Physical examination
Physical examination (including clinical examination ) is an in medicine of frequently used term for the examination of a patient with one's own senses and simple tools. The exploratory or gross examination of the entire body or its organ systems is also referred to as a full body examination.
The physical examination is regarded as a necessary basis of the diagnosis. The procedure is according to the so-called IPPAF schema:
- I - inspection, viewing,
- P - palpation, scanning
- P - percussion, tapping, and
- A - auscultation, listening to body regions and
- Odor perception ( eg, ammonia, acetone, alcohol in the exhaled air ).
- F - Functional test at the end of the study
The physical examination is an important part of the clinical training of medical students each. It is ( by tapping = percussion) learned in so-called knock courses on volunteer patients and follows a fixed scheme to achieve completeness and systematics. Usually, the investigation begins at the head and ends at the foot, where it is geared to the various organ systems.
At the beginning, in addition to the state of consciousness ( awake oriented? ) Assessed the so-called general health and nutritional state. In unconscious patients, the degree of disturbance of consciousness is examined by various stimuli (up to the pain stimulus by pinching ). The skin color of the patient reveals a possible anemia (anemia), lung and heart disease ( cyanosis) or bile stasis ( jaundice). Spots and other skin symptoms may indicate infection or other diseases, leg swelling (edema ) of heart failure or renal dysfunction. Arthritis or tremors of the hands can often be identified at first glance.
In the area of the head and neck pupillary responses and visual acuity will be tested and the fundus considered ( " mirrored "). The latter are, for example, evidence of hypertension. The oral mucosa is considered, skull and cervical spine are rapped, lymph nodes and the thyroid gland are palpated, listened to the neck vessels with the stethoscope. The sensory and motor function of the twelve cranial nerves can be examined in detail.
Other areas that can be accessed in a manner similar to the investigation, the spine, the chest including the heart, lung and breast; the abdomen, the kidney region on both sides, the lymph node regions in the armpits and the groin, genitals, arms and legs ( with the known reflex tests) as well as the central nervous system.
The depth of analysis is guided by the question. Often one or two symptoms are quickly found that affect the progress of the diagnostics. In rare cases of unclear clinical picture, a detailed examination of all body regions be necessary, which can last up to an hour. In practice, the investigation is often shortened and made deliberately. Never only the heart and lungs through the neckline of the dress should ( jokingly referred to as " cash triangle ") are examined in order to save time and the patient undressing, except in an emergency.
Only when all these studies provide no clear clinical picture, devices of modern medicine (for example, magnetic resonance imaging) used to clarify the disease and its extent. Only a synopsis allows the doctor to put together an appropriate therapy.