A physical examination is a routine test your primary care provider (PCP) performs to check your overall health. A PCP may be a doctor, a nurse practitioner, or a physician assistant. The exam is also known as a wellness check

1. Physical examination
Mr. ABHAY RAJPOOT

2. Physical examination
•Physical examination is defined as a complete
assessment of a patient’s physical and mental
status.
•A physical assessment is the systematic
collection of objective information that is
directly observed or is elicited through
examination techniques

3. Indication of physical examination
• On admission
• On discharge
• On follow up
• Health camps
• Before and after diagnostic and therapeutic
procedure.

4. TECHNIQUE OF PHYSICAL EXAMINATION

5. INSPECTION

6. GENERAL INSPECTION OF A CLIENT
FOCUSES ON
• Overall appearance of health or illness
• Signs of distress
• Facial expression and mood
• Body size
• Grooming and personal hygiene

7. PALPATION

8. PRINCIPLES OF PALPATION
• Examiner should have short fingernails.
• Examiner should warm your hands prior to placing
them on the patient.
• Encourage the patient to continue to breathe
normally throughout the palpation.
• If pain is experienced during the palpation.
discontinue the palpation immediately.
• Inform the patient where, when, and how the
touch will occur, especially when the patient
cannot see what examiner is doing.

9. LIGHT PALPATION

10. DEEP PALPATION

11. PERCUSSION

12. TYPE OF PERCUSSION
• DIRECT PERCUSSION

13. INDIRECT PERCUSSION

14. AUSCULTATION

15. FOUR CHARACTERISTICS OF SOUND
• 1.Pitch (ranging from high and low):frequency or
number of oscillations generated per second by
vibrating object
• 2. Loudness (ranging from soft to loud): amplitude
of sound
• 3. Quality (gurgling or swishing)
• 4. Duration (short, medium or long)

16. OLFACTION

17. EQUIPMENTS
• STETHOSCOPE

18. OPHTHALMOSCOPE

19. OTOSCOPE

20. SNELLEN CHART

21. NASAL SPECULUM

22. VAGINAL SPECULUM

23. TUNING FORK

24. PERCUSSION HARMER

25. SPHYGMOMANOMETER

26. POSITIONING
Sitting/fowler’s

27. STANDING

28. SUPINE AND PRONE

29. DORSAL RECUMBENT

30. Sim’s

31. LITHOTOMY

32. KNEE-CHEST

33. PREPARING THE ENVIRONMENT

34. PREPARING THE PATIENT
• PSYCHOLOGICAL PREPERATION

35. PHYSICAL PREPERATION

36. ARTICLES REQUIRED
• Screen to provide privacy
• Bowl for antiseptic lotion
• Kidney tray and paper bag
• Weighing machine and height scale
• Patient gown

37. ARTICLES REQUIRED
• Bath blanket to cover the patient
• Draw sheet to cover patient’s chest
• Square drum containing test tube,
gauze piece, cotton swab, specimen
bottle, swabsticks
• Gloves
• lubricant

38. ARTICLES REQUIRED
• Torch
• Ophthalmoscope
• Snellen’s chart
• Book for colour blindness
• Pen
• Flash card
• Autoscope with speculum of different sizes
• Percussion Hammer
• Tuning fork

39. ARTICLES REQUIRED
• Nasal speculum
• Mouth gag
• Laryngeal mirror
• Tongue depressor
• Stethoscope
• Inch tape

40. ARTICLES REQUIRED
• Sterile tray for vaginal examination
• Proctoscope
• Vitals Tray

41. ARTICLES FOR NEUROLOGICAL
EXAMINATION
• Powder, soap
• Snellen’s chart
• Pencil or pen
• Cotton wicks
• Torch
• Tuning fork
• Salt, sugar

42. ARTICLES FOR NEUROLOGICAL
EXAMINATION
•Tongue depressor
•2 test tubes one with hot water and other
with cold water
•Safety pins
•Sharp object like key
•Reading material to assess eyes and
language of person
•Knee harmer

43. GENERAL SURVEY
• Identification data
• Gender
• Age
• Signs of distress
• Body type
• Posture
• Gait

44. GENERAL SURVEY
• Body movements
• Hygiene and grooming
• Body odour
• Affect and mood
• Speech
• Substance abuse:

45. VITALS SIGNS

46. HEIGHT AND WEIGHT:

47. ASSESSING INTEGUMENT SYSTEM
• Assessing skin
• Skin color
 Erythema

48. CYANOSIS

49. Jaundice

50. Pallor

51. Inspect skin vascularity
• Ecchymosis

52. PETECHIEA

53. Inspect skin lesion

54. Palpate skin temperature, texture,
moisture and turgor

55. EDEMA

56. PITTING EDEMA

57. ASSESSING NAILS
• Shape; convex
• Angle : between nail and its base is 160
degrees
• Texture: smooth, nail base should be firm and
non tender
• Color: pinkish nail bed with translucent white
tips
• Capillary refill

