Basic Facts

• The physical examination is the process by which a health care provider investigates the body of a patient for signs of disease.
• After giving the patient an opportunity to give an overview of his or her medical problem (history), the physician proceeds to perform a physical examination.

A More Detailed Explanation

Depending upon the patient's condition and suspected medical problems, a physician may include one or more of the following four phases of the physical examination: 

Inspection

During this portion of the examination, the physician inspects or looks at different parts of the patient's body. For example, while inspecting the eyes, the physician could obtain a clue about an overactive thyroid that could be responsible for the patient's rapid heart beat. A characteristic growth on the eyelids could point to a high cholesterol level that is a risk factor for coronary artery disease. 

Inspection of the neck veins and their prominence could be indicative of heart failure. A bluish discoloration of the tongue and nail beds could point to a low oxygen level in the blood, while pallor or a pale appearance could indicate a low level of hemoglobin.  Additionally, inspection of the chest may provide information about enlargement of the heart. Thus, a physician obtains an enormous amount of information even before touching the patient.  

Palpation or "hands-on examination"

During palpation, the physician uses his or her hands to examine the patient. During this phase, the physician can feel the heart beat and diagnose enlargement. Loud heart murmurs may also be felt as a fine vibration through the chest wall. This is known as a "thrill."  Palpation of the belly could help diagnose liver enlargement, find the tenderness of an active ulcer, or help uncover an aneurysm.

The patient's pulses are also felt to help determine if there is disease of the blood vessels in the arms or legs (which might account for calf pain when the patient walks, for example). Tenderness during palpation of blood vessels may point to the presence of phlebitis (inflammation of the veins) or arteritis (inflammation of the arteries).  Pressing the legs and feet with the fingertip can diagnose the presence of edema or excess fluid.

Percussion or Tapping

During percussion, the physician places one finger on the patient and then taps that finger with the index finger of the other hand. Since hollow and solid areas generate different vibrations, the physician uses this technique to determine if he or she is tapping over an air filled structure (like lung tissue) or over a fluid filled or solid structure (like a liver).  This allows physicians to measure the size of various organs (heart, liver, etc.) and determine if fluid/solid tissue is present where normally air would be expected (as in pneumonia, for example).  

Auscultation or listening with a stethoscope

During auscultation, the physician listens to the patient's heart beat, lungs and blood vessels of the neck, abdomen and groin. 

Abnormal heart sounds are a clue to the presence of heart disease. The location, character and timing of a heart murmur (the sound that is created by turbulent blood flow across heart valves) can be used to diagnose various heart valve diseases. However, it should be emphasized that murmurs may also be heard in many normal individuals.

Similarly, blockages in the arteries of the neck and those that supply the legs may also produce turbulent blood flow. This turbulence can be heard with a stethoscope, and the sound created is known as a "bruit" (pronounced broo-ee).  When heard over the arteries that supply blood to the kidneys, a bruit can be a clue to the underlying reason for elevated blood pressure readings.

Listening to the lungs, when integrated with the history and other portions of the physical examination, can help diagnose such conditions as heart failure, asthma, bronchitis, pneumonia, and even a collapsed lung.  

 Licensed from HeartSite.com.  Reviewed and modified for CardioSmart by the ACC February 29, 2008.