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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…

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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…

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.…

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…

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…

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…

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…

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…

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…

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…

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…

The chest and lungs allow for respiration. The purpose of respiration is to keep the body adequately supplied with oxygen and protected from excess accumulation of carbon dioxide. Respiration involves the movement of air back and forth from the alveoli to the outside environment, gas exchange across the alveolar-pulmonary capillary membranes, and circulatory system transport of oxygen to, and carbon dioxide from, the peripheral tissues. This…

Examination of the ears, nose, and throat provides information about their integrity and function, as well as the associated respiratory and digestive tracts. The special senses of smell, hearing, equilibrium, and taste are also associated with the ears, nose, and mouth. Anatomy and Physiology Ears and Hearing The ear is a sensory organ that identifies, localizes, and interprets sound and helps to maintain balance. It is…

The comprehensive eye examination involves a series of tests evaluating vision, as well as the general health of the eyes, and includes screening for ophthalmologic diseases or ocular manifestation of systemic diseases. Anatomy and Physiology The eye is the sensory organ that transmits visual stimuli to the brain for interpretation ( Fig. 12.1 ). It occupies the orbital cavity; only its anterior aspect is exposed. The…

The head provides the bony housing and protective cover for the brain, including the organs that provide senses of vision, hearing, smell, and taste. The neck provides stability and support for the head and holds vital vessels, the trachea, esophagus, and spinal cord. A flexible cervical spine is necessary for head movement, balance adaptation, and increasing extent of vision. Anatomy and Physiology The skull is composed…

The lymphatic system is examined region by region during the examination of other body systems (i.e., head and neck, breast and axillary, genitalia, and extremities) and by palpating the spleen. Sometimes you may perform a comprehensive lymphatic examination, exploring all the areas in which the lymph nodes are accessible. Individual chapters in this book discuss the lymphatic system in specific body areas. Physical Examination Components 1.…

Skin provides an elastic, self-regenerating, protective covering for the body. The skin and its appendages are an important means by which we are viewed in the world and physical appearances are often critical to the well-being of patients. Examination of the skin, hair, and nails is performed as part of both the comprehensive and focused physical examination. The skin, hair, and nails can provide external visible…

An individual’s weight and body composition (proportion of fat and fat distribution) offer information about health status and may provide a clue to the presence of disease when out of balance. Nutrition is considered the science of food as it relates to promoting optimal health and preventing chronic disease. Nutritional intake and status offer insight into an individual’s health status. A nutritional assessment is an analysis…