Physical examination: Difference between revisions
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In health care, the '''physical examination''' is a "systematic and thorough inspection of the patient for physical signs of disease or abnormality."<ref>{{MeSH}}</ref> | In health care, the '''physical examination''' is a "systematic and thorough inspection of the patient for physical signs of disease or abnormality."<ref>{{MeSH}}</ref> | ||
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It is usually wise to take the patient's [[Medical history taking|history]] before performing the physical examination. Knowing the patient's [[Medical history taking#chief complaint|chief complaint]], and significant previous history, will guide the examination. If the examiner knows that one of the patient's eyes is prosthetic, it is not necessary to use the [[opthalmoscope]] to inspect the (nonexistent) internal eye structures. If a patient is complaining of knee pain, more attention should be given to that area and related topics such as observing the patient walk than, for example, examining the scalp. | It is usually wise to take the patient's [[Medical history taking|history]] before performing the physical examination. Knowing the patient's [[Medical history taking#chief complaint|chief complaint]], and significant previous history, will guide the examination. If the examiner knows that one of the patient's eyes is prosthetic, it is not necessary to use the [[opthalmoscope]] to inspect the (nonexistent) internal eye structures. If a patient is complaining of knee pain, more attention should be given to that area and related topics such as observing the patient walk than, for example, examining the scalp. | ||
There are several ways to perform a basic review; the important aspect is that there should be complete coverage. A common approach is "regional", in which the patient is placed in a series of positions and examining techniques best done in that position are done. <ref name=Scut>{{citation | There are several ways to perform a basic review; the important aspect is that there should be complete coverage. A common approach is "regional", in which the patient is placed in a series of positions and examining techniques best done in that position are done. <ref name=Scut>{{citation | ||
| title = The Effective Scutboy: The Principles and Practice of Scut | | title = The Effective Scutboy: The Principles and Practice of Scut | ||
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| publisher = Appleton & Lange}}</ref> Another approach can be slower but sometimes preferable, especially when the examination is focused on a specific system, is to move from position to position looking at aspects of one system at a time. | | publisher = Appleton & Lange}}</ref> Another approach can be slower but sometimes preferable, especially when the examination is focused on a specific system, is to move from position to position looking at aspects of one system at a time. | ||
===Regional method=== | ===Regional method=== | ||
The regional method can begin when the patient walks into the room, or is asked to walk across it. | |||
====Standing and walking==== | |||
An examination often begins with taking the height and weight if this has not been done; this also gives the examiner to observe the patient's walking gait, apparent balance, and other movement-related signs. | An examination often begins with taking the height and weight if this has not been done; this also gives the examiner to observe the patient's walking gait, apparent balance, and other movement-related signs. | ||
====Seated==== | |||
A wide number of observations will be taken in a seated position. Depending on the layout of the examining room, the preference of the examiner, and the comfort of the patient, it may be useful to do some of these while the patient is in a chair, perhaps after the history has been taken from the comfortably seated patient. Some procedures, however, are best done when the patient is seated on the edge of the examining table, so it is simple to move between the patient's front and back. | A wide number of observations will be taken in a seated position. Depending on the layout of the examining room, the preference of the examiner, and the comfort of the patient, it may be useful to do some of these while the patient is in a chair, perhaps after the history has been taken from the comfortably seated patient. Some procedures, however, are best done when the patient is seated on the edge of the examining table, so it is simple to move between the patient's front and back. | ||
In the chair, a starting point is taking basic [[vital sign]]s, <ref>Especially when there is suspicion of cardiovascular disease, it is wise to take blood pressures on both arms, in sitting, standing, and lying positions</ref>, inspection of the face including [[fundoscope|fundoscopic]] viewing of the eyes and [[otoscope|otoscopic]] viewing of the ears, etc. | In the chair, a starting point is taking basic [[vital sign]]s, <ref>Especially when there is suspicion of cardiovascular disease, it is wise to take blood pressures on both arms, in sitting, standing, and lying positions</ref>, inspection of the face including [[fundoscope|fundoscopic]] viewing of the eyes and [[otoscope|otoscopic]] viewing of the ears, etc. | ||
[[Auscultation]] of the chest is usually easier with the patient sitting on the table, since the examiner will listed from the front and back. Examples of other tests conveniently done in this position include the [[patellar reflex]], examination of the feet and ankles (e.g., skin state, [[edema]], skin sensitivity such as testing for [[stocking and glove paresthesia]]). | [[Auscultation]] of the chest is usually easier with the patient sitting on the table, since the examiner will listed from the front and back. Examples of other tests conveniently done in this position include the [[patellar reflex]], examination of the feet and ankles (e.g., skin state, [[edema]], skin sensitivity such as testing for [[stocking and glove paresthesia]]). | ||
====Supine==== | |||
When the patient is [[supine]], this is the usual time to [[palpation|palpate]] the abdomen, testing the effect of leg raising in terms of range of motion and specific reactions such as [[Kernig's | When the patient is [[supine]], this is the usual time to [[palpation|palpate]] the abdomen, testing the effect of leg raising in terms of range of motion and specific reactions such as [[Kernig's and Brudzinski's sign]]s, etc. | ||
