Nervous SystemCheck for feelings of anxiety, apprehension, tremors, convulsions, history of psychiatric care, changes in memory, changes in judgment, pain, paresthesia (numbness), paralysis, and coordination.
Musculoskeletal SystemNote the presence of muscular pain, swelling, deformity, disability or pain in joints, weakness, atrophy, and cramps.
After getting as much information as possible from questioning, a physical examination must then be performed. In general, use the same system format that was employed in taking the medical history. (NOTE: As stated in the section on history taking, depending upon the complaint of the patient and your suspicions of his or her illness, it is not necessary to perform a complete physical examination in every case.)
Vital SignsTake and record temperature, pulse, respiration, and blood pressure
SkinThe human skin, which is sometimes referred to as the mirror of an individuals health because it often reflects diseases of other organs, should be examined visually and also by palpation. Observe for visible abnormalities such as warts, cysts, scales, and vesicles. An important point to remember in the visual examination of the skin is color. Changes in coloration are often tipoffs to various ailments; for example, a bluish tinge can indicate congestive heart failure, pneumonia, or any other condition in which the oxygen content of the hemoglobin is reduced. Changes in skin coloration can also be caused by abnormal deposits of pigmentation, such as increases of bilirubin in the skin and sclera as found in jaundice. Note the temperature, texture, elasticity, moisture, and presence or absence of edema. It is important to include the epidermal appendages in the examination of the skin; for example, note the condition of the nail beds (matrix) since abnormalities in the matrix can often indicate local or systemic disorders. Condition of the hair can also indicate local or systemic disorders, such as coarse, dry, and brittle hair, as found in many cases of hypothyroidism.
HeadLook for any abnormal head movements, such as spasms, tremors, and tilting. Note the size and shape of the head. Note any signs of swelling, discolorations (especially in facial bones), and bloody or watery discharge from the nose and ears. Test the sections over the sinuses by palpation and percussion to detect any signs of tenderness. Check for range of motion (provided there is no neck injury). Inspect the eyes for normal extraocular movements, equality of pupils, pupillary reaction to light, and accommodation. Check for position and alignment of the eyes, abnormal protrusions, recessions, and spacing; note the position of the eyelids to the eyeballs; observe for swelling of the lacrimal apparatus; note any opacities in the lens and cornea and swellings or nodules in the conjunctival and sclera. Examine the oral cavity for signs of bleeding or inflamed gums, coating or swelling of the tongue, ulcers, inflamed throat, pus, and condition of teeth.
NeckWhen inspecting the neck, look for any signs of asymmetry, unusual pulsations, growths, stiffness or limitation of movement, enlargement of the thyroid gland, and swollen lymph nodes behind the ears, on the sides of the neck, and in the supraclavicular area. Test swallowing ability.
Ears, Nose, and ThroatWhen inspecting the ears, include the external ear. This area is sometimes so obvious that it is often overlooked. Examine the external auditory canal for any signs of wax or trauma. Note the position, color, and shape of the tympanic membrane. Look for signs of blood, pus, redness, or swelling. Test for hearing loss by using a tuning fork, a ticking watch, or the human voice. Observe the nose for signs of swelling or trauma. Use a nasal speculum to check for obstructions, redness, and infection. Inspect the throat for signs of blood, pus, redness, swelling, tenderness, and any swellings or growths. Check the condition of the teeth, gums, tongue, palate, tonsils, uvula.
Respiratory SystemDetermine if the patient is coughing and if the cough is productive or nonproductive. If productive, examine the sputum for quantity, color, viscosity, and odor. Look for skeletal deformities or funnel chest and exaggerated or abnormal posture. Check the accessory respiratory muscles in the neck for deformity. Take note of rate, depth, symmetry, and pattern of respirations. Palpate the chest wall