Life Alert FACT FILE: The Physical Examination
Edited Article and Commentary by Dr. Don Rose, Writer,
Life Alert
--
Ever wonder what a complete physical exam (or physical) is supposed to consist of?
Curious what your doctor is actually measuring when he or she examines you, and
why? The following information, from the
entry on the Wikipedia website (the free online encyclopedia), may answer
some of your questions. Knowing what goes into a physical can help make you a better
consumer of medical services, and may help you think of questions to ask your doctor
before you put on the backwards paper robe. -Dr. Don Rose
--
Introduction
In medicine, the physical examination or clinical examination is the process by
which the physician investigates the body of a patient for signs of disease. It
generally follows the taking of the medical history — an account of the symptoms
as experienced by the patient. Together with the medical history, the physical examination
aids in determining the correct diagnosis and devising the treatment plan. This
data then becomes part of the medical record.
Although doctors have varying approaches as to the sequence of body parts, a systematic
examination generally starts at the head and finishes at the extremities. After
the main organ systems have been investigated by inspection, palpation, percussion
and auscultation, specific tests may follow (such as a neurological investigation,
orthopedic examination) or specific tests when a particular disease is suspected.
With the clues obtained during the
history and
physical examination
the doctor can now formulate a
differential diagnosis, a list of potential
causes of the symptoms. Specific diagnostic tests (or occasionally empirical therapy)
generally confirm the cause, or shed light on other, previously overlooked causes.
While the format of examination as listed below is largely as taught and expected
of medical students, a specialist will focus on their particular field and the nature
of the problem described by the patient. Hence a cardiologist will not in routine
practice undertake neurological parts of the examination other than noting that
the patient is able to use all four limbs on entering the consultation room and
during the consultation become aware of their hearing, eyesight and speech. Likewise,
an orthopedic surgeon will examine the affected joint, but may only briefly check
the heart sounds and chest to ensure that there is not likely to be any contraindication
to surgery raised by the anesthetist.
A complete physical examination includes evaluation of general patient appearance
and specific organ systems. It is recorded in the
medical record in a standard layout which facilitates
others later reading the notes. In practice, the
Vital signs of
Temperature examination,
Pulse and
Blood pressure are usually measured first.
Vital Signs
Temperature
Temperature recording gives an indication of core body temperature, which is normally
tightly controlled (thermoregulation) as it affects the rate of chemical reactions.
The main reason for checking body temperature is to solicit any signs of systemic
infection or inflammation in the presence of a fever (temp > 101.4 F or sustained
temp > 100.4 F). Other causes of elevated temperature include
hyperthermia. Temperature depression (
hypothermia) also needs to be evaluated. It is also
noteworthy to review the trend of the patient's temperature. A patient with a fever
of 101 F does not necessary indicate an ominous sign if his previous temperature
has been higher.
Blood pressure
The blood pressure is recorded as two readings, a high
systolic pressure which is the maximal contraction of the
heart and the lower
diastolic or resting pressure. The difference between the systolic and diastolic
pressure is called the pulse pressure. The measurement of these pressures is now
usually done with an
aneroid or electronic
sphygmomanometer. The classic measurement device
is a
mercury sphygmomanometer, using a column of mercury measured off in
millimeters. In the United States and UK, the common
form is millimeters of mercury, whilst elsewhere
SI units of pressure are used.
There is no natural 'normal' value for blood pressure, but rather a range of values
that on increasing are associated with increased risks. The guideline acceptable
reading also takes into account other co-factors for disease. Elevated blood pressure
hypertension
therefore is variously defined when the systolic number is persistently over 140-160
mmHg. Low blood pressure is
hypotension.
Pulse
The pulse is the physical expansion of the artery. Its rate is usually measured
either at the wrist or the ankle and is recorded as beats per minute. The pulse
commonly taken is the
radial artery at the wrist. Sometimes the pulse cannot be taken at the wrist
and is taken at the elbow (
brachial artery), or at the neck against the
carotid artery. The pulse rate can also be measured
by listening directly to the
heart beat using a
stethoscope.
Respiratory rate
Varies with age, but normal adults usually have 12-20 breaths per minute.
Basic Biometrics
Height
A statiometer is the device used to measure height, although often a height stick
is more frequently used for
vertical measurement of adults or children older than 2. The patient is
asked to stand
barefoot.
Height declines during the day because of compression of the
intervertebral discs. Children under age 2 are
measured lying
horizontally.
Weight
A
scale
is used to measure weight.
Body mass index or BMI is used to calculate the
relationship between healthy height and
obesity.
Pain
Because of the importance of
pain to the overall wellness of the patient,
subjective measurement is considered to be a vital
sign. Clinically, pain is measured using a
FACES scale which is a series of faces from '0' (no pain at
all showing a normal happy face) to '5' (the worst pain ever experienced by the
patient). There is also an analog scale from '0' to maximum '10'. It is important
to allow patients to make their own choices on a pain scale. Physicians and health
care workers frequently understate patient pain.
Structure of the Written Examination Record
General appearance
- Obvious apparent features as the patient enters the consulting room and in the course
of taking the history (e.g. mobility problem or deafness)
- JACCOL, a mnemonic
for Jaundice,
suggestion of Anemia
(pale color of skin or
conjunctiva), Cyanosis
(blue coloration of lips or extremities), Clubbing of fingernails, Oedema of ankles, Lymph nodes of neck, armpits, groins.
Organ systems
Related Wikipedia Resources
This article is based primarily on a Wikipedia.org entry called “
Physical examination”.
The information provided is, to the best of our knowledge, reliable and accurate.
However, while
Life Alert always strives
to provide true, precise and consistent information, we cannot guarantee 100 percent
accuracy. Readers are encouraged to review the original article, and use any resource
links provided to gather more information before drawing conclusions and making
decisions.
The article on this
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the Wikipedia content it is based on are covered by Wikipedia’s
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Don Rose writes books, papers and articles on computers, the Internet, AI, science
and technology, and issues related to seniors.
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