CLINICAL MEDICINE 1

METHODS OF PHYSICAL EXAMINATION

TITLE
INTRODUCTION d. After explaining to the patient the character
and sequence of physical examination, and the need to do certain
 A physical examination is an organized systematic process of gathering maneuvers that might cause some discomfort, obtain patient’s
objective data through a head–to-toe or general systems examination. consent to show respect.
 Its purpose is to determine the state of well-being of the patient, whether
a disease is present or not. What is an ideal examination room?
 The most important complimentary part of the medical history
 The examination can be 1. Examining bed or table with beddings
a. A complete physical assessment 2. Pillows
b. An assessment of a body system 3. Drapes
c. An assessment of a body part based on the clinical judgement of 4. Weighing scale with height measuring rod
the patient 5. Patient gown
 By the end of examination, one may arrive a rational tentative diagnosis 6. Sink with running water
or in many cases confirm your diagnosis. 7. Soap
8. Clean hand towel or disposable tissue
Initial and serial physical examination 9. Waste container that can be opened by foot
10. .Visual acuity charts
a. Provide the foundation for the diagnostic and therapeutic plan for 11. Basin for soiled instrument
the patient 12. Gooseneck lamp
b. Evaluate the progress and assess effectiveness of prescribed 13. Tray with flashlight, gloves, lubricant normal saline, cotton tipped
intervention or treatment applicators
14. Blood pressure apparatus and stethoscope

What should a medical bag contain?

1. Stethoscope
2. Blood pressure apparatus
3. Thermometer
4. Penlight
5. Ophthalmoscope
6. Otoscope
7. Tongue depressor
8. Tape measure
9. Tuning fork
10 Reflex hammer
11. Examination gloves
12. Cotton balls
Preparation in Performing the Physical Examination 13. Near visual acuity chart
14. Disinfectant
a. Greet the patient appropriately and properly introduce yourself.
b. Spend some time explaining the procedure to the patient. Methods of Physical Examination
c. Do the examination in an organized and unhurried manner.
d. Be ready always with your instruments. 1. Inspection
e. Maintain privacy of the patient by providing an examination room 2. Palpation
with curtains or divider. 3. Percussion
f. For women, cover the breasts with folded towel or gown. 4. Auscultation
g. Keep patient comfortable by adjusting room temperature or  The above are the four points of a medical students compass.
providing warmth with blanket.  Mastery of the different methods is a prerequisite for a correct
physical examination.
Physician Preparation  Many times, these methods are sufficient to diagnose and treat
patients.
a. Give full attention and time to your patient during the examination.  With diligence and repeated PE, you will develop your clinical sense
b. Not only must the patient’s comfort be assured but yours as well. of sight, smell, hearing and touch.
c. Dress appropriately and comfortably.  inspection : sense of sight
d. Go to the restroom prior to examination if needed.  palpation: sense of touch
e. Wear gloves if the patient has a draining wound, is bleeding, is  percussion: sense of touch and hearing
vomiting or has an infection.  auscultation : sense of hearing
f. Wear a face mask also if needed.
g. Keep hands warm especially prior to palpation. Physical examination must be carried out with a. A watchful eye,
h. Likewise, stethoscope must be warm also prior to auscultation. b. A sensitive touch,
c. A discerning ears
Patient Preparation d. An alert sense of smell.
Above all, what is needed is an alert MIND free of dogma and routine.
a. Ensure the patient’s comfort. Each clinical problem, no matter how routine it may appear to be on the
b. Ask for his need to go to the restroom prior to the examination. surface, calls for an unprejudiced approach.
c. Inquire for his thoughts that might cause anxiety and encourage Each possible clue must be pursued; nothing can be taken for granted”
him to ask his concerns. Maxwell M. Wintrobe

