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Difference between revisions of "Physical examination"
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The '''physical examination''', in | 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 | |||
This was written to review the physical exam and serve as a template for the examination at [[autopsy]]... where one sees a lot more 'cause the subject doesn't have to be in one piece after one is done. | This was written to review the physical exam and serve as a template for the examination at [[autopsy]]... where one sees a lot more 'cause the subject doesn't have to be in one piece after one is done. | ||
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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, | *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 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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===Extras=== | ===Extras=== | ||
*Calf tenderness - think about DVT/PE. | *Calf tenderness - think about [[DVT]]/PE. | ||
*Homans' sign - calf pain on dorsiflexion (suggestive of DVT). | *Homans' sign - calf pain on dorsiflexion (suggestive of DVT). | ||
*Vitals - may help figure-out tumour vs. infection. | *Vitals - may help figure-out tumour vs. infection. | ||
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*Vitals | *Vitals | ||
**Tachycardia in hyper. | **Tachycardia in hyper. | ||
**Rhythm disturbance (e.g. atrial fibrillation) in hyper. | **Rhythm disturbance (e.g. [[atrial fibrillation]]) in hyper. | ||
==Abdomen== | ==Abdomen== | ||
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One should palpate the painful area last (for practical and psychological reasons). | One should palpate the painful area last (for practical and psychological reasons). | ||
=== | ===Inspection=== | ||
*Masses, scars, lesions, signs of trauma & previous surgery. | *Masses, scars, lesions, signs of trauma & previous surgery. | ||
*Distension. | *Distension. | ||
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*Clubbing. | *Clubbing. | ||
*Palmer erythema. | *Palmer erythema. | ||
*Dupuytren's contracture. | *[[Dupuytren's contracture]]. | ||
Body: | Body: | ||
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==Spleen== | ==Spleen== | ||
=== | ===Inspection=== | ||
*Masses etc. | *Masses etc. | ||
*Stigmata of liver disease, lymphadenopathy. | *Stigmata of [[liver]] disease, [[lymphadenopathy]]. | ||
===Percussion=== | ===Percussion=== | ||
*Castell's sign - most sensitive. | *Castell's sign - most sensitive. | ||
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*Adnexal masses. | *Adnexal masses. | ||
*Tenderness - adnexal. | *Tenderness - adnexal. | ||
*Cervical motion tenderness (think PID, appendicitis | *Cervical motion tenderness (think PID, [[appendicitis]]). | ||
==Neurologic== | ==Neurologic== | ||
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*CN IX, X: "Ah" - palate symmetry. | *CN IX, X: "Ah" - palate symmetry. | ||
*CN XI: sternomastoid - strength. | *CN XI: sternomastoid - strength. | ||
*CN XII: stick-out tongue. | *CN XII: stick-out [[tongue]]. | ||
Skipped: | Skipped: | ||
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*CN VII: skip taste ant. 2/3, parotid gl., lacrimal gl., stapedius m. | *CN VII: skip taste ant. 2/3, parotid gl., lacrimal gl., stapedius m. | ||
*Skip CN VIII entirely. | *Skip CN VIII entirely. | ||
===Screening neurologic exam=== | ===Screening neurologic exam=== | ||
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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== | ||
*[[Clinical history]]. | *[[Clinical history]]. | ||
==References== | |||
{{reflist|2}} | |||
[[Category:Clinical]] | |||