Techniques of the Physical Examination Part 2

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Techniques of the Physical ExaminationPart 2

• By
• Donald G. Hudson, D.O.

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Objectives

• Discuss methods of examining each body system
• Compare normal vs. abnormal findings
• Review potential abnormal findings and their
  potential relevance

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Reminders

• Keys to the Physical Exam
• Inspection
• Palpation
• Auscultation
• Percussion
• Key Tools in the Physical Exam
• BP cuff Stethoscope
• Senses

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Skin Nails

• General Appearance Potential Abnormalities
• Jaundice, Cyanotic, Pale, Pink/Norm
• Moist, dry, exfoliation
• Hot, warm, cool, cold
• Lesions
• Petechiae, Purpura (blanching?)
• cellulitis, pressure ulcer, burn, scar

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The Skin
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Skin Lesions
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Primary Lesions
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Primary Lesions
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Skin Lesions
Kaposis sarcoma Bates, Barbara, MD. A Guide to
Physical Examination and History Taking, fourth
edition. J.B. Lippincott. 1987.
Malignant Melanoma Bates, Barbara, MD. A Guide
to Physical Examination and History Taking,
fourth edition. J.B. Lippincott. 1987.
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Skin Lesions
Varicella
Cellulitis
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Skin Lesions
Lyme Disease Rash
Urticaria
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Skin Lesions
Port-Wine Stain
Rash from Rubber Product
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Nails
Nail Psoriasis
Bates, Barbara, MD. A Guide to Physical
Examination and History Taking, fourth edition.
J.B. Lippincott. 1987.
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Skin Lesions
What type of work might this person do?
What might have caused this?
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HEENT

• Head Face
• old scar, size/shape, appearance
• Eyes
• Pupils
• Sunken, protruding
• periorbital ecchymosis or edema
• visual acuity
• Nose throat
• sounds, growths, tonsils
• Color (white, red, pink)

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HEENT
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HEENT
Cushings Disease
Myxedema
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HEENT
Goiter
Exophthalmos
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HEENT
Tonsils
Ulcerative basal cell carcinoma
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HEENT
Acromegaly
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HEENT
HYPHEMA
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HEENT
SLE - Butterfly Rash
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HEENT

• What specific testing or examinations should be
  done with regard to the HEENT exam?
• What specific abnormalities might you find and
  why?

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Neck
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Neck
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Chest Respiratory System
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Chest Respiratory System

• What specific things should you consider
  evaluating or examining with regard to the chest
  respiratory system? (Groups 1 2)
• What are some abnormal findings and what might
  they tell you about the patient? (Group 3)
• Group Discussions

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Cardiovascular
What is a likely chronic illness for this person?
What is this condition?
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Cardiovascular
Thrombophlebitis
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Cardiovascular

• What specific questions, tests, examinations, etc
  should you include when assessing the entire
  cardiovascular system (include peripheral
  vascular)? (Groups 2 3)
• What might these findings tell you about your
  patient?
• What are the specific organs and structures
  involved in the assessment? (Group 1)
• Group Discussions

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Abdominal
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Abdominal
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Nervous System
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Neurologic System Exam

• LOC, Pulse, Motor and Sensory are the basics
• Cranial Nerves
• Pupillary response to light (III)
• Ocular movement (III, IV, VI)
• Clench teeth (V)
• Show teeth Raise eyebrows (VII)
• Open mouth and stick out tongue (XII)
• Gag Reflex (IX, X)
• Shrug shoulders (XI)
• Symmetry, Pain response, Point discrimination

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Nervous System

• What specific questions, tests, examinations, etc
  should you include when assessing the entire
  nervous system (exclude equipment testing such as
  CT, MRI)? (Groups 1 3)
• What might these findings tell you about your
  patient?
• What organs or structures are you assessing?
  (Group 2)
• Group Discussions

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Additional Diagnostics

• Blood glucose level
• Pulse oximetry
• ECG
• Diagnostic (12 Lead) ECG
• Cincinnati Prehospital Stroke Scale
• Future
• Cardiac Enzymes, Predictive instruments,
  Abdominal Ultrasound

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Summary

• Examine each body system area when performing the
  comprehensive physical exam
• Consider knowledge of pathophysiologies and apply
  to the physical exam

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Laboratory Session

• Lung Sounds
• Heart Sounds
• Practicing the Comprehensive Physical Exam
  including
• history taking
• approaching the patient