9/17/2023 0 Comments Physical exam normal findingsThe presence or absence of ascites in patients with known liver disease has been shown to be difficult to determine when using physical exam techniques alone. For example, judging the presence or absence of râles is more likely to be agreed upon by several observers and on repeated exams by a single blinded observer, than is the graded intensity of breath sounds. The concept of interobserver and intraobserver variability has been introduced when looking at specific isolated findings. For instance, the assessment of whether clubbing of the fingers is present or absent has significant interobserver variability and has been demonstrated to be influenced by the clinical appearance of the patient.Ī number of studies have attempted to look at the validity of the physical exam as a diagnostic tool. Interpretation of isolated physical findings is often influenced by the presence or absence of historical information and coexisting physical findings. The astute physician constantly reviews and adds to the repertoire of techniques for physical examination.Įvaluation of the physical examination in terms of sensitivity and specificity is difficult. For instance, the failure to discriminate between and know the origin of carotid bruits and transmitted sounds of valvular origin can have critical significance.Īs knowledge of disease changes, the techniques of physical examination become augmented. Understanding the pathophysiologic mechanism of a physical abnormality is essential for correct diagnosis and management. The physical examination, however, can be the weak link in this chain if it is performed in a perfunctory and superficial manner. If the history and physical examination are linked properly by the physician's reasoning capabilities, laboratory tests should in large measure be confirmatory. The physical examination is a key part of a continuum that extends from the history of the present illness to the therapeutic outcome. When examining an anatomic region, the observer must be alert to the appearance of any abnormality and question at the time the morphologic aspects of the abnormality and its clinical significance. It would be tedious, by contrast, to examine the vascular system in its entirety, followed by a complete neurologic examination and the other organ systems each in turn. For instance, from examination of the head and neck, the physician must identify the vascular, neurologic, lymphatic, skeletal, and integumentary components and must relate them to their complements in other body regions. On the other hand, the physician must be able to ascertain the integrity of the various organ systems from regional examinations. The complete examination should proceed in an orderly fashion with a minimum of required position shifts by the patient ( Table 4.2). The patient may benefit from a brief summary of relevant findings and may require reassurance about what has and has not been found.Īs the environment affects the quality of the physical examination, it is wise to arrange for quiet and privacy, darkening the room for parts of the examination, and comfort for the patient and examiner. An examination that ends abruptly may diminish the value of the doctor–patient relationship and may destroy its therapeutic content. Be certain that draping material is used appropriately and that personal areas are not subjected to undue exposure. …" Patients should be prepared for unpleasant portions of the examination.Īside from explanations and reassurance, it is not necessary to maintain a continuous conversation with the patient during the examination. The patient should be addressed politely and asked to perform the required maneuvers of the examination, a technique far preferable to imperative language such as, "I want you to. The best resource available to the physician to set the stage for the physical examination is to communicate respect and a genuine interest in the patient's welfare. Aside from the hospital room and office, physical examination may occur in a variety of other settings where it is difficult to establish privacy and quiet.
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