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What does your doctor do in a physical examination?

A physical examination together with a medical history is used by your doctor to assist in the diagnosis process. Physical examinations are great for the fact that they can be interpreted immediately. Physical examinations are not only reserved for patients experiencing symptoms but is also recommended as a way of ensuring your general health is good you won't always notice symptoms when something is wrong. For example, your blood pressure may be high but you may not be experiencing any obvious symptoms.

There can be great variation in how detailed a physical examination depending on the patient's requirements. A physical examination may be brief but a complete physical examination involves evaluating everything from the patient's appearance to specific organ systems. All the information is recorded which then becomes your medical record.

There are several techniques your doctor may use during a physical examination. A visual examination is used to visually assess parts of the body by looking for abnormal color, shape, size, texture etc. Palpation involves feeling the body using the hands in order to assess size, shape, location and level of pain etc. Percussion involves producing a sound by tapping or scraping a part of the body which can allow determination of parameters such as organ size and density. Finally, auscultation involves listening to sounds produced by organs such as the stomach, lungs, heart.

Your doctor will utilize a variety of instruments during a physical examination such as a thermometer to measure your temperature; a blood pressure monitor to measure blood pressure; a stethoscope to listen to organs such as the abdomen, heart and lungs; an ophthalmoscope to examine the eyes; a speculum to allow examination of the cervix; and an otoscope to examine inside the mouth, ears or nose

During a physical examination, the doctor will first record your medical history. He may make notes on your general appearance and then check your vital signs temperature, pulse, blood pressure. He will then measure your height and weight. Any pain being experienced will also be noted (usually be the patient's perception of the pain on a scale of 1-10). The doctor will then proceed through a range of possible examinations on various parts of your body as detailed below. As mentioned earlier, each doctor will perform physical examination in different orders and in varying detail depending on the patient's requirements.

The doctor can evaluate the abdominal area by examining the abdomen, liver, spleen, kidneys, costo-vertebral angle, anus and rectum by using a variety of techniques such as visual examination, percussion, palpation and auscultation. The doctor may also look for a linguinal hernia and take a stool sample.

A skin examination will involve visually examining the skin's color, texture, turgor, moisture, pigmentation, lesions, hair distribution and warmth in order to assess general health and detect local and systemic disease. The skin on the legs may also be examined to detect arterial and venous insufficiency.

The doctor may do an ear, nose and throat assessment by examining the external ear, internal ear and nose an otoscope is used to examine the inside of the ear or nose. A basic hearing test may also be conducted.

Heart functioning can be assessed by measuring the radial pulse, auscultation of the heart, palpation of the precardium, examination of the neck veins, suprasternal notch and precardium. The limbs may also be assessed for evidence of edema.

The doctor evaluates the head and neck area by examining the head, scalp, mouth, salivary glands, thyroid gland and cervical nodes. During this examination organs such as the tonsils, tongue, gums, scalp, teeth and membranes can be assessed.

Various assessment techniques may be performed on male and female sexual organs. The doctor may examine the vagina, cervix, breasts, axillary nodes, penis scrotum, inguinal nodes and may perform a pap smear, bimanual examination or a rectovaginal examination.

The doctor will also examine and evaluate the spine, arm, leg and neck joints to assess such things as joint mobility and spine alignment. The lungs may be assessed by measuring the respiratory rate, examining the trachea position, chest expansion and percussion, voice transmission and listening to the lungs. An eye examination may involve a vision test, inspection of structures around and in the eye and assessment of the functioning of muscles and pupils of the eye.

A patient's nervous system can be assessed by evaluating the mental status, cranial nerves, motor system, sensory system, reflexes, cerebellar function and gait. The cranial nerves can be evaluated by performing a variety of tests involving various sensory organs such as the eyes, mouth, skin and ears. The patient's mental status is usually assessed verbally. Evaluation of the motor system utilizes tests involving the arm and leg muscles and the cerebellar functioning can be tested by asking the patient to perform specific movements.

Further tests will be ordered by the doctor if deemed necessary e.g. blood tests. The doctor may then offer you advice on how to prevent disease and maintain or improve your health. You may even receive written information about what screening or preventative services you should undertake. Obviously it is then up to you whether you follow up your doctor's advice on further tests, screenings, lifestyle changes etc.

Listed are some of the more common assessments and measurements that may be performed during a physical examination.

General appearance 
* e.g. mobility problems, deafness, jaundice, cyanosis, swelling of ankles etc
Vital signs
Temperature
Blood pressure
Pulse
Other parameters
Weight
Height
Pain	- scale of 1-10
Abdominal area
* Abdomen	
* Liver
* Spleen
* Kidneys
* Costo-vertebral angle 
* inguinal hernia 
* anus 
* rectum
* Stool sample
Skin
Ear, Nose, Throat
* Ear  external and internal
* Hearing 
* Nose 
Heart 
* Pulse
* Neck veins
* Precardium
* Suprasternal notch
* Heart auscultation
* Edema
Head and Neck
* Head
* Mouth
* Salivary glands
* Thyroid gland
* Cervical nodes
Sexual organs
* cervix
* Pap smear
* Vagina
* Bimanual examination
* Rectovaginal examination
* Breast 
* Axillary nodes
* Penis
* Scrotum
* Inguinal nodes
* Female genitalia
Joints
* neck
* arms
* leg
* spine
Lungs
* Respiratory rate
* Trachea position
* Chest observation
* Chest expansion
* Voice transmission
* Chest percussion
* Lung auscultation
Eyes
* External examination
* Conjunctivae
* Visual acuity
* Papillary reaction
* Visual field
* Eye muscles
* Internal examination
Nervous system
* Mental status
* Cranial nerves
* Motor system
* Sensory system
* Reflexes
* Cerebellar function
* Gait

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