58. ABNORMALITIES OF NAIL
• Koilonychias (spoon nail)
• clubbing
• Paranychia

59. ASSESSING HAIR AND SCALP
• color,
• texture and distribution.
• Thickness and lubrication of hair

60. INSPECT THE SCALP
• Cleanliness, color, dryness,
• Lump, lesions,
• Lice (pediculus humanus capitus)
• Dandruff etc

61. HEAD AND NECK
ASSESSING THE SKULL
• for size, symmetry
• any nodules or masses

62. INSPECT THE FACE

63. ASSESS THE EYE
• Inspect external eye structure
• Position and alignment
• Exophthalmoses

64. ASSESS THE EYE
• Eye brows
• Eye lid :
• ectropion(eversion ,lid margin turn out)
• entropion(inversion, lid margin turns inwards)
• ptosis( abnormal drooping of lid over pupil

65. ASSESS THE EYE
• Eye lashes : sty.
• Eye balls
• Conjunctiva and sclera{ Paleness, redness
or purulent,jaundice}

66. ASSESS THE EYE
• Cornea and iris :arcus senilis

67. PUPILLARY REFLEX TO LIGHT

68. VISUAL ACUITY

69. INSPECT INTERNAL EYE STRUCTURES

70. EXTRA OCULAR MOVEMENTS

71. PERIPHERAL VISION

72. EARS
AURICLES
• EAR CANAL AND TYMPANIC MEMBRANE

73. HEARING
• WEBER’S TEST:
• RINNE, S TEST:

74. NOSE AND SINUSES

75. INSPECT THE MOUTH PHARYNX
AND NECK
•LIPS: lesions ,pallor (anemia),
cyanosis(respiratory cardiovascular problems),
cherry colored
•BUCCAL MUCOSA , GUMS AND TEETH: teeth
look for alignment , dental caries.buccal mucosa
is a good site to visualize jaundice and
pallor.leukoplakia (thick white patches ) is a
precancerous lesion.
•TONGUE
•FLOOR OF MOUTH
•PHARYNX:

76. ABNORMAL FINDINGS
• pallor, cyanosis or redness
• lesions, swollen lips red tonsils, swollen red
bleeding gums,
• white coating of tongue fissured tongue from
dehydration.
• bright red tongue seen in deficiency of iron
b12 or niacin,
• black tongue

77. ASSESS THE NECK

78. PALPATE TRACHEA AND LYMPH
NODES

79. PALPATE THE THYROID GLAND

80. ASSESS THE THORAX AND LUNGS
• INSPECT THE THORAX
• Abnormal findings :increase in chest size and
contour , abnormal breathing pattern with the
use of accessory muscles, unequal chest
expansion, and abnormal breath sounds,
barrel chest, pigeon chest

81. PALPATE THE THORAX

82. PERCUSS THE THORAX

83. AUSCULATE BREATH SOUND
• Bronchial sounds heard over the trachea are high –
pitched, harsh sounds with expiration longer than
inspiration .
• Bronchovesicular sounds: heard over the main
stem bronchus and is moderate (blowing) sound
with inspiration equal to expiration.
• Vesicular sounds are soft , low pitched and heard
best in base of lungs during inspiration longer than
expiration.

84. ABNORMAL BREATH SOUNDS
• WHEEZE
• RHONCHI
• CRAKLES
• FRICTION RUB

85. CARDIO VASCULAR SYSTEM
• INSPECT NECK AND PRECORDIUM
• PALPATE THE PRECORDIUM
• AUSCULATATE HEART SOUND

86. AUSCULTATION

87. ASSESSING THE BREAST AND AXILLA
• INSPECT BREAST AND AXILLA
• PALPATION OF BREAST AND AXILLA

88. ASSESSING THE ABDOMEN

89. QUADRANTS OF ABDOMEN

90. INSPECT THE ABDOMEM

91. AUSCULTATE BOWEL SOUNDS

92. PERCUSS THE ABDOMEN

93. PALPATE THE ABDOMEN

94. ASSESS MUSCULO SKELTAL SYSTEM
• INSPECT AND PALPATE MUSCLE

95. MUSCULO SKELTAL SYSTEM
• PALPATE THE BONES
• INSPECT AND PALPATE THE JOINTS
• INSPECT SPINAL CURVES
• kyphosis

96. AFTER CARE
• Make the patient comfortable
• Recording and reporting
• Replace all articles