CLPR 5020

INTRODUCTION TO THE PHYSICAL EXAM

Welcome to Quarter 2
CLPR!

you will now embark on a journey

where you will need to
teach the eye to see, the finger to feel and
the ear to hear
Sir William Osler
The Four Principles of PE
Inspection
Palpation
Percussion
Auscultation
 Inspection
The novice examiner rushes to utilize their
toys, forgetting the powerful tool they have
in observation.

Finished files are the result

of years of scientific study
combined with the
experience of years.

How many Fs are in the above box?

Example taken from the Textbook of Physical Diagnosis, Swartz

 Palpation
The use of tactile sense of touch to
determine the characteristics of an organ
system.
You will be able to feel:
a lymph node
a vein
an ovary
abdominal organs
 Palpation
Lets try palpating the radial stylus
Find your own radial stylus, palpate with
your fingers using whatever technique that
seems best to you, then try on your
partner.

radial stylus
Palpation
Palpating the radial stylus
Next:
Use the flat pads of your fingers, palpate using
a flat circular motion, smaller circles to larger
ones.
Which way was easier, which method
allowed you to feel more detail and with
more clarity?
Palpation
Teaching the finger to feel
The more you use the same hand and
fingers for palpation, the more sensitive
they will become
This will take practice
Ex. For IV catheter placement and blood draws,
the dominant hand is holding the needle,
therefore you will need to train your non-
dominant hand to feel for veins.
Percussion
The examiner taps on the patient, producing
sounds.
Percussion helps to determine whether the
underlying tissues are filled with air, fluid, or
solid material.
Percussion
Resonant sounds are
low pitched, hollow
sounds heard over
normal lung tissue.

Flat or extremely dull

sounds are normally
heard over solid
areas such as
bones.
Percussion
Dull or thud-like sounds are normally heard
over dense areas such as the heart or liver.
Dullness replaces resonance when fluid or
solid tissue replaces air-containing lung
tissues, such as occurs with pneumonia,
pleural effusions, or tumors.
Percussion
Hyperresonant sounds are louder and
lower pitched than resonant sounds.
Normally heard when percussing the chests of
children and very thin adults.
Hyperresonant sounds may also be heard
when percussing lungs hyperinflated with
air, such as may occur in patients with
COPD, or patients having an acute asthmatic
attack. An area of hyperresonance on one
side of the chest may indicate a
pneumothorax.
Percussion
Tympanic sounds are hollow, high, drum-
like sounds.
Tympany is normally heard over the
stomach, but is not a normal chest sound.
Tympanic sounds heard over the chest
indicate excessive air in the chest, such as
may occur with pneumothorax.
Percussion of the normal abdomen
produces tympanic sounds
Auscultation
Listening to the sounds produced by
internal organs using a stethoscope
Before Doing An Exam
Make sure you have all the equipment
you need.
Will you need a pillow or sheet to make the
patient comfortable?
Do you need your patient to gown up?
If you do, then offer them a gown. Ask
them to disrobe appropriately and put on
gown with opening to back.
You should step out while they change.

Can also ask them to crack the door

when they are ready for you.
Before Doing An Exam
Before touching your patient, WASH YOUR
HANDS!

Be cognizant of where you are positioned in

relation to the patient.
Most exams are performed with clinician
standing to the RIGHT of the patient.
That means you are standing on the patients
LEFT side.
Special Considerations
Permission
Privacy
Patient comfort
Confidentiality
Clinical observer / witness
Inappropriate actions vs
misunderstandings
CLPR Lab
Be respectful of your classmates.
Careful about joking around, what is funny to one
may not be to everyone.
Being disrespectful to another student will result in the
instructor asking you to leave and count as an unexcused
absence.
Wear appropriate clothing and tie your hair back
if applicable!
You will not be allowed in lab if your attire is
inappropriate. This will result in an unexcused
absence.
Keeping nails trimmed short.
Bring your equipment to each lab.