Thursday, January 5, 2012

Physical Examination: Approach and Overview

In this section, we outline the
physical examination on most new patients or patients being admitted to the
hospital. For more
complaints will dictate what segments of the examination you elect to perform.
You will .nd a more extended discussion of the approach to the examination,
its scope (comprehensive or focused), and a table summarizing
the examination sequence in Chapter 3, Beginning the Physical Examination:
General Survey, and Vital Signs. Information about anatomy and physiology,
interview questions, techniques of examination, and important abnormalities
are detailed in Chapters 3 through 16 for each of the segments of the
physical examination described below.

It is important to note that
is developing a systematic sequence of examination.
may need notes to remember what to look for as you examine each region
of the body; but with a few months of practice, you will acquire a routine
sequence of your own. This sequence will become habit and often prompt
you to return to an exam segment you may have inadvertently skipped, helping
you to become thorough.

As you develop your own sequence of examination,
minimize the number of times you ask the patient to change position
supine to sitting, or standing to lying supine. Some segments of the physical
examination are best obtained while the patient is sitting, such as examinations
of the head and neck and of the thorax and lungs, whereas others
are best obtained supine, as are the cardiovascular and abdominal examinations.
Some suggestions for patient positioning during the different segments
of the examination are indicated in the right-hand column in
comprehensive physical examination and provideoverview of all its components. You will conduct a comprehensiveproblem-oriented, or focused, assessments, the presentingthe key to a thorough and accurate physical examinationAt .rst, youan important goal is tofromred.
Most patients view the physical examination with at least some anxiety. They
feel vulnerable, physically exposed, apprehensive about possible pain, and
uneasy about what the clinician may .nd. At the same time, they appreciate
the clinician’s concern about their problems and respond to your attentiveness.
With these considerations in mind, the skillful clinician is thorough
without wasting time, systematic without being rigid, gentle yet not afraid
to cause discomfort should this be required. In applying the techniques of
inspection, palpation, auscultation, and percussion, the skillful clinician examines
each region of the body, and at the same time senses the whole patient,
notes the wince or worried glance, and shares information that calms,
explains, and reassures.

For an overview of the physical examination, study the following example of
the sequence of examination now.
place different segments of the examination, especially the examinations of the
musculoskeletal system and the nervous system.
below. With practice, you will develop your own sequence, keeping
the need for thoroughness and patient comfort in mind. After you complete
your study and practice the techniques described in the regional examination
chapters, reread this overview to see how each segment of the examination
.ts into an integrated whole.
Some of these options are indicatedNote that clinicians vary in where they

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