PHYSICAL EXAMINATION 5 The physical examination adds information obtained by inspection, palpation, percussion and auscultation. Inspection 6 A wide array of sophisticated instruments are available to assist with examinations,but a well-performed visual inspection can often reveal more information. Inspection should begin with the patient's general appearance , state of nutrition, symmetry, and posture. Wasting and hallmarks of poor nutrition may indicate chronic disease; poor grooming or slack posture may suggest depression or low self-esteem. The physician then proceeds to more specific examination of the skin - looking for redness or other signs of infection, hair loss, nail thickening and moles or other areas of pigmentation _ and inquires about any recent changes in skin lesions that could indicate early cancer. inspection also should encompass, in particular areas that the patient normally would not be able to see, such as the scalp the back, and the buttocks. Palpation 7 Palpation is the act of felling the surface of the body with the hands to determine the characteristics of the organs beneath the surface. I can be performed with one hand or two and can be light or deep. Light palpation is used to detect tenderness, muscle spasm, or rigidity of the abdomen. Deep palpation of the abdomen is used to determine the size of the liver, spleen, or kidneys and to detect an abnormal mass. 8 Palpation also is used to detect and evaluate abnormal lesions in the breast, the prostate gland, the lymph nodes, or the testes. Palpation also can detect cardiac enlargement if the point of maximal impulse (PMI) ”of the heart is farther to the left than normal. Percussion 9 Percussion s is a diagnostic procedure used to determine the density of a pat by tapping the surface with short, sharp blows and evaluating the resulting sound. In the abdomen in can be used to detect fluid (ascites), a gaseous distention of the intestine as occurs in bowel obstruction, or an enlargement of the liver. It is used most often to evaluate the chest in case of pneumonia or emphysema. Auscultation 10 Auscultation is performed with a stethoscope to evaluate sounds produced by heart, the lungs, the blood vessels, or the bowel. Listening to the sound of air passing in and out of the lungs can be useful in detecting an obstruction, as in asthma, or an inflammation, as in bronchitis or pneumonia.