Physical Address

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The Physical Examination

The Basic Procedures In the previous chapters, the general rules for mastering the art of taking the history are discussed. The specific skills necessary to perform a proper physical examination are discussed in this chapter. The four principles of physical examination are as follows: Inspection Palpation Percussion Auscultation To achieve competence in these procedures, the student must, in the words of Sir William Osler, “teach the…

Deconstructing Racism and Bias in Clinical Medicine

Introduction Biases exist at every level of the clinical encounter, and numerous studies have documented their impact on cognitive errors and clinical outcomes. Although bias can be most obvious in the direct clinician patient relationship, it occurs structurally and at the institution and medical system level as well. The 2003 Institute of Medicine Report “Unequal Treatment” proposed that conscious (explicit) and unconscious (implicit) biases of physicians…

Understanding Complementary and Alternative Medicine

General Considerations Complementary and alternative medicine (CAM) includes a group of diverse medical and health care systems, practices, and products, taken from around the world, that fall outside the realm of conventional medicine. Many aspects of CAM are rooted in ancient systems of healing from China, Tibet, India, Japan, Korea, Mongolia, Africa, and the Americas. Today, CAM alongside conventional medicine is widely used to treat and…

The Patient’s Responses

Responses to Illness Health is characterized by a state of well-being, enthusiasm, and energetic pursuit of life's goals. Illness is characterized by feelings of discomfort, helplessness, and a diminished interest in the future. Once patients recognize that they are ill and possibly face their own mortality, a series of emotional reactions occurs, including anxiety, fear, depression, denial, projection, regression, anger, frustration, withdrawal, and an exaggeration of…

The Interviewer’s Questions

Basic Principles Good communication skills are the foundation of excellent medical care. Even with the exciting new technology that has appeared since 2000, communicative behavior is still paramount in the care of patients. Studies have shown that good communication improves health outcomes by resolving symptoms and reducing patients’ psychological distress and anxiety. In the United States, 85% of all malpractice lawsuits are based on poor communication…

Emergency or Life-Threatening Situations

An emergency situation, whether it is unresponsiveness, an acute medical condition, drug overdose, or trauma, requires a change in the usual sequence of history taking and examination. Life-threatening conditions, such as airway obstruction, cardiac arrest, hypovolemic shock, and respiratory failure, must be identified rapidly and managed. The steps to complete the assessment for life-threatening conditions take seconds, not minutes. The rapid sequential assessment process focuses on…

Putting It All Together

This chapter asks that you integrate all you have learned about interviewing, building a history, and performing the physical examination. It offers a suggested approach and sequence for performing all steps of the physical examination. However, each patient presents with unique circumstances, and flexibility in your approach and examination sequence is encouraged. With experience, you will adapt easily while listening carefully to your patients and ensuring…

Neurologic System

The nervous system, with its central and peripheral divisions, maintains and controls all body functions by its voluntary and autonomic responses. The evaluation of motor, sensory, autonomic, cognitive, and behavioral elements makes neurologic assessment one of the most complex portions of the physical examination. This chapter focuses on assessment of the cranial nerves, cerebellar function and proprioception, sensory function, and the superficial and deep tendon reflexes.…

Musculoskeletal System

The musculoskeletal system provides the stability and mobility necessary for physical activity. Physical performance requires bones, tendons, ligaments, muscles, and joints that function smoothly and effortlessly. Because the musculoskeletal system serves as the body’s main defense against external forces, injuries are common. Moreover, numerous disease processes affect the musculoskeletal system and can ultimately cause disability. The purpose of this chapter is to review a systematic approach…

Anus, Rectum, and Prostate

Examination of the anus and rectum may be performed as part of a routine health visit. In patients with a prostate, examination may include the prostate. Examination of these structures is also performed when the patient has a specific concern. Anatomy And Physiology The rectum and anus form the terminal portions of the gastrointestinal (GI) tract ( Fig. 21.1 ). The anal canal is approximately 2.5…

Male Genitalia

For ease of communication, in this textbook the term “male genitalia” refers to the following anatomic structures: penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles, regardless of the gender identity of the patient. Examination of the male genitalia is typically performed when a patient presents with a specific concern, as part of the newborn examination, or as part of a routine well child or adult…

Female Genitalia

For ease of communication, in this textbook the term “female genitalia” refers to the following internal and external anatomic structures: mons pubis, labia, clitoris, vestibular glands, vagina, cervix, uterus, fallopian tubes ovaries, and bony pelvis, regardless of the gender identity of the patient. Examination of the female genitalia is typically performed when a patient presents with a specific concern, as part of the newborn examination, for…

Abdomen

The abdominal examination is performed as part of the comprehensive physical examination or when a patient presents with signs or symptoms suggestive of an abdominal disease process. It involves the core examination skills in a particular sequence: inspection, auscultation, percussion, and palpation. Additional procedures are used to detect serious abdominal pathology. During the abdominal examination, pay careful attention to the patient’s comfort level or degree of…

Breasts and Axillae

The breast examination is typically performed when a patient presents with a specific breast concern, as a follow-up to an abnormal examination or increased risk for breast cancer, or as part of a routine health visit. Examination of the breasts includes examination of the axillae and relevant lymph node chains. A major focus of the examination in adults is identification of breast masses, skin, or vascular…

Blood Vessels

The physical examination of the venous and arterial structures of the vascular system is a critical component of patients’ evaluation. You can gain great insight into their overall cardiovascular status, specifically the detection of peripheral artery disease (PAD) of the lower extremities, which is associated with an increased risk of stroke and cardiovascular events. Physical Examination Components Blood Vessels 1. Palpate the arterial pulses in distal…

Heart

The main heart function is to circulate blood through the body and lungs in two separate circulations (one circuit being the body, the second being the lungs). The heart lies in the mediastinum, to the left of the midline, just above the diaphragm, cradled between the medial and lower borders of the lungs. The cardiac examination is performed as part of the comprehensive physical examination or…