Methods and pysical exaMethods and pysical examinationmination

Methods and pysical exaMethods and pysical examinationmination

1Inspection2Palpation ▲3Percussion ▲4Auscultation ▲5Smell

1inspection

Definition:By observing the patients systemic and local features with eyes to draw a conclusion or presume a diagnosis.

least mechanical,hardest to learn

General visual inspection—as a whole

Contents: age,facial expression,skin type tone and pattern of speech,position posture ， gait, nutrition,deformity

or asymmetry of face,limbs,trunk

Close visual inspection—

a single anatomic region

Contents ： mucous membrane,eyes,nose,mouth,

tongue ， muscle,bones, joints (the closer you look,the more you see)

2Palpation

intrductionspecific qualities elicited by palpatio

nmethods of palpationannouncements

introduction

definition:the act of feeling using the sense of touch to judge.

structures:(every part of the body) external structures, structures accessib

le through the body orifices, bones,joints,muscles,superficial nerves, ligaments,tendon sheaths

range:exclusive,important for abdomenthe most sensitive locus of the examiner: (1)finger pulp (2) palmar surface of the metacarpophala

ngeal joint is sensitive to vibration (3)skin of back hand is sensitive to tempera

ture

specific qualities elicited by palpationTextur MoistureSkin temperatureCharacteristics of massesPrecordial cardiac thrust Crepitus tenderness thrills vocal fremitus

Methods of palpation

Light palpationDeep palpationBimanual palpation

Light palpation• Suitable for: joints,soft tissue,superficia

l arteries,vein and nerve• Depth: 1 cm• Method:gently slide fingertips over skin

surface,then use cooperatiing action of metacarpophalangeal joint and wrist joint to rotate and glide.• Notices:lightly touch

Deep palpation• Suitable for:celiac change and neck,breasts,large muscle masses• depth :2 cm• Methods:deep slipping palpation deep press palpation ballottement

Bimanual palpationSuitable for: liver, spleen,kidney, Methods:put left palm on the back of

the organ,then hold to the right hand to make the organ betwwen two hands.

NoticeInform motive to patientsWarm and gentleProper position （ lie on one side ） Urinate if palpate inferior bellyDo and think

3percussion• Definition:the act of striking the surface

of the body to elicit a sound.• Method of percussion ： direct percussi

on inderect percussion

Most commonly used

Direct percussion

• Definition:striking the body surface directly with fingers,hand,reflex hammer

• Method:move intermedial tridactylism of right hand to each other,then slap the site

• Suitable for:exclusive change of chest and abdomen(pneumothorax ， generous pleural fluid)

indirect percussion

Methods (1)press the palmar surface of the left long fin

ger firmly onto the body surface as a pleximeter,only the distal phalanx should touch the wall,other fingers slightly uplift. the tip of the right long finger strike a sharp blow on the distal interphalangeal joint of the pleximeter as a plexor .

corecct wrong pose of indirect percussion

(2)The examiner holds the plexor finger flexed and rigid and delivers the blow by bending only the wrist; the elbow and shoulder should not move.

(3)After the stroke ,the plexor rebound quickly from the pleximeter

(4)Struck two or three staccato blows in one place.

Suitable for: thorax , abdomenNotices:environment is quiet proper position compare symmetrical site change of percussion sound proper strength

percussion soundResonance: airfilled lung(normal lung)Dullness:percussion over the heart when it

is covered by lung Tympany:percussion the gastric air bubbleFlatness:percussion the thigh musclesHyperresonance:emphysematous lung

4Auscultation

Direct auscultationInderect auscultation:through stethoscop

e

Inderect auscultationLung:breath souds,whispers,voice sounds, crackles,frictionHeart:normal heart sounds,gallops,murmu

rs rhythm disturbances,pericardial rubs and knocks

Vessels of neck:murmurs in the thyroid, carotid,subclavian arteries,venous hums

Abdomen:bowel sounds,murmurs from aneurysms and stenotic arteriesSkull:bruit of an arteriovenous fistulaJoints,tendon sheaths,muscles for crepi

tus

stethoscope

Vibrating air column:connect the body wall to the ears.

Chestpiece:combines the bell and diaphragm

Earpiece:connected by a spring

earpieces

chestpiece

diaphragm

Air column

Air column

earpieces

diaphragm

chestpiece bell

Using the stethoscope,one shoud pay attention: earpiece without air leakage,pain,discomfort diaphragm pressed tightly against the wall eliminate the extraneous noises practice

5smellDefinition:the act by judging the relatio

nship between abnormal smell and disease.Source of smell:breath,sputum,vomitu

s feces,urine,pus