Physical examination(体格检查).ppt

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1、Physical examination Department of Endocrinology Hainan medical college Wang Xinjun（王新军）（王新军） 18789826999Physical examinationlIt is the process of examining the patients body to determine the presence or absence of physical problems.We use each of our four senses to elicit signs of disease:lInspecti

2、on视诊（sight and smell）lPalpation触诊（touch）lPercussion叩诊（touch and hearing）lAuscultation听诊（hearing）“teach the eye to see,the finger to feel,and the ear to hear”lWhat is the fifth?Smelling（嗅诊）InspectionlInspection is the search for physical signs by observing the patient with your eyes and sense of smel

3、l.lFirst step in examining a patient or body part It includes a general survey of the patients mental status（精神状况）posture（姿势）body movement gait（步态)breath odor（呼吸气味）skin type pattern of speech stature（身材）state of nutrition（营养状况)lacromeglyHow to inspectlMake sure the room is in a comfortable temperatu

4、relUse good lighting,preferably sunlightlLook and observe before touchinglCompare symmetrical body partsMental status and personal groominglDoes the patient look well or sick?lIs he comfortable in bed?lDoes he appear in distress?lIs he alert or is he groggy?lDoes he look acutely or chronically ill?p

5、oor nutrition sunken eyes temporal wasting loose skinlDoes the patient appear clean?lIs her hair combed?lDoes she bite her nails?Posture姿势lIt may reveal significant informationlCongestive heart failure:sit in a chair the entire nightlThus the positions of the patient at the time of the examination m

6、ay suggest certain disease possibilitiesPalpation lPalpation is employed on every part of the body accessible to the examining fingers.lThe palpation of abdomen is particularly importantlThe examiner touches and feels the patients body part with his hands to examine texture（质地）Moisture skin temperat

7、ure characteristics of massestenderness（触痛）of an organ or body partCharacteristic of massessize（大小）shape consistency（密度）motilitysurface regularitypresence or absence of expansile or transmitted pulsation.Methods of palpation lAlways begin palpation in an area of the abdomen that is farthest from the

8、 location of painTypes of palpationlLight palpation（浅部触诊）lDeep palpation（深部触诊）lBimanual palpation（双手触诊法）Light palpationDeep palpationlUsed to determine organ size as well as the presence of abdominal masseslThe patient should be instructed to breathe quietly through the mouth and to keep arms at the

9、 sides Deep palpationBimanual palpationlUses two hands,one on each side of the body part being palpatedlIt is employed during the processes of breasts liver,spleen,kidney or abdominal masses examinationBimanual palpationPercussion lPercussion is the act of striking the surface of the body to elicit

10、a sound.lPercussion of a body part produces a sound that indicates the type of tissue within the organlIt is particularly important in examining the chest and abdomenPercussion It is used to detect diaphragmatic movement（横隔膜运动）,the size of heart,edge of liver and spleen et al.Methods of Percussion l

11、Indirect percussion（间接叩诊法）lDirect percussion（直接叩诊法）Indirect Percussion lThe examiner places the middle finger of one hand(left hand)firmly against the patients surface wall(chest or abdomen),with palm and other fingers held off(离开)the skin surfacelThe tip of the right long finger of the hand strikes

12、 a quick,sharp blow to the terminal phalanx of the left finger on the skin surfaceIndirect PercussionlThe motion of the striking finger（叩击手指的运动）should come from the wrist（手腕）and not from the elbow（肘）lUsually,two or three staccato blows are struck in one place,and then the pleximeter is moved elsewhe

13、re for a second series of blows to compare the sounds.Direct percussionlWhen you elicit sound by striking the body surface directly with your fingers,hand,or reflex hammer,the procedure is called direct or immediate percussion.Percussion According to the identity of the tissue,amount of air gas cont

14、aining and distance of the organ from the skin surface,the percussion sound include:resonance（清音）Tympany（鼓音）Hyperresonance（过清音）Dullness（浊音）Flatness（实音）Quality of Percussion lResonance清音:percussion over a structure containing air within a tissue,such as the lung,produces a resonantlTympany鼓音:percussi

