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Fundamentals of Physical Examination

Fundamentals of Physical Examination. Chapter 5. Physical Examination. Inspection Palpation Percussion Auscultation. Physical Exam. Determine the correct diagnosis Proficiency is attained through practice Typical format for recording the exam includes: Initial impression Vital signs

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Fundamentals of Physical Examination

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  1. Fundamentals of Physical Examination Chapter 5

  2. Physical Examination • Inspection • Palpation • Percussion • Auscultation

  3. Physical Exam • Determine the correct diagnosis • Proficiency is attained through practice • Typical format for recording the exam includes: • Initial impression • Vital signs • HEENT • Neck • Thorax • Abdomen • Extremities

  4. Head • Facial expression • Nasal flaring • Cyanosis • Pursed lip breathing

  5. Eyes • Pupillary reflexes – PERRLA • Mydriasis • Miosis • Ptosis • Diplopia • Nystagmus

  6. Neck • JVP • Accessory muscle use • Tracheal position • Lymph nodes • Carotid pulse

  7. Lung Topography Anterior Chest Posterior Chest

  8. Lung Topography Lateral Chest

  9. Thoracic Cage Landmarks Anterior Chest Posterior Chest

  10. Lung Fissures

  11. Thoracic Inspection • Thoracic configuration • Pectus carinatum • Pectus excavatum • Kyphosis • Scoliosis • Kyphoscoliosis • Flail chest • Central cyanosis • Breathing patterns • Apnea • Biots • Cheyne stokes • Kussmauls • Apneustic • Paradoxical • Asthmatic • Breathing Effort • Retractions/bulging • Abdominal paradox • Respiratory alterans • Hoover’s sign

  12. Thoracic Palpation • Vocal fremitus • Tactile fremitus • Thoracic expansion • Skin and subcutaneous tissues

  13. Thoracic Percussion • Indirect percussion • Lung fields • Normal resonance • Increased resonance • Decreased resonance • Diaphragmatic Excursion

  14. Lung Auscultation • Tracheal breath sound • Bronchovesicular • Vesicular • Bronchial • Adventitious • Wheeze • Crackles • Rhonchi • Stridor • Pleural friction rub

  15. Figure 05-19 Location on chest wall where normal bronchovesicular and vesicular breath sounds are heard. A, Anterior bronchovesicular. B, Posterior bronchovesicular. C, Anterior vesicular. D, Posterior vesicular. (From Wilkins RL, Hodgkin JE, Lopez B: Fundamentals of lung and heart sounds, ed 3, St Louis, 2004, Mosby.)

  16. Wheezing vs Crackles

  17. Voice Sounds • Brochophony • Egophony • Whispering pectoriloquy

  18. Precordium • Heart topography • Point of maximal impulse – PMI • Heart sounds

  19. Neurologic Exam • Suspected brain or spinal cord injury • Assessment of LOC • Brainstem

  20. Abdomen • Hepatomegaly • Ascites

  21. Extremities • Clubbing • Cyanosis • Pedal edema • Capillary refill • Peripheral skin temperature

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