This article outlines common clinical methods used by clinician/doctor during patient physical examination through;
A step-by-step approach
Consider the inverted “J” format.
Use a suitable stethoscope utilizing both the diaphragm and bell effectively at the auscultatory areas (mitral, tricuspid, aortic and pulmonary areas)
#Change position of patient for different murmurs
#Area of maximum intensity
#Grading (Grade 1-6)
A simultaneous general examination for the respiratory system includes: –
5.Position of the trachea
7.Rhonchial fremitus (if present)
1.Position of the patient
2.Anterior – percuss from the clavicle downwards comparing the left and right sides of the chest
4.Lateral – percuss from the axilla region downwards comparing the left and right sides of the chest comparing the left and right sides of the chest
5.Interpretation of the percussion notes (resonant, dull, stony dull and hyper-resonant)
1.Breath sounds – listen to the breath sounds using both sides of the stethoscope from the top to the bottom at the anterior, posterior and lateral aspects of the chest. Take note of the quality and intensity of the sounds. The quality of breath sounds is described as either vesicular or bronchial.
2.Interpretation of the breath sounds i.e. bronchial and vesicular breath sounds
3.Vocal resonance – note if normal, decreased or increased
4.Sounds associated with vocal resonance
5.Auscultate for the added sounds noting the precise site where it is found
Some of the general features in gastro-intestinal diseases include: -finger clubbing,palmar,leuconychia, jaundice,pruritus and scratch mark.
Listen for the bowel sounds and note whether they are increased, normal, decreased or absent
Inspect the perineum in the dorsal or left lateral position
Grade 0 No movement, Complete paralysis
Grade 1 A flicker of contraction only
Grade 2 Power detectable only when gravity is excluded
by appropriate postural adjustment
Grade 3 The limb can be held against the force of gravity
but not against the examiner’s resistance
Grade 4 There is some degree of weakness, usually
described as poor, fair or moderate strength
Grade 5 Normal power is present
Perception of sensations depends on the physiological interaction of afferent (sensory) inputs at different levels in the nervous system. The important tests are light touch, vibration, position sense and pin-prick (surface pain). Begin with testing sensation of touch and position and test pain later when the patient has gained confidence.
2)Position sense/proprioception – this is appreciation of passive movements
3)Stereognosis –recognition of size, shape, weight and form of objects
Bedside assessment of autonomic function includes check for papillary responses to light, skin (whether dry or sweating), resting tachycardia and slow pulse rate with deep inspiration. Some of the autonomic abnormalities include inability to maintain blood pressure in erect position, constipation and other gastrointestinal motility, incontinence of urine, impotence and papillary areflexia.
The main feature is neck stiffness. The common causes of meningeal irritation are meningitis and sub arachnoid haemorrhage.
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