Introduction to History and Physical Exam by luk10459


									Introduction to History and
      Physical Exam
 Robert Woodward, MD MBA
      Program Coodinator
 Clinical Practice Preceptorship
            Goal and Objectives

• Goal:
  – To introduce the student to the history and physical
• Objectives:
  – The student shall be able to recognize components of
    the routine history and physical exam
  – The student shall feel comfortable observing a
    physical exam in the preceptor’s office

• Inpatient                         • Outpatient (SOAP note)
   –   Chief Complaint                –   Subjective
   –   History of Present Illness     –   Objective
   –   Past Medical History           –   Assessment
   –   Social History                 –   Plan
   –   Review of Systems

• Vital Signs                     •   Cardiovascular
   – BP, RR, Temp, Pulse          •   Abdominal
   – ? Pain Scale                 •   Peripheral Vascular
• General Appearance              •   Musculoskeletal
   – Age, nutrition, clean, etc
                                  •   Neurological
• HEENT and Neck
                                  •   Genital/Rectal
• Pulmonary and Thorax                – Breasts and Axillae
                    Vital Signs

•   Pulse- Take radial pulse and count beats for 1 min
•   Respiratory Rate- Count Respirations for 1 min
•   Temperature- In adults, use oral thermometer!
•   Blood Pressure
    Blood Pressure Cuff

Normal Eardrum
             HEENT and Neck

• Head –inspect and palpate
• Ears- external and internal
• Eyes- inspect, check fundi, pupil reflexes,
  peripheral vision
• Nose- inspect and palpate
• Throat- inspect with light and tongue depressor
  – (brush your teeth)
• Neck- feel for lymph nodes and thyroid

•   Lungs- 3 lobes on right, 2 on left
•   Inspection (to look) for deformities
•   Palpation (to touch) for masses, vibration
•   Percussion (to tap on)
    – Cut your finger nails
• Auscultation (to listen to a body part with a
  stethoscope) both front and back

• Lung
  – Alternate both sides and go down the back and do
    lower lateral areas
  – Test for Bronchophony- “99”-loud and clear
     • Normal is muffled and indistinct through chest wall
  – Test for Ergophony “EE”- sounds like “AY”
     • Normal is a muffled long “E” sound
  – Whispered Pectoriloquy- whispers heard clearly
     • Normal is faint and indistinct
                   Cardiac Exam

• Inspection
• Palpation for Point of
  Maximum Impulse or
• Auscultation
   – Aortic, Pulmonic,
     Tricuspid, Mitral areas
   – S1, S2, murmurs, gallops,
                  Abdominal Exam

•   Inspection
•   Auscultation****
•   Percussion
•   Light and Deep Palpation
•   Liver Span, Spleen
•   Special tests
    – Eg. for appendicitis
             Musculoskeletal Exam

•   Inspection
•   Tone
•   Palpation
•   Range of Motion
    – Passive and Active
• Strength
               Neurological Exam

•   Mental Status (Mini Mental Status Exam)
•   Cranial Nerves I-XII
•   Muscle Tone
•   Strength
•   Reflexes- Bicep, Tricep, Brachioradialis, Knee, Ankle
•   Sensation- Pain, Cold, Soft Touch, Vibration
•   Higher Cerebral Function
•   Cerebellar Function- Coordination
             Contact Physicians

• Schedule visit in:
  –   October
  –   November/December
  –   January/February
  –   March/April
• Get White Jacket
  – Consider getting stethescope

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