M1: Overview of Physical Examination Flashcards
Skill in Physical diagnosis is acquired with
Experience
To identify the physical signs of disease. Pathologic processes result in specific PE findings. Normal as important as abnormal finding. Objective findings.
Physical Examination
Should be performed methodically and thoroughly, with consideration for the patient’s comfort and modesty.
Physical Examination
The examination of a new patient must extend from ___________ in an objective search for abnormalities.
Head to Toe
Provides enough information to accurately diagnose a patient’s illness most of the time.
History & PE
Subjective in nature
History
Objective in nature
PE
Key to a thorough and accurate PE is developing a
Systematic Sequence of Examination
Is thorough without wasting time. Systematic without being rigid. Gentle yet not afraid to cause discomfort should this be required.
Skillful Clinician
Observe the patient’s general state of health. Weight, posture, manner of speaking and LOC.
General survey
Measure height, weight, BP, PR & Temp.
Vital signs
Observe for any lesions noting location, distribution, arrangement, type & color. Check hair, nails & hands.
Skin
Examine hair, scalp, skull & face.
Head
Check visual acuity & visual fields. Position & Alignment. Use oblique lighting & ophthalmoscope.
Eyes
Inspect auricles, canals and drums. Check acuity. Check lateralization(weber) & compare air and bone conduction(rinne)
Ears
Examine external nose and palpate tenderness
Nose and sinuses
Inspect lips, mucosa, gums, teeth, tongue, palate, tonsils and pharynx.
Throat
Inspect and palpate cervical lymph nodes. Note for mass and pulsation.
Neck
Inspect and palpate spine and muscles
Back
Inspect muscles and spine if upper back. IAP the chest. Ide tify the level of diaphragmatic dullness. Listen to breath sounds.
Posterior Thorax and Lungs
Inspect breast, axillary nodes & etc
Breasts, Axillae and Epithroclear nodes
IPP chest. Listen to both breath and adventitious sounds.
Anterior Thorax and Lungs
Observe jugular venous pulsation, JV pressure. Use bell of stethoscope among baby
CVS
IAPP. Assess liver, spleen and kidney.
Abdomen
Examine legs while patient is on supine. Further assessed when patient stands
Lower extremities
Examination of Patient Supine
PVS, Musculoskeltal system & Nervous system
Examination with the patient standing
Genitalia and Hernias in men, PVS, Musculoskeltal system & Nervous system
Inspect the sacrococcygeal and perineal areas.
Rectal exam in men
Examine external genitalia. Obtain pap smear.
Genital & Rectal Exam among women
Are set of principles that have been created through reflection and discussion to guide our behavior.
Ethics
Guide our professional behavior, are not static, but several principles have guided clinician throughout ages
Medical Ethics
First. Do no harm.
Nonmaleficence
Do good for the patient
Beneficence
Patients have the right to determine what’s in their own best interest
Autonomy
Physicians need to discuss with the patient about nature of proposed care and etc.
Informed consent
Withholding a serious diagnosis, misinterpreting or limiting discussion of prognosis and all
Nondisclosure of Info
Not to tell others what we learn from our patients
Confidentiality
Mean fairness. People should receive what they deserve.
Justice