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 CLINICAL MEDICINE 1
METHODS OF PHYSICAL EXAMINATION
TITLE
Inspection 6. THRILLS DETECTED BY THE
DISTAL PALMAR ASPECTS OF
 Visual examination of a person in search of a physical sign or features THE
(objective data) METACARPOPHALANGEAL
 The first technique used. JOINTS
 What examiner sees, hears and smells.
 Symmetry is observe.
 Do a general visual inspection first followed by a closer visual assessment 7. HEAVES DETECTED BY THE
of each area. PROXIMAL ASPECTS OF THE
 Lighting must be natural light or uniform white as possible so as not to METACARPOPHALANGEAL
alter true colors. JOINTS
 Oblique lighting is useful in detecting subtle changes in surface contour
and motions
 Make a thorough inspection.
 Never forget to look at the back of the patient and feet.
8. CHEST WALL PALPATION
Palpation USING THE PALMAR
ASPECTS OF THE
Examination by touch METACARPOPHALANGEAL
The examiner feels for JOINTS
a. texture
b. size
c. consistency
d. location of body parts 9. CHEST WALL PALPATION
e. masses USING THE ULNAR SIDE
f. tenderness (fifth metacarpal and fifth
g. temperature Phalanges)
 The tips of fingers are most sensitive for fine tactile discrimination like
apical impulse or lifts at precordial area.
 The Dorsa of the hands or fingers has much thinner skin used for taking
temperature
 Distal palmar of metacarpophalyngeal joints best detect:
1. RADIAL PULSE PULSATION USING THE - Thrills in precordial area
PADS OF THE INDEX AND MIDDLE FINGERS - AV fistula bruit
- Bruit of major arteries
 Palmar of metacarpophalangeal joints best detect the heaves and lifts in
precordium.
2. CAROTID ARTERY PALPATION USING THE INDEX AND MIDDLE  Palmar aspects of metacarpophalangeal joints and ulnar side of 5th
FINGERS (or metacarpal and 5th phalanges are sensitive to detect vocal vibrations
LEFT THUMB) through chest wall.
on the right
carotid artery in 1. SINGLE-HAND TECHNIQUE 2. Two-handed deep palpation
the lower third technique
of the neck.
3. PALPATING FOR THE BRACHIAL ARTERY

3. LIVER PALPATION
4. DISTAL TIPS OF THE FINGER PADS FOR APICAL IMPULSE

4. HOOK TECHNIQUE
5. DETECTING APICAL IMPULSE USING THE TIPS OF THE MIDDLE AND
INDEX FINGERS

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 CLINICAL MEDICINE 1
METHODS OF PHYSICAL EXAMINATION
TITLE
Percussion - Stethoscope with the ff: characteristics
a. Ear tips that fit snugly and
 Examination of the body by tapping it with fingers. painlessly.
 By striking the surface of the body, it elicits a characteristics percussion b. Choose ear tips of the proper size,
note depending of the vibration of the underlying organ and of the align the ear pieces with angles of
overlying tissues’ composition. the ear canal.
 Compare all areas bilaterally, using one side as control for the other. c. Thick-walled tubing to maximize
 Have a short fingernail so as not to inflict pain on the patient or oneself. transmission of sounds.
2 methods: Approximately 12 inches but not
1. Indirect, mediate ,or bimanual percussion this method is longer than 15 inches.
commonly used in examining the thorax and abdomen
2. Direct or immediate percussion this is not commonly used strike
the part under examination directly with the finger, without the
intervention of another finger or pleximeter.
3.
How to do it?

1. Relaxed wrist ensures delivery of repetitive blows of equal force

2. Neither the elbow nor shoulder should move
3. After the stroke, withdraw the plexor quickly from pleximeter so as to
elicit an audible clear percussion note and not dampen the vibration.
4. Apply 2 or 3 blows in each position with equal force
5. Move the pleximeter elsewhere for a second series of blows to compare
the sounds.
6. Commonly use in percussion of thorax and abdomen.

REFERENCE

METHODS OF PHYSICAL EXAMINATION: PowerPoint slides from CANVAS and

lecture discussion via Googlemeet by Dr.Divine Fundimera, September 2020.

 Fist percussion
- Commonly used to elicit tenderness from the liver or kidneys.
- The ulnar surface of the fist delivers a firm blow directly or
indirectly.

 Auscultation
- Examination by listening for sounds produced within the body.
- It uses a stethoscope to block sounds not to magnify.
- Use diaphragm firmly against the skin and bell lightly against the
skin.
- The bell and diaphragm of the stethoscope is used to detect the
characteristics of the heart, lungs and bowel sounds including
location, timing, duration, pitch and intensity.
- Auscultation also allows detection of bruit or turbulence over
arterial vessels.

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