Physical Exam for Diagnosis

Clinical pharmacologySurat Tanprawate, MD, MSc (Lond.), FRCP(T) Division of Neurology, Department of Medicine Faculty of Medicine, Chiangmai Universitywww.surattanprawate.comPhysical examination : the method you should knowMedical data recordRecommended book and videoThe clinical data approach and recordingIdentication data: age, sex, address, career Chief complaint Present illeness Past history+Family history+History of drug use and drug allergy Physical examinationThe clinical data approach and recordingProblem lists Investigation Provisional diagnosis Differential diagnosis Final diagnosis Progression note -> S.O.A.P format (inpatient) F/U -> clinical f/u, score test, lab f/uChief complaintChief complaint comprises of= Onset + duration + symptoms or group of symptoms (syndrome) First step of clinical thinking is symptomatology (!"#"$%&'") Chief complaint : symptomatology -1General: Weight, appetite, fever, sleep, mood. Eyes: Blindness, discharge, conjunctivitis, proptosis, ptosis. Ears: Deafness, discharge(otorhea), pain, tinitus, fullness, dizziness. Nose: Blockage, discharge(rhinorhea), postnasal drip, bleeding(epistaxis), headache, cheek swelling.Chief complaint : symptomatology -2Gastrointestinal systems: abdominal pain, nausea, vomiting, atulence, heartburn, dysphagia, jaundice, mass, hematemesis, melena., diarrhea, constipation, abdominal pain, mass, hematochezia, bowel habit change. Cardiovascular system: Exercise intolerance, nocturnal dyspnea, chest pain, tightness, palpitation, syncope, cough, edema. Respiratory system: Cough, sputum, hemoptysis, breathlessness, hoarseness, stridor, wheezing, chest pain.Chief complaint : symptomatology -3Nervous system: cortical : alteration of consciousness, seizure cranial nerve: diplopia, visual loss, dysphagia, deafness motor system: weakness, abnormal movement, ataxia sensory system: numbness, pain, headache autonomic dysfunction: syncope, bowel and bladder dysfunctionSurat Tanprawate, Chiangmai 2015. Dont do physical examination as a blind men. A resident physician in the Granada Relocation Center, examining a patient's throat.Parker, Tom, Photographer (NARA record: 4682167) - U.S. National Archives and Records AdministrationScope and content: The full caption for this photograph reads: Granada Relocation Center, Amache, Colorado. Doctor Gerald A. Duffy, resident physician, examining the throat of one of the rst arrivals.Physical examinationType General or screening physical examination Focused or specic physical examination exam in the detail that guided by the history or screening examPhysical examinationtoolsPhysical examinationmanuvers Inspection (() Palpation ()*) Percussion (+)",) Auscultation (-.)musculoskeletal Inspection (() Palpation ()*) Motion (/01) Measure (23)Vital signTemperature (T), respiratory rate(RR), pulse rate or heart rate (HR or PR), blood pressure (BP) Vital signs are objective guideposts that provide data to determine a persons state of health. Vital signs include temperature, pulse, respiration (collectively called TPR), and blood pressure (BP). Another indicator of a patients health status is pulse oximetry.TemperatureTempFrom Bonewit-West K: Clinical procedures for medical assistants, ed 8, St Louis, 2011, Saunders.PulsePulse-what to checkPulse rate tachycardia (>100) bradycardia (