1. Physical Examination 2 nd Affiliated Hospital China Medical University 内科 郑长青

2. What is physical examination? Physical examination is a fundamental examining method, it is proceeded by the sense organs such as eyes, ears, nose and hands or simple tools –stethoscope and plexor.

3. The basic methods of physical examination 1 inspection 2 palpation 3 percussion 4 auscultation 5 smelling

4. 1 Inspection includes a general view of the patient’s mental status development nutrition posture body movement gait facial expression complexion

5. Inspection

6. For example pallor anemia exophthalmus hyperthyroidism cyanosis(lips) mitral face moon face cushing syndrome spider angioma liver cirrhosis barrel chest pulmonary emphysema

7. Inspection

8. Gastric type pylorus obstruction Abdomenal respiratory movement normal men children disappear acute peritonitis lower extremity edema right heart failure skeleton and joints deformity

9. 2 Palpation mainly used in abdominal examination mass: location size contour consistency mobility tenderness pulsation

10. palpation

12. The methods of palpation Light palpation Deep Palpation deep slipping palpation bimanual palpation deep press palpation ballottement

13. The methods of palpation light palpation abdominal muscle tensity abdominal tenderness

14. Light palpation

15. Deep Palpation deep slipping palpation ---deep mass bimanual palpation ---liver spleen kidney deep press palpation ---tenderness point ballottement

16. bimanual palpation liver and spleen

17. deep press palpation tenderness point

18. Cholecystic point Murphy’s sign ---acute cholecystitis Appendix point McBurney point ---acute appendicitis

19. rebound tenderness ---acute peritonitis ballottement ---liver enlargement ---splenomegaly with massive ascites

20. ballottement

21. Notice: patient in supine position ask patient flex his thighs and knees, tell patient relax his abdomenal muscles. Doctor stands at the right side of patient, warm hand, use your palmar aspect of finger, examining gently and lightly, from superficial to deep.

22. 3 Percussion lungs ---margin heart ---size and shape liver ---upper margin ascites ---shifting dullness

23. Percussion methods There are two methods that may be used for percussion Indirect percussion Direct percussion

24. Indirect Percussion pleximeter ---usually the middle finger of left hand plexor ---usually the middle finger tip of right hand

25. Indirect percussion

27. Direct percussion This method can be done by striking chest with the palmar aspect of right hand or the tips of all of the fingers held firmly together, mainly used to examine massive fluid in thoracic cavity.

28. Direct Percussion

29. Percussion Sounds Resonance Dullness Tympany Flatness Hyperresonance

30. Resonance The sound heard normally over lungs moderately low in pitch

31. Dullness: This is a short high pitched and is not loud. The sounds heard over heart or liver which are covered with lung tissues or during pneumonia.

32. Tympany: Somewhat similar to the sound of a drum. The sound in loud intensity, it results from air in a chamber such as stomach and bowel or in pneumothorax

33. Flatness: Flatness will be present when there is an extensive pleural effusion or over a solid organ such as the liver and heart

34. Hyperresonance It is lower pitch than normal resonance, it is heard normally in children and pulmonary emphysema in adult

35. 4 Auscultation there are two methods of auscultation: direct auscultation with the ear; indirect auscultation with the stethoscope.

37. by these two methods we can listen to the sounds produced from heart lungs and abdomen or the blood vessel note

38. There are two principal type of stethoscope the bell and the diaphragm the diaphragm type of chestpiece is more suitable to listen to the high pitched tones

39. such as the murmur of aortic regurgitation the bell type is more suitable to listen to the low pitched rumble such as the murmur of mitral stenosis

40. Notice: The stethoscope should be placed firmly against the chest wall or other part of the body to exclude extraneous sounds

41. 5 Smelling to identify the unusual odor which produced from patient such as the odor of sweat sputum pus fluid vomitus stool urine breath