1. PHYSICAL METHOD OF EXAMINATION Dr. Sangram Biswal Deptt. Of Epidemiology and Preventive Medicine

2. PHYSICAL EXAMINATION  Use the 5 sense to make a precise diagnosis  Common technique used for physical examination – Inspection Palpation Percussion Auscultation Succussion Mensuration  Taking temperature, pulse and respiration

3. o To gain information through the sense of touch o Handling the tissue by means of the finger o One or both hands may be used (direct palpation) o With probe (indirect palpation) o To know – Presence of pain Variation in size, shape, consistency Temperature PALPATION Contd….

4. Interpretations of Palpation - 1) Resilient Structure quickly resumes its normal shape after cessation of pressure 2) Doughy Pressure causes pitting as in oedema 3) Firm Solid structure 4) Fluctuating Wave like movement is produced by application of alternate pressure 5) Emphysematous Structure is swollen, produces crepitating or crackling sound on pressure Contd….

5.  Art of striking any part of the body that organ or tissue will produce an audible sound and nature of sound gives idea about the condition of the organ emitting sound  Mostly employed in disease of the abdominal cavity  In large animal by – 1)Pleximeter and 2)Percussion hammer or Plexor PERCUSSION

8. Finger-finger percussion –  In small animal by using both hands  Middle finger of one hand acting as pleximeter  Flexed middle finger of the other hand as a hammer Mediate percussion - Finger or pleximeter is placed over the area being struck Immediate percussion –  Striking the part directly with the finger tips  Percussion in large animal of limited value  Internal organs are too large  Presence of sub-cutaneous fat in pig  Wool coat in the sheep

9. No air space between the pleximeter and skin Hand using the hammer must be at a higher level than the hand holding the pleximeter The handle of the hammer must not be held too firmly Rest loosely between the thumb and 1 st two finger To deliver a swinging blow Movement should come from the wrist Not from the elbow or shoulder Blows should fall perpendicular onto the pleximeter or directly on the part of the body being examined Strong percussion is used for examination of deeply seated structures Weak percussion for superficially situated

10. GENERAL GUIDANCE  Requires much practice  Depends on experience  Familiar of instrument PERCUSSION SOUNDS Resonant – Characteristic of the sound emitted by air containing organs Ex - Lungs Tympanic – Striking a hollow organ containing gas under pressure Ex – Tympany of rumen or caecum Dull – Emitted by a solid organ like the liver or heart