Physical examination or clinical examination (to be) _____ the process by which a health care provider (to investigate) ___________________ the body of a patient for signs of disease. It generally (to follow) _________________ the taking of the medical history — an account of the symptoms as experienced by the patient. Together with the medical history, the physical examination (to aid) _______ in determining the correct diagnosis and devising the treatment plan. This data then (to become) ____________ part of the medical record.
Although providers (to have) _________________ varying approaches as to the sequence of body parts, a systematic examination generally (to start) ____________ at the head and finishes at the extremities. After the main organ systems (to investigate) _____________________________________ by inspection, palpation, percussion and auscultation, specific tests may (to follow) ___________________ (such as a neurological investigation, orthopedic examination) or specific tests when a particular disease (to suspect) ___________________________________.
With the clues obtained during the history and physical examination the healthcare provider can now (to formulate) _____________________ a differential diagnosis, a list of potential causes of the symptoms. Specific diagnostic tests (or occasionally empirical therapy) generally (to confirm) __________________________ the cause, or shed light on other, previously overlooked, causes.
A complete physical examination (to include) ________________ evaluation of general patient appearance and specific organ systems.
Temperature recording (to give) _______________ an indication of body temperature.
The main reason for checking body temperature (to be) _____ to solicit any signs of systemic infection or inflammation in the presence of a fever (temp > 101.4 F or sustained temp > 100.4 F). Other causes of elevated temperature (to include) ______________ hyperthermia. Temperature depression (hypothermia) also (to need) _______________ to be evaluated. It (to be) ________ also noteworthy to review the trend of the patient's temperature.
The
blood pressure (to record) ___________________ as two readings, a high systolic pressure which (to be) _____ the maximal contraction of the heart and the lower diastolic or resting pressure. Usually the blood pressure (to take) __________________ in the right arm unless there (to be) _____ some damage to the arm. The difference between the systolic and diastolic pressure (to call) _________________ the pulse pressure. The measurement of these pressures (to do) _____ now usually ___________ with an aneroid or electronic sphygmomanometer. The classic measurement device (to be) ______ a mercury sphygmomanometer, using a column of mercury measured off in millimeters.
The
pulse (to be) ______ the physical expansion of the artery. Its rate (to measure) _____ usually _______________________ either at the wrist or the ankle and (to record) __________________ as beats per minute. The pulse rate can also (to measure) ____________________ by listening directly to the heartbeat using a stethoscope. The pulse (to vary) __________ with age. A newborn or infant can (to have) ___________ a heart rate of about 130-150 beats per minute. A toddler's heart (to beat) _____________ about 100-120 times per minute, an older child's heartbeat (to be) _____ around 90-110 beats per minute, adolescents around 80-100 beats per minute, and adults pulse rate (to be) _______ anywhere between 50 and 80 beats per minute.
Varies with age, but the normal reference range is 16-20 breaths/minute.
Height [‘hait] (to be) ______the
anthropometric longitudinal growth of an individual. A statiometer is the device used to measure height although often a height stick (to be) ______ more frequently used for vertical measurement of adults or children older than 2. The patient (to ask) ____________ to stand barefoot. Height (to decline) ____________ during the day because of compression of the intervertebral discs. Children under age 2 (to measure) ______________ lying horizontally.
Weight (to be) ______ the anthropometric mass of an individual. A scale (to use) ____________ to measure weight.
Body mass index or BMI (to use)_______________ to calculate the relationship between healthy height and weight and obesity or being overweight or underweight.
Because of the importance of pain to the overall wellness of the patient, subjective measurement (to consider) __________________________ to be a vital sign.
General appearanceObvious apparent features as the patient (to enter) __________ the consulting room and in the course of taking the history (e.g. mobility problem or deafness)
Jaundice, suggestion of Anaemia (pale colour of skin or conjunctiva), Cyanosis (blue coloration of lips or extremities), Clubbing of fingernails, Oedema of ankles, Lymph nodes of neck, armpits, groins.
Organ systemsCardiovascular system
Blood pressure, pulse rate and rhythm.
Jugular venous pressure (JVP), peripheral oedema and evidence for pulmonary oedema.
Precordial exam (cardiac exam)
Lungs
Respiratory rate, chest expansion, lung auscultation
Breasts
Abdomen
Abdominal examination (to note) __________ in particular any tenderness, bloating, organ enlargement, or aortic aneurysm.
No abdominal examination (to be) ______ complete without a Rectal examination
Genitalia
Musculoskeletal system
Nervous system, including mental status
Head and neck
Skin
Check of the hair to see if the hair growth (to recede) _______________ (baldness) or there is loss of hair (alopecia).
Check of the skin (to tell) _________ if there (to be) ________ marks such as hemangioma or strawberry marks or changes to the skin. Dark spots on the skin (to be) ______ also places where cancerous changes can (to appear) ____________ because the face, head and neck (to be)______ most usually sun exposed. Specific skin conditions may (to associate) ___________________ with specific diseases.
