Physical examination Heart Inspection: apical impulse, or its location, area and intensity Palpation: assessing point of maximum impulse, thrills, fremitus Percussion: percuss the hearts borders, the relative dullness or absolute dullness borders Auscultation: the heart rates, rhythm, heart sounds, murmur abnormalities of the S1, S2, splitting of S2, systolic clicks, diastolic opening snaps, vocal fremitus premature beats
Physical examination • Heart: Inspection: apical impulse, or its location, area and intensity Palpation: assessing point of maximum impulse, thrills, fremitus Percussion: percuss the heart’s borders, the relative dullness or absolute dullness borders Auscultation: the heart rates, rhythm, heart sounds, murmur, abnormalities of the S1, S2, splitting of S2, systolic clicks, diastolic opening snaps, vocal fremitus, premature beats
Physical examination Radial artery: pulse rate, rhythm(regular or irregular) pulse deficit The pulse may be described as normal, diminished increased, or double-peaked Peripheral vascular signs: capillary strike signs, bruits, abnormal artery movement
Physical examination • Radial artery: pulse rate, rhythm (regular or irregular), pulse deficit. The pulse may be described as normal, diminished, increased, or double-peaked. • Peripheral vascular signs: capillary strike signs, bruits, abnormal artery movement
Abdomen Inspection: symmetry, size, abdominal distention, abdominal striae, pitting(concave abdomen) respiratory movement, skin lesion pigmentation, surgical scar, umbilicus, hernia, body hair, venous distention and direction of blood flow, peristaltic waves; ecchymoses Palpation: the tenderness of abdominal wall. rebound tenderness, mass(location, size, shape, texture tenderness, motion, mobility
Abdomen • Inspection: symmetry, size, abdominal distention, abdominal striae, pitting (concave abdomen), respiratory movement, skin lesion, pigmentation, surgical scar, umbilicus, hernia, body hair, venous distention and direction of blood flow, peristaltic waves; ecchymoses • Palpation: the tenderness of abdominal wall, rebound tenderness, mass (location, size, shape, texture, tenderness, motion, mobility)
Abdomen Liver: size, character, surface, edge, tenderness, motion Gallbladder: size, shape, tenderness Spleen: size, character, tenderness, surface, edge Kidney: size, shape, character, tenderness, mobility Bladder: distention, costovertebral angle tenderness
Abdomen • Liver: size, character, surface, edge, tenderness, motion. • Gallbladder: size, shape, tenderness • Spleen: size, character, tenderness, surface, edge • Kidney: size, shape, character, tenderness, mobility • Bladder: distention, costovertebral angle tenderness
Abdomen Percussion: liver dullness borders, hepatic tenderness over the right upper quadrant, shifting dullness Auscultation bowel sounds. vascular bruits Anus and rectum: anal fissure anal fistula, pile, digital rectal examination
Abdomen • Percussion: liver dullness borders, hepatic tenderness over the right upper quadrant, shifting dullness • Auscultation: bowel sounds, vascular bruits •Anus and rectum: anal fissure, anal fistula, pile, digital rectal examination