Life Alert FACT FILE: The Physical Examination

Based on the Wikipedia.org entry on “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 Life Alert page and the Wikipedia content it is based on are covered by Wikipedia’s Copyleft License. Please go to the Wikipedia Copyrights page for more information about that license.

Don Rose writes books, papers and articles on computers, the Internet, AI, science and technology, and issues related to seniors.

For more information about Life Alert and its many services and benefits for seniors – available in New York, California, Florida, and other states nationwide -- please visit the following websites:

http://www.lifealert.net
http://www.seniorprotection.com
http://www.lifealertnewyork.com
Life Alert® is a registered trademark of Life Alert Emergency Response, Inc.
© Copyright © 1987–, Life Alert, Inc.
All Rights Reserved.