient relax his abdomenal muscles. Doctor stands at the right side of patient, warm hand, use your palmar aspect of finger, examining gently and lightly, from superficial to deep.

3 Percussionlungs ---marginheart ---size and shape liver ---upper margin ascites ---shifting dullness

Percussion methods

There are two methods that may be used for percussion Indirect percussion Direct percussion

Indirect Percussion pleximeter ---usually the middle finger of left hand plexor ---usually the middle finger tip of right hand

Indirect percussion

Direct percussion This method can be done by striking chest with the palmar aspect of right hand or the tips of all of the fingers held firmly together, mainly used to examine massive fluid in thoracic cavity.

Direct Percussion

Percussion Sounds

Resonance DullnessTympany Flatness Hyperresonance

Resonance The sound heard normally over lungs moderately low in pitch

Dullness: This is a short high pitched and is not loud. The sounds heard over heart or liver which are covered with lung tissues or during pneumonia.

Tympany: Somewhat similar to the sound of a drum. The sound in loud intensity, it results from air in a chamber such as stomach and bowel or in pneumothorax

Flatness: Flatness will be present when there is an extensive pleural effusion or over a solid organ such as the liver and heart

Hyperresonance It is lower pitch than normal resonance, it is heard normally in children and pulmonary emphysema in adult

4 Auscultation

there are two methods of auscultation: direct auscultation with the ear; indirect auscultation with the stethoscope.

by these two methods we can listen to the sounds produced from heart lungs and abdomen or the blood vessel note

There are two principal type of stethoscope the bell and the diaphragm the diaphragm type of chestpiece is more suitable to listen to the high pitched tones

such as the murmur of aortic regurgitation the bell type is more suitable to listen to the low pitched rumble such as the murmur of mitral stenosis

Notice: The stethoscope should be placed firmly against the chest wall or other part of the body to exclude extraneous sounds

5 Smelling to identify the unusual odor which produced from patient such as the odor of sweat sputum pus fluid vomitus stool urine breath