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

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

3. 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

4. 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

5. The Skin

6. Skin Lesions

7. Primary Lesions

8. Primary Lesions

9. Skin Lesions Kaposi’s sarcoma Malignant Melanoma
Bates, Barbara, MD. A Guide to Physical Examination and History Taking, fourth edition. J.B. Lippincott
Malignant Melanoma
Bates, Barbara, MD. A Guide to Physical Examination and History Taking, fourth edition. J.B. Lippincott

10. Skin Lesions
Varicella
Cellulitis

11. Skin Lesions
Lyme Disease Rash
Urticaria

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

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

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

15. 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)

16. HEENT

17. HEENT
Cushing’s Disease
Myxedema

18. HEENT
Goiter
Exophthalmos

19. HEENT
Tonsils
Ulcerative basal cell carcinoma

20. HEENT
Acromegaly

21. HEENT
HYPHEMA

22. HEENT
SLE - Butterfly Rash

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

24. Neck

25. Neck

26. Chest & Respiratory System

27. 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

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

29. Cardiovascular
Thrombophlebitis

30. 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

31. Abdominal

32. Abdominal

33. Nervous System

34. 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

35. 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

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

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

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