Physical Diagnosis Secrets

The Cardiovascular Exam

Generalities Cardiovascular examination is centered around five main components – all essential for making a diagnosis. In this section we shall discuss inspection , palpation , and percussion . Next we shall address auscultation, first with heart sounds and extra…

The Breast

Generalities The clinical breast examination (CBE) as screening tool for breast cancer is a controversial, changing field; it has mostly been studied in conjunction with screening mammography. (1) Inspection 1. Which areas should be examined? Breast tissue is contained in…

The Thyroid

Generalities The thyroid may not be the most important organ in a busy general practice, but in physical diagnosis it is second only to the heart in number of examination errors and lack of physician’s confidence. This is unfortunate, as…

The Neck

A Neck Features and Swellings (1) Generalities The neck is an important crossroad of anatomic structures and organ systems, the most important of which is the thyroid (discussed in Chapter 8 ). 1. What neck features should be identified during…

Nose and Mouth

A The Nose (1) Generalities If you can excuse the pun, it is wise to be nosy about the nose. In fact, examination of this important facial appendix may reveal unsuspected abnormalities that lead to a diagnosis of either systemic…

The Ear

Generalities The ear is an important site for physical examination; abnormalities may reflect either local or systemic disease. It also is an important sensory organ, whose function can be assessed (albeit in a rudimentary manner) with basic bedside tools. 1.…

The Eye

Generalities The eye is often bypassed or cursorily examined. Yet from measurement of visual acuity to funduscopy, all components of the exam can unlock important secrets, not only of the eye but also of the body. Some findings are so…

The Skin

A Basic Terminology and Diagnostic Techniques 1. How many skin diseases exist? What are the two main categories of skin lesions ? There are more than 1400 skin diseases. Yet, only 30 are important, common, and worth knowing. The first…

Vital Signs

Generalities Measuring vital signs is the initial but still essential part of bedside examination. Unfortunately, this task is often relegated to nonphysicians, sometimes even technicians. Yet, as the word implies, vital signs can provide a wealth of crucial information, some…

General Appearance, Facies, and Body Habitus

General Appearance 1. What is the value of carefully examining the patient’s general appearance? It is the Sherlockian value of making a diagnosis at first sight, sometimes while walking down a street. Attentive and knowledgeable observation is a time-honored skill…