15、on over a hollow air-containing structure,such as the stomachQuality of Percussion lHyperresonance过清音:the quality of percussion sound such as in pulmonary emphysema（肺气肿）lDullness浊音:percussion over a solid organ,such as the liver Quality of Percussion lFlatness实音:flatness occurs when there is no air

16、present in the underlying tissue.For example,flatness is found over the muscle of the arm or thigh.Sounds produced by Percussion Record of finding Quality Where heardResonance Hollow Normal lungHyperresonance Booming Air-filled lungsTympany Drumlike AbdomenDullness Thudlike LiverFlatness Flat Muscle

17、,bone Auscultation lA method used to“listen”to the sounds of the body during a physical examinationlAuscultation is used to examine the heart and lungs.stethoscopeAuscultation lDirect auscultationlIndirect auscultationHow to use the stethoscope lDos warm the diaphragm or bell explain what youre list

18、ening for and answer patients question promptlylDonts do not apply too much pressure when using the bell do not try to listen through clothingHow to auscultate lEliminate distracting noiseslExpose the body part you are going to auscultatelUse the diaphragm(膜型）to listen for normal heart sounds,and bo

19、wel soundslPress the diaphragm firmlylUse the bell（钟型）to listen for abnormal heart sounds or bruits（杂音)lHold the bell lightlySMELLlOdors on the breath from acetone,alcohol,and some poisons may lead quickly to a diagnosis.lFoul-smelling sputum suggests bronchiectasis or lung abscess.Vital signs生命征 an

20、d anthropomorphic datalTemperaturelPulselRespirationslBlood pressureMeasurement of the brachial artery pressurelThe patient may be either sitting or lying in the supine position仰卧位.lThe patient should have been resting for some time.Measurement of the brachial artery pressurelBare the arm and affix

21、the collapsed cuff气袖 snugly and smoothly,so the distal margin of the cuff is at least 3cm proximal to the antecubital fossa肘窝.lRest the supinated arm on the table or bed with the antecubital fossa approximately at the level of the heart.Measurement of the brachial artery pressurelPalpate for the exa

22、ct location of the brachial arterial pulse.Measurement of the brachial artery pressurelInflate the cuff to a pressure about 30 mmHg above the point where the palpable pulse disappears.lOpen the valve slightly so the pressure drops gradually(no more than 2mmHg per second)while making observations by

23、auscultation.Measurement of the brachial artery pressurelWith the bell of the stethoscope pressed lightly over the brachial artery,note the pressure at which sounds first become audible:this reading is taken as the systolic pressure收缩压.Measurement of the brachial artery pressurelAs deflation proceed

24、s,the sounds become louder and maintain a maximum for a considerable range before becoming muffled.lFinally,note the point where the sounds disappear:this reading is taken as the diastolic pressure舒张压.Pulse pressure脉压lThe pulse pressure is the difference between the arterial systolic and diastolic p

25、ressures.Examination of the lymph nodeslPalpation of the cervical lymph nodes颈部淋巴结lPalpation of axillary lymph nodes腋窝淋巴结cervical lymph nodes颈部淋巴结lPreauricular耳前lPostauricular耳后lSuboccipital 枕后lSubmandibular颌下lSubmental颏下lJugular（anterior triangle）颈前lPoststernocleidomastoid颈后lSupraclavicular 锁骨上cerv

26、ical lymph nodesaxillary lymph nodes腋窝淋巴结lLateral axillary group外侧淋巴结群lPectoral group 胸肌淋巴结群lSubscapular group 肩胛下淋巴结群lCentral group中央淋巴结群lInfraclavicular group 腋尖（锁骨下）淋巴结群questionslHow to measure the bood pressure?lWhat is pulse pressure?lSounds produced by Percussion?lPalpation of the cervical lymph nodeslPalpation of axillary lymph nodes