Techniques of the Physical Examination Part 2 By Donald G. Hudson, D.O.

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

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

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

The Skin

Skin Lesions

Primary Lesions

Primary Lesions

Skin Lesions Kaposi’s sarcoma Malignant Melanoma 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.

Skin Lesions Varicella Cellulitis

Skin Lesions Lyme Disease Rash Urticaria

Rash from Rubber Product Skin Lesions Port-Wine Stain Rash from Rubber Product

Nails Nail Psoriasis Bates, Barbara, MD. A Guide to Physical Examination and History Taking, fourth edition. J.B. Lippincott. 1987.

Skin Lesions What type of work might this person do? What might have caused this?

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

HEENT

HEENT Cushing’s Disease Myxedema

HEENT Goiter Exophthalmos

HEENT Tonsils Ulcerative basal cell carcinoma

HEENT Acromegaly

HEENT HYPHEMA

HEENT SLE - Butterfly Rash

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

Neck

Neck

Chest & Respiratory System

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

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

Cardiovascular Thrombophlebitis

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

Abdominal

Abdominal

Nervous System

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

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

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

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

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