===System-oriented=== | |||
This section deals with the level appropriate for a general examination. A focused [[neurology|neurological]] or [[pulmonary]] examination, for example, will involve many more specialized examining techniques, and perhaps instrumental tests done in the examining room. | |||
==Research on the accuracy of the physical examination== | ==Research on the accuracy of the physical examination== | ||
Guidelines have been proposed for conducting research on the physical examination.<ref name="pmid18347878">{{cite journal |author=Simel DL, Rennie D, Bossuyt PM |title=The STARD Statement for Reporting Diagnostic Accuracy Studies: Application to the History and Physical Examination |journal=J Gen Intern Med |volume=23 |issue=6 |pages=768–74 |year=2008 |month=June |pmid=18347878 |doi=10.1007/s11606-008-0583-3 |url=http://dx.doi.org/10.1007/s11606-008-0583-3 |issn=}}</ref> | Guidelines have been proposed for conducting research on the physical examination.<ref name="pmid18347878">{{cite journal |author=Simel DL, Rennie D, Bossuyt PM |title=The STARD Statement for Reporting Diagnostic Accuracy Studies: Application to the History and Physical Examination |journal=J Gen Intern Med |volume=23 |issue=6 |pages=768–74 |year=2008 |month=June |pmid=18347878 |doi=10.1007/s11606-008-0583-3 |url=http://dx.doi.org/10.1007/s11606-008-0583-3 |issn=}}</ref> | ||
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==References== | ==References== | ||
{{reflist|2}} | |||
==External links== | ==External links== | ||
* [http://sgim.org/index.cfm?pageId=666 The Rational Clinical Examination Series] | * [http://sgim.org/index.cfm?pageId=666 The Rational Clinical Examination Series] | ||
Revision as of 13:14, 6 October 2008
Template:TOC-right In health care, the physical examination is a "systematic and thorough inspection of the patient for physical signs of disease or abnormality."[1]
Components of the physical examination
- For links to more information, see: Physical examination: Subtopics
It is usually wise to take the patient's history before performing the physical examination. Knowing the patient's chief complaint, and significant previous history, will guide the examination. If the examiner knows that one of the patient's eyes is prosthetic, it is not necessary to use the opthalmoscope to inspect the (nonexistent) internal eye structures. If a patient is complaining of knee pain, more attention should be given to that area and related topics such as observing the patient walk than, for example, examining the scalp.
There are several ways to perform a basic review; the important aspect is that there should be complete coverage. A common approach is "regional", in which the patient is placed in a series of positions and examining techniques best done in that position are done. [2] Another approach can be slower but sometimes preferable, especially when the examination is focused on a specific system, is to move from position to position looking at aspects of one system at a time.
Regional method
The regional method can begin when the patient walks into the room, or is asked to walk across it.
Standing and walking
An examination often begins with taking the height and weight if this has not been done; this also gives the examiner to observe the patient's walking gait, apparent balance, and other movement-related signs.
Seated
A wide number of observations will be taken in a seated position. Depending on the layout of the examining room, the preference of the examiner, and the comfort of the patient, it may be useful to do some of these while the patient is in a chair, perhaps after the history has been taken from the comfortably seated patient. Some procedures, however, are best done when the patient is seated on the edge of the examining table, so it is simple to move between the patient's front and back. In the chair, a starting point is taking basic vital signs, [3], inspection of the face including fundoscopic viewing of the eyes and otoscopic viewing of the ears, etc.
Auscultation of the chest is usually easier with the patient sitting on the table, since the examiner will listed from the front and back. Examples of other tests conveniently done in this position include the patellar reflex, examination of the feet and ankles (e.g., skin state, edema, skin sensitivity such as testing for stocking and glove paresthesia).
Supine
When the patient is supine, this is the usual time to palpate the abdomen, testing the effect of leg raising in terms of range of motion and specific reactions such as Kernig's and Brudzinski's signs, etc.
System-oriented
This section deals with the level appropriate for a general examination. A focused neurological or pulmonary examination, for example, will involve many more specialized examining techniques, and perhaps instrumental tests done in the examining room.
Research on the accuracy of the physical examination
Guidelines have been proposed for conducting research on the physical examination.[4]
History of the physical examination
Walker has compiled the following dates in the development of the techniques for the physical examination.[5]
- Hippocrates: A Rational Profession 460–370 b.c
- Vesalius: Establishment of an Accurate Anatomy, 1543
- Sydenham: The Nosology of Disease, 1666
- Morgagni: The Foundation of Pathologic Anatomy, 1761
- Auenbrugger: The Discovery of Percussion, 1761
- Laennec: The Stethoscope, 1816
- Helmholtz: The Ophthalmoscope, 1850
- Carl Wunderlich: The Thermometer, 1871
- Erb and Westphal: The Reflex Hammer, 1875
- Riva Rocci: The Sphygmomanometer for measuring blood pressure, 1896
References
- ↑ Anonymous (2024), Physical examination (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Harrell, Robert A. & Gary S. Firestein (3rd edition, 1988), The Effective Scutboy: The Principles and Practice of Scut, Appleton & Lange
- ↑ Especially when there is suspicion of cardiovascular disease, it is wise to take blood pressures on both arms, in sitting, standing, and lying positions
- ↑ Simel DL, Rennie D, Bossuyt PM (June 2008). "The STARD Statement for Reporting Diagnostic Accuracy Studies: Application to the History and Physical Examination". J Gen Intern Med 23 (6): 768–74. DOI:10.1007/s11606-008-0583-3. PMID 18347878. Research Blogging.
- ↑ Walker HK (1990). “The Origins of the History and Physical Examination”, Walker HK, Hall WD, Hurst JW: Clinical methods: the history, physical, and laboratory examinations, 3rd. London: Butterworths. ISBN 0-409-90077-X.