Physical examination: Difference between revisions
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The '''physical examination''', in | [[File:MMSA Checking Blood Pressure.JPG|thumb|A blood pressure check. (WC/Kilbosh)]] | ||
The '''physical examination''', also '''clinical examination''', in medicine is the art of acquiring information while looking fancy. The findings usually don't make the [[diagnosis]]. The [[clinical history|history]] is often far more important. | |||
The bit below is far from comprehensive and doesn't even think of pretending to be that. | The bit below is far from comprehensive and doesn't even think of pretending to be that. | ||
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**Nasal flaring. | **Nasal flaring. | ||
**Cyanosis - lips, lingual frenulum. | **Cyanosis - lips, lingual frenulum. | ||
*Trachea midline? | *[[Trachea]] midline? | ||
*Accessory neck muscle use. | *Accessory neck muscle use. | ||
Peripheral: | Peripheral: | ||
*Clubbing (lung causes DDx: abscess, [[bronchiectasis]], [[cancer]], decreased O2, empyema, [[fibrosing alveolitis]]). | *[[Clubbing]] (lung causes DDx: abscess, [[bronchiectasis]], [[cancer]], decreased O2, empyema, [[fibrosing alveolitis]]). | ||
**Clubbing should be viewed with suspicion in patient with [[COPD]], as it should not be seen in the context of pure [[emphysema]].<ref>URL: [http://medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/Clubbing.pdf http://medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/Clubbing.pdf]. Accessed on: 23 September 2010.</ref> Clubbing in COPD is relatively rare; thus, in the context of COPD and smoking it should prompt a search for an occult [[lung cancer]].<ref>URL: [http://www.merck.com/mmhe/sec04/ch045/ch045a.html http://www.merck.com/mmhe/sec04/ch045/ch045a.html]. Accessed on: 23 September 2010.</ref> | **Clubbing should be viewed with suspicion in patient with [[COPD]], as it should not be seen in the context of pure [[emphysema]].<ref>URL: [http://medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/Clubbing.pdf http://medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/Clubbing.pdf]. Accessed on: 23 September 2010.</ref> Clubbing in COPD is relatively rare; thus, in the context of COPD and smoking it should prompt a search for an occult [[lung cancer]].<ref>URL: [http://www.merck.com/mmhe/sec04/ch045/ch045a.html http://www.merck.com/mmhe/sec04/ch045/ch045a.html]. Accessed on: 23 September 2010.</ref> | ||
*Cyanosis - fingernails. | *Cyanosis - fingernails. | ||
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===Palpation=== | ===Palpation=== | ||
*Trachea midline (may be deviated in tension pneumothorax). | *Trachea midline (may be deviated in tension [[pneumothorax]]). | ||
*Tactile fremitus (boy-o-boy or 99). | *Tactile fremitus (boy-o-boy or 99). | ||
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*Finger flexors C8. | *Finger flexors C8. | ||
*Thumb abduction and adduction T1. | *Thumb abduction and adduction T1. | ||
==Peripheral vascular exam== | |||
Appearance: | |||
*Edema. | |||
*Erythema. | |||
*Hair loss. | |||
*Ulcers - bottom (more likely arterial). | |||
*Gangrene. | |||
*Scars. | |||
Feel: | |||
*Pulses: | |||
**Femoral artery pulse - femoral triangle. | |||
**Popliteal artery pulse - behind the knee. | |||
**Posterior tibial artery pulse - inferior and posterior to the medial malleolus. | |||
**Doralis pedis pulse - on dorsal surface of the foot. | |||
==See also== | ==See also== | ||