This document provides an overview of the components and procedures involved in performing a thorough physical examination. It discusses inspecting, palpating, percussing, and auscultating different body systems including the head, eyes, neck, lungs, heart, abdomen, and extremities. Key assessment techniques are outlined for each system, such as examining pupillary reflexes, respiratory patterns, lung sounds, heart sounds, organ size, and peripheral circulation. The goal of the physical exam is to accurately determine diagnoses through systematic practice of these evaluation methods.

1. Fundamentals of Physical
Examination
Chapter 5

2. Physical Examination
• Inspection
• Palpation
• Percussion
• Auscultation

3. Physical Exam
• Determine the correct diagnosis
• Proficiency is attained through practice
• Typical format for recording the exam includes:
– Initial impression
– Vital signs
– HEENT
– Neck
– Thorax
– Abdomen
– Extremities

4. Head
• Facial expression
• Nasal flaring
• Cyanosis
• Pursed lip breathing

5. Eyes
• Pupillary reflexes – PERRLA
• Mydriasis
• Miosis
• Ptosis
• Diplopia
• Nystagmus

6. Neck
• JVP
• Accessory muscle use
• Tracheal position
• Lymph nodes
• Carotid pulse

7. Lung Topography
Anterior Chest Posterior Chest

8. Lung Topography
Lateral Chest

9. Thoracic Cage Landmarks
Anterior Chest Posterior Chest

10. Lung Fissures

11. Thoracic Inspection
• Thoracic configuration
– Pectus carinatum
– Pectus excavatum
– Kyphosis
– Scoliosis
– Kyphoscoliosis
– Flail chest
• Central cyanosis
• Breathing patterns
– Apnea
– Biots
– Cheyne stokes
– Kussmauls
– Apneustic
– Paradoxical
– Asthmatic
• Breathing Effort
– Retractions/bulging
– Abdominal paradox
– Respiratory alterans
– Hoover’s sign

15. Thoracic Palpation
• Vocal fremitus
• Tactile fremitus
• Thoracic expansion
• Skin and subcutaneous tissues

17. Thoracic Percussion
• Indirect percussion
• Lung fields
– Normal resonance
– Increased resonance
– Decreased resonance
• Diaphragmatic Excursion

18. Lung Auscultation
• Tracheal breath sound
• Bronchovesicular
• Vesicular
• Bronchial
• Adventitious
– Wheeze
– Crackles
– Rhonchi
– Stridor
– Pleural friction rub

19. Figure 05-19 Location on chest wall where normal bronchovesicular and vesicular breath sounds
are heard. A, Anterior bronchovesicular. B, Posterior bronchovesicular. C, Anterior vesicular. D,
Posterior vesicular. (From Wilkins RL, Hodgkin JE, Lopez B: Fundamentals of lung and heart
sounds, ed 3, St Louis, 2004, Mosby.)

20. Wheezing vs Crackles

21. Voice Sounds
• Brochophony
• Egophony
• Whispering pectoriloquy

22. Precordium
• Heart topography
• Point of maximal impulse – PMI
• Heart sounds

23. Neurologic Exam
• Suspected brain or spinal cord injury
• Assessment of LOC
• Brainstem

24. Abdomen
• Hepatomegaly
• Ascites

25. Extremities
• Clubbing
• Cyanosis
• Pedal edema
• Capillary refill
• Peripheral skin temperature