Sauña, Kenneth A.

IM Written output August 2019

PHYSICAL EXAMINATION

- Is a tool that helps us formulate a more accurate diagnosis

- It is part of the overall care of patients
- Helps identify the physical signs of disease
- Objective findings
- Performed systematically with the consideration for the patient’s comfort and modesty
- Cephalocaudal
- Keep on practicing and familiarizing ourselves in order to build experience in gaining success in eliciting signs of
disease
- History is subjective while PE is objective
- History and PE go hand-in-hand

GENERAL CONSIDERATIONS
1. Most patients view the PE with at least some anxiety since they could feel vulnerable, physically exposed,
apprehensive about possible pain, uneasy about what the clinician may find but at the same time, they
appreciate the clinician’s concern about their problems and respond to your attentiveness.

THE SKILLFULL CLINICIAN

- Is thorough at the same time efficient
- Does not compartmentalize and is systematic without being rigid
- Gentle yet not afraid to cause discomfort should this be required
- Inspection, Auscultation, Palpation, Percussion are the main components

A. GENERAL SURVEY
- Observe the patient’s general state of health, height, weight, build, and sexual dev’t
- Obtain the patient’s height and weight
- Not posture, motor activity and gait, how the patient is dressed, grooming, personal hygiene, and any odors
of the body or breath
- Watch the patient’s facial expressions and note manner, affect, and reactions to persons and things in the
environment.
- Listen to the patient’s manner of speaking and note the state of awareness or level of consciousness

B. VITAL SIGNS
- Blood pressure (N for adults is <120/80 mm Hg)
-> force of blood pushing against the artery walls during contraction and relaxation of the heart.

- Heart rate (N for adults is 60 to 100 bpm)

- -> measured as # of heartbeats per minute.

- Respiratory rate (N for adults is 12 to 20 cpm)

-> # of breaths a person takes per minute

- Temperature (N range is about 36.5 to 37.4C)

- -> can be taken orally, rectally, axillary, by ear or by skin

- O2 saturation
-> The extent to which hemoglobin is saturated with oxygen

C. SKIN
- Observe the skin of the face, body and extremities and its characteristics
- Identify any lesions, noting their location, distribution, arrangement, type and color
- Inspect and palpate scalp, hair, hands and nails.
- Continue your assessment of the skin as you examine other regions of the body
Note: there is no exclusive PE for the skin, we assess the skin per segment of the examination (head and
neck, back, abdomen, etc.)

D. HEENT
Head: Examine the hair, scalp, skull and face.

Eyes: Check visual acuity and screen the visual fields. Note the position and alignment of the eyes. Observe the
eyelids and inspect the sclera and conjunctiva of each eye. With oblique lighting, inspect each cornea, iris, and
lens, compare the pupils, and test their reactions to light. Assess EOMs. With an opthalmoscope, inspect the
ocular fundi.

Ears: Inspect the auricles, canals, and tympanic membranes. Check auditory acuity, test lateralization and bone
and air conduction using a tuning fork.

Nose and sinuses: examine the external nose; using a light and a nasal speculum, inspect the nasal mucosa,
septum and turbinates. Palpate for tenderness of the frontal and maxillary sinuses.

Throat (or mouth and pharynx): inspect the lips, oral mucosa, gums, teeth, tongue, palate, tonsils, and pharynx.

E. NECK
- Inspect and palpate the cervical lymph nodes.
- Note any masses or unusual pulsations in the neck
- Feel for any deviation in the trachea
- Observe sound and effort in patient’s breathing.
- Inspect and palpate thyroid gland

F. THORAX AND LUNGS

- Inspect and palpate the spine and muscles of the upper back.
- Inspect, palpate and percus the chest
- Listen to the breath sounds, identify adventitious breath sounds and if indicated listen to transmitted voice
sounds.

G. BREAST AND AXILLA

- In a woman, inspect the breasts with her arms relaxed, then elevated, and then with her hands pressed on
her hips
- In either sex, inspect the axillae and feel for axillary nodes
- Feel for the epitrochlear nodes

H. CARDIOVASCULAR SYSTEM
- Observe the jugular venous pulsations, and measure the jugular venous pressure in relation to the sternal
angle.
- Inspect and palpate the carotid pulsations
- Listen for carotid bruits
- Inspect and palpate the precordium
- Note the location, diameter, amplitude and duration of the apical impulse
- Listen at the apex, and lower sternal border with the bell of a stethoscope.
- Listen at each auscultatory area with the diaphragm.
- Listen for the first and second heart sounds, and for physiologic splitting of the second heart sound.
- Listen for any abnormal heart sounds or murmurs
I. ABDOMEN
- Inspect, Auscultate and percuss the abdomen
- Palpate lightly and then deeply
- Assess the liver and spleen by percussion and then palpation
- Try to feel the kidneys and palpate the aorta and its pulsations
- If you suspect any kidney etiology of a condition, percuss posteriorly over the costovertebral angles.

J. EXTREMITIES with the patient Supine

- Palpate the brachial, radial, femoral pulses and if indicated the popliteal, posterior tibial and dorsalis pedis
pulses.
- Palpate the inguinal lymph nodes
- Inspect for edema, any discoloration or ulcers.
- Palpate for pitting edema

- Note any deformities or enlarged joints.

- If indicated, palpate the joints, check their range of motion, and perform any necessary maneuvers.

CLOSING REMARKS
- Ensure privacy of the patient and perform proper hand hygiene before and after patient interaction or prior to
performing any procedures that involves the patient.