General physical examination pdf

We recognize the current debate where some decry clinical examination because of the lack of evidence supporting many techniques. Where evidence exists, however, we highlight this in a new feature for this edition: evidence-based examination boxes EBEs. We are convinced of the need to acquire and hone clinical examination skills to avoid unnecessary expensive and potentially harmful over-investigation.

Nevertheless, there is a need to evaluate rigorously many clinical symptoms and signs. It is possible to open this book on almost any page and find a topic that cries out for evidence-based analysis.

We continue to hope that the book will stimulate this inquiry and would encourage these responses and incorporate them in future editions. To download click below. You made some decent factors there. Moreover, it is a unique situation in which both patient and physician understand that the interaction is intended to be diagnostic and therapeutic. Almost without exception, some medical history about the patient is available at the time of the physical examination.

Rarely, there may be no history, or at best brief recordings of acute events. Information pertinent to the physical examination can be learned from observation of speech, gestures, habits, gait, and manipulation of features and extremities.

Interactions with relatives and staff are often revealing. Pigmentary changes such as cyanosis, jaundice, and pallor may be noted. Diaphoresis, blanching, and flushing may provide clues about vasomotor tone related to mood or physiologic abnormalities.

Aspects of patient habits, interests, and relationships can be ascertained from pictures, books, magazines, and personal objects at the bedside. Aside from the hospital room and office, physical examination may occur in a variety of other settings where it is difficult to establish privacy and quiet.

The best resource available to the physician to set the stage for the physical examination is to communicate respect and a genuine interest in the patient's welfare. The patient should be addressed politely and asked to perform the required maneuvers of the examination, a technique far preferable to imperative language such as, "I want you to. Aside from explanations and reassurance, it is not necessary to maintain a continuous conversation with the patient during the examination.

Avoid embarrassing the patient. Be certain that draping material is used appropriately and that personal areas are not subjected to undue exposure. An examination that ends abruptly may diminish the value of the doctor—patient relationship and may destroy its therapeutic content. The patient may benefit from a brief summary of relevant findings and may require reassurance about what has and has not been found.

The single most useful device for optimal performance of the physical examination is an inquisitive and sensitive mind. Next most useful is mastery of the techniques of observation, palpation, percussion, and auscultation. Less important are the tools required for the examination Table 4.

As the environment affects the quality of the physical examination, it is wise to arrange for quiet and privacy, darkening the room for parts of the examination, and comfort for the patient and examiner. The complete examination should proceed in an orderly fashion with a minimum of required position shifts by the patient Table 4. On the other hand, the physician must be able to ascertain the integrity of the various organ systems from regional examinations.

For instance, from examination of the head and neck, the physician must identify the vascular, neurologic, lymphatic, skeletal, and integumentary components and must relate them to their complements in other body regions. It would be tedious, by contrast, to examine the vascular system in its entirety, followed by a complete neurologic examination and the other organ systems each in turn.

When examining an anatomic region, the observer must be alert to the appearance of any abnormality and question at the time the morphologic aspects of the abnormality and its clinical significance. Positions of Patient and Examiner during the Physical Examination. The general physical examination can take many forms depending upon circumstances. Most often, the examiner evaluates body regions in a general way, looking for abnormalities.

Clues derived from the history signal the need for a more precise and detailed examination of a given system. A thorough physical examination often includes the sequence presented in Table 4. The clinically significant physical examination is a flexible entity that should vary with the needs of the patient. Periodic examinations for health assessment need to be comprehensive, as do most hospital admission examinations.

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