1、The Physical Examination?“Teach the eye to see,the finger to feel,and the ear to hear”.?The examiner must be able to identify,analyze,and synthesize the accumulated information into a comprehensive assessment.GoalPreparationWhat do patients need to be preparedWhat doctors need to prepareWhat equipme
2、nt you may need-As a physician?Elegant appearance（仪表端庄）?Decent manner（举止得体）?Kind attitude（态度和蔼）?Highly responsibility（有责任感）?Good medical morals（良好医德）-for a patient?The patient should be made as comfortable as possible during the examination.?The patient should be properly draped.?Proper expose.Can y
3、ou name these pieces of examination equipment?RequiredOptional?Stethoscope(听诊器）?Tongue blades（压舌板）?Penlight（电筒）?Tape measure（卷尺）?Sphygmomanometer（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
4、觉检测卡）Equipment for physical examinationSequential(有顺序的)-Conducted in head to toe order:head-neck-chest-abdomen-spine-extremities-anal-genital-nerve systemVital Signs 生命体征?Temperaturein degrees Celcius or Fahrenheit,?Pulse in beats per minute,?Respiratory rate in breaths per minute?Blood Pressure e.g
5、.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?Inspection inspek?n（视诊）?Palpation p?lp?i?n（触诊）?Percussion p?k?n（叩诊）?Auscultation?:sk?ltei?n（听诊）?What is the fifth?Smelling（嗅诊）1.Inspection1.Inspection?Method o
6、f observation used during physical examination?It includes a general survey of the patients?General appearance?State of nutrition（营养状况）?Body habitus（体型）?Symmetry（对称）?Posture and gait（体位和步态）?SpeechMental status and personal grooming(装扮)?Does the patient look well or sick?Is he comfortable in bed?Does
7、 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?Posture and gait?It may reveal significant information?Congestive heart failure:sit in a chair the entire night?Patients with the pancreatic cancer:assuming an upright or sit
8、ting posture?Gait 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（Parkinsons disease）跨阈步态（peroneal nerve paralysis）鸭步态(hip dysplasia)2.PalpationPalpation?Methods of“feeling the hands used during physical examinations”?The e
9、xaminer 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 part?The palpation of abdomen is particularly importantTypes of palpation?Light palpation（浅部触诊）?Used to feel for pulses,tenderness,muscle spasm（肌
10、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 palpation（深部触诊）?Used to determine organ size as well as the presence of abdominal massesLight palpationDeep palpation?generalized peritonitis：the abdomen is described as“board-lik
11、e”?Appendicitis：?migration of pain:from stomach-high to the right lower quadrant?Rebound tenderness 3.PercussionPercussion?A methods of“tapping”of body parts during physical examination with fingers,hands,or small instruments to evaluate the size,consistency,borders and presence of fluid in body org
12、ans?Percussion of a body part produces a sound that indicates the type of tissue within the organ?It is particularly important in examining the chestand abdomenMethods of Percussion?Indirect percussion（间接叩诊法）?Direct percussion（直接叩诊法）Quality of Percussion Record of findingWhere heard?Resonance（清音）?Ty
13、mpany（鼓音）?Hyperresonance（过清音）?Dullness（浊音）?Flatness（实音）?Normal lung?Air-filled lungs?Abdomen?Liver?Muscle,bone4.AuscultationAuscultation?A method used to“listen”to the sounds of the body during a physical examination?a fine stethoscope and good listening skillsHow to auscultate?Eliminate distracting
14、 noises?Expose the body part you are going to auscultate?Use the diaphragm(膜型）to listen for normal heart sounds,and bowel sounds?Press the diaphragm firmly?Use the bell（钟型）to listen for abnormal heart sounds or bruits（杂音)?Hold the bell lightlyHow to use the stethoscope?Dos?warm the diaphragm or bell
15、?Donts?do not apply too much pressure when using the bell?do not try to listen through clothingExercise#1?What things might you be able detect when you examine the hands of a patient?Exercise#1Examination of the hands?Hepatic palms?Color,rashes,scars,cyanosis,lines on the palms(Downs syndrome)?Pulse?Reflexes,Strength?Ataxia（共济失调）,tremor（小震）?Malformation of joints,swelling(for example in rheumatoid arthritis),Clubbing（杵状指）?Edema?Shape and color of the nails
