2. Physical Examination  Proposal: collection of patient ’ s body statement

3. Methods IInspection PPalpation PPercussion AAuscultation OOdors

4. Request  Examination should be conducted with gentleness,dignity and consideration,not hasty and rough.note your relationship.  Environment:silent,bright,keep warm.  Examination must accord some order.  Patients should be made as comfortable as possible during the examination.  Patients should be properly draped,expose the area to be examined, and prepared for the examination.  Examing table should be situated so that the doctor has access to both side of the patient.

5. Inspection  Inspection means observation.It is first step in every physical examination of the patient.  By eyes or some tool  Require good light condition.  Content:general condition,age,sex,development, facial feature,gait…..  Chest,abdormin,limbs,joint.

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7. Palpation  Palpation is the act of feeling with the hand or hands.  Further defines things we see and reveal things we can not see.  It is used to confirm and amplify the findings observed on inspection.  If there is reason to suspect pathology or pain in any area, palpate that area last.

8. 1.Light palpation  Using the pads of fingers with hand parallel to the area to be examined.  First palpate slowly and gently. Method of Palpation

9. 2.Deep palpation  Put your other hand on the palpating hand to add addition pressure.

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12.  (1)Deep slipping palpation ： Have the patient respire slowly and deeply,watching the patient’s face,and slipping palpate.

14.  (2)Deep press palpation  Watching the patient’s face,and palpate with press.

15.  (3)Bimanual palpation ： Left and right hands coordenated Deep slipping palpation with one hand anteriorly, while the other handthrust forward from the flank.

16.  (4)Ballottement ： When the abdormen is large or full of fluid.

18.  All texture should be noted  Skin,lymph node, vessle,mass or organ.

19. Percussion  Percussion is thumping with the hand or instrument on a part of the body to produce vibration and note what happens to the sound waves.  Examine the thorax,abdormen or other structure.

20. Methods  1.Direct percussion Use plexor direct blow to the area to be examined,or palmer aspects of all finger. Very rough  2.Indirect percussion This is the method in almost universal use today. The tip of the right middle finger (plexor) strikes the tip of the left middle finger(pleximeter) laid firmly against the skin thus producing a sound.

23. Analysis of percussion tones  According it’s  1.Intensity:amplitude of vibration  2.Frequency:number of vibration per second  3.Quality:difficult to describe.violin-piano  4.Duration:time that it last

24. Percussion  1.Resonance:normally over lungs  2.hyperresonance:lower pitch than normal resonance,has a deep “blooming”charater.  3.Tympany:ralatively musical sound,somewhat similar to the sound of a drum.  4.Dullness: is the opposite of resonance and hyperresonance,the sound is short,high pitched and is not loud.  5.Flatness:sound similar to striking a barrel filled with water.

25. Auscultation  Listening to sounds produced within the body, murmur, respiration sound  Two ways:  1.Immediate auscultation: With the unaided ear  2.Mediate auscultation:with stethoscope.

26.  Stethoscope ：  A bell or diaphragm connected with rubber tubing to earpieces.  It can transmit sound clearly and exclude extraneous noise.

27. Odors(smelling)  Smell is a sense occasionally useful in diagnosis.  Example:  Halitosis-poor oral and dental hygiene  Fetid breath is common in lung abscess.

28. NOTES  Methods of physical examination  Methods of palpation  Methods of percussion  Kinds of percussion sound