Physical Examination Health Article

The examination

Before examiners question the patient, they will observe a person's overall appearance, general health, and behavior. Measurements of height and weight are made. Vital signs such as pulse, breathing rate, body temperature, and blood pressure are recorded.

With the person being examined in a sitting position, the following systems are reviewed:

• Skin. The exposed areas of the skin are observed; the size and shape of any lesions are noted.
• Head. The hair, scalp, skull, and face are examined.
• Eyes. The external structures are observed. The internal structures can be observed using an ophthalmoscope (a lighted instrument) in a darkened room.
• Ears. The external structures are inspected. A lighted instrument called an otoscope may be used to inspect internal structures.
• Nose and sinuses. The external nose is examined. The nasal mucosa and internal structures can be observed with the use of a penlight and a nasal speculum.
• Mouth and pharynx. The lips, gums, teeth, roof of the mouth, tongue, and pharynx are inspected.
• Neck. The lymph nodes on both sides of the neck and the thyroid gland are palpated.
• Back. The spine and muscles of the back are palpated and checked for tenderness. The upper back, where the lungs are located, is palpated on the right and left sides and a stethoscope is used to listen for breath sounds.
• Breasts and armpits. A woman's breasts are inspected with the arms relaxed and then raised. In both men and women, the lymph nodes in the armpits are felt with the examiner's hands. While the person is still sitting, movement of the joints in the hands, arms, shoulders, neck, and jaw can be checked.

While the person is lying down on the examining table, the examination includes:

• Breasts. The breasts are palpated and inspected for masses.
• Front of chest and lungs. The area is inspected with the fingers, using palpation and percussion. A stethoscope is used to listen to internal breath sounds.

The head should be slightly raised to examine:

• Heart. A stethoscope is used to listen to the heart's rate and rhythm. The blood vessels in the neck are observed and palpated.

The person being examined should lie flat for an examination of the:

• Abdomen. Light and deep palpation is used on the abdomen to feel the outlines of internal organs, including the liver, spleen, kidneys, and aorta, a large blood vessel.
• Rectum and anus. With the person lying on the left side, the outside areas are observed. An internal digital examination (using a gloved finger), is usually done for persons over 40 years old. In men, the prostate gland is also palpated.
• Reproductive organs. The external sex organs are inspected and the area is examined for hernias. In men, the scrotum and testicles are palpated. In women, a pelvic examination is completed using a speculum and a sample for a Papanicolaou test (Pap test) may be taken.
• Legs. While lying flat, the legs are inspected for swelling, and pulses in the knee, thigh, and foot area are found. The groin area is palpated for the presence of lymph nodes. The joints and muscles are observed.
• Musculoskeletal system. With the person standing, the straightness of the spine and the alignment of the legs and feet is noted.
• Blood vessels. The presence of any abnormally enlarged veins (varicose), usually in the legs, is noted.

In addition to evaluating a person's alertness and mental ability during the initial conversation, inspection of the nervous system may include:

• Neurologic screen. The person's ability to take a few steps, hop, and do deep knee bends is observed. The strength of the handgrip is felt. While sitting in an upright position, the reflexes in the knees and feet can be tested with a small hammer. The sense of touch in the hands and feet can be evaluated by testing reaction to pain and vibration.
• The 12 nerves in the head (cranial) that are connected directly to the brain. They control the senses of smell and taste, strength of muscles in the head, reflexes in the eye, facial movements, gag reflex, vision, hearing, and muscles in the jaw. General muscle tone and coordination, and the reaction of the abdominal area to stimulants like pain, temperature, and touch may also be evaluated.