In Medicine it is always necessary to start with the observation of the sick and to always return to this as this is the paramount means of verification. Observe methodically and vigorously without neglecting any exploratory procedure, using all that…
Generalities This is a difficult area of physical exam, but one necessary in ambulatory medicine and often rewarding. One of ten patients presenting to a primary care office will do so because of musculoskeletal complaints. Most of these can be…
Generalities In times of magnetic resonance imaging (MRI) and computed tomography (CT), the neurologic exam may seem almost anachronistic. Yet, as the leading British neurologist McDonald Critchley (1900–1997) once said during one of his United States visits, “CT scanning will…
A General Considerations Lymph nodes are important. A methodical search may yield invaluable clues in cancer or systemic disease. Some “sentinel” nodes have even entered medical folklore, forever linked by eponyms to the physicians who first described them. 1. Which…
1. What is the role of the pelvic exam? To provide an essential component of the female exam, which, when well performed, allows for “low-tech” cancer screening plus the detection of various obstetric-gynecologic conditions – including pregnancy. 2. How can…
Generalities Examination of male genitalia and the rectum is an important but often overlooked part of the physical examination, usually conducted rather quickly at the end. There is no gain in being prudish about it (or, even worse, skipping it…
Generalities Conventional teaching has long recognized the abdomen as “the grave of the internist,” since in contrast to the chest, this cavity has been quite unyielding to physical exam. Although maneuvers devised by generations of physicians to unlock the secrets…
Generalities Lung auscultation has long suffered from a complex and onomatopoeic terminology that goes back to the original stethoscope and its inventor. Recent application of computer technology has rekindled this art by facilitating acoustic analysis. Still, its major difficulty lies…
Generalities Chest inspection, palpation, and percussion are the foundations of physical exam. Percussion is 15 years older than the United States, the brainchild of an Austrian innkeeper’s son who figured out that patients’ chests could behave like barrels of wine.…
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…