1、“Teach the eye to see,the finger to feel,and the ear to hear”.The examiner must be able to,and the accumulated information into a comprehensive assessment.GoalPreparation What do patients need to be preparedWhat doctors need to prepareWhat equipment you may needElegant appearance（仪表端庄）Decent manner（
2、举止得体）Kind attitude（态度和蔼）Highly responsibility（有责任感）Good medical morals（良好医德）lThe patient should be made as comfortable as possible during the examination.lThe patient should be properly draped.lProper expose.Can you name these pieces of examination equipment?RequiredOptional(听诊器）Tongue blades（压舌板）Pe
3、nlight（电筒）Tape measure（卷尺）（血压计）Reflex hammer（叩诊锤）Safety pins（大头针）Gloves（手套）Gauze pads（纱布垫）Lubricant gel（润滑油）Nasal speculum（鼻窥镜）Tuning fork:(音叉)Pocket visual acuity card （袖珍视觉检测卡）Equipment for physical examinationSequential(有顺序的)-Conducted in to order:head-neck-chest-abdomen-spine-extremities-anal-ge
4、nital-nerve systemVital Signs 生命体征Temperature in degrees Celcius or Fahrenheit,Pulse in beats per minute,Respiratory rate in breaths per minuteBlood Pressure e.g.120/80 mmHg is usually read as one hundred twenty over 80 millimeters of Mercury.Vital Signs vaitl sain生命体征How to read this?The principles
5、Inspection inspekn（视诊）Palpation plpin（触诊）Percussion pkn（叩诊）Auscultation:skltein（听诊）What is the fifth?Smelling（嗅诊）1.Inspection1.InspectionuMethod of observation used during physical examinationuIt includes a general survey of the patients General appearanceState of nutrition（营养状况）Body habitus（体型）Symm
6、etry（对称）Posture and gait（体位和步态）Speech Mental status and personal grooming(装扮)Does the patient look well or sick?Is he comfortable in bed?Does he appear in distress?Is he alert or is he groggy（醉酒的）?Does he look acutely or chronically ill?Does the patient appear clean?uIt may reveal significant inform
7、ationCongestive heart failure:sit in a chair the entire nightPatients with the pancreatic cancer:assuming an upright or sitting postureuGait abnormalities may result from a variety of neurologic and musculoskeletal conditions.痉挛步态（stroke）剪刀步态（脑瘫，Cerebral palsy）慌张步态（慌张步态（Parkinsons disease）跨阈步态（peron
8、eal nerve paralysis）鸭步态(hip dysplasia)2.PalpationPalpation Methods of“feeling the hands used during physical examinations”The examiner touches and feels the patients body part with his hands to examine size（大小）consistency（密度）texture（质地）location（部位）tenderness（触痛）of an organ or body partThe palpation
9、of abdomen is particularly importantTypes of palpationLight palpationUsed to feel for pulses,tenderness,muscle spasm（肌痉挛）rigidity（硬度）,surface skin texture（质地）,temperature,moisture（湿度）or mass,its size,location,hardness and outline（轮廓）Deep palpationUsed to determine organ size as well as the presence
10、of abdominal massesLight palpationDeep palpationlgeneralized peritonitis：the abdomen is described as“board-like”lAppendicitis：migration of pain:from stomach-high to the right lower quadrantRebound tenderness 3.PercussionPercussion A methods of“tapping”of body parts during physical examination with f
11、ingers,hands,or small instruments to evaluate the size,consistency,borders and presence of fluid in body organsPercussion of a body part produces a sound that indicates the type of tissue within the organIt is particularly important in examining the chest and abdomenMethods of Percussion Indirect pe
12、rcussion（间接叩诊法）Direct percussion（直接叩诊法）Quality of Percussion Record of findingWhere hearduResonance（清音）uTympany（鼓音）uHyperresonance（过清音）uDullness（浊音）uFlatness（实音）Normal lungAir-filled lungsAbdomenLiverMuscle,bone4.AuscultationAuscultation A method used to“listen”to the sounds of the body during a phy
13、sical examinationa fine stethoscope and good listening skillsEliminate distracting noisesExpose the body part you are going to auscultateUse the diaphragm(膜型）to listen for normal heart sounds,and bowel soundsPress the diaphragm firmlyUse the bell（钟型）to listen for abnormal heart sounds or bruits（杂音)H
14、old the bell lightlyHow to use the stethoscope warm the diaphragm or belldo not apply too much pressure when using the belldo not try to listen through clothingExercise#1What things might you be able detect when you examine the hands of a patient?Exercise#1 Examination of the hands Hepatic palmsColor,rashes,scars,cyanosis,lines on the palms(Downs syndrome)PulseReflexes,StrengthAtaxia（共济失调）,tremor（小震）Malformation of joints,swelling(for example in rheumatoid arthritis),Clubbing（杵状指）EdemaShape and color of the nails
