Why is he feeling me

The physical exam

Despite the numerous technical examination methods available in medicine today, physical examination is still indispensable. Their great advantage is that the doctor can do it at any time without the need for any particularly expensive aids. The investigation gives him an initial overview. In many cases it provides - together with the information on the medical history - already indications for the cause of the complaints, which lead the patient to the doctor. This often results in a suspected diagnosis. The doctor can also receive information as to whether targeted further examinations are necessary.

Physical examination scheme

Doctors usually carry out a physical full-body examination according to a fixed procedure: They cover the individual regions of the body from head to toe. The examination is made up of several techniques: viewing (inspection), palpation (palpation), tapping (percussion), listening with a stethoscope (auscultation) and testing the individual body functions (functional test).

Example of an examination finding

The written report largely follows this scheme. During a check-up, the doctor often keeps things brief and focuses on certain aspects. If there are no other changes compared to the previous finding, he will make a note of this accordingly. However, the report is mostly heavily encrypted for the layperson using abbreviations and technical terms. In a rather concise form, the findings report can look like this, for example:

75 year old patient in good condition AZ and obese EZ (175cm, 98 kg, BMI 32 kg / m²). Fully oriented, language fluent, no Foetor, Skin dry, warm, no scars, no bruises. Mucous membranes well supplied with blood.

Head free to move, no Meningism. Pupils medium-wide, isokor, reactive to light and convergence. Paranasal sinuses free, tooth status intact, throat not inflamed. Lymph nodes on the neck slightly enlarged, not painful on pressure, easy to move. Other lymph node status normal.

Neck veins not congested. Thyroid gland not enlarged. No pathological Noise over the Carotids.
thorax symmetrical. SonorousKnocking sound. Vesicular breath sound both sides, none Rattling noises.

NormalHeart sounds. No extra sounds or pathological Heart murmurs.
Abdominal wall soft, intestinal noises lively, no pressure pain, none pathologicalResistances. Spleen and liver not palpable.

extremities warm, don't edematous. No Varicosis. RR 130/80 mmHg, pulse rhythmical, 70 / min. Foot pulses well palpable on all sides.
Good joint mobility, normal muscle tone, none Paresis, no Sensory disturbancesMuscle reflexes can be triggered on both sides. No pathological reflexes.

The following paragraphs explain the abbreviations and technical terms in italics.

Assessment of general physical condition

First, the doctor gets an overview of the general condition (AZ) of the patient. Is he strong but weakened, or is he frail? Does he look older or younger than he actually is? Does he speak completely normally, or, for example, hesitantly, slurred, nasal or hoarse? Does it have a noticeable smell (Foetor) on the body or bad breath (foetor ex ore)?

Just looking at the patient can provide valuable information about some diseases. A noticeable paleness of the skin and mucous membranes can indicate anemia. A dry tongue and standing folds of skin after pulling the skin between thumb and forefinger indicate possible dehydration. This can result from insufficient fluid intake or excessive fluid delivery. If necessary, the doctor can determine possible causes through specific inquiries.

In particular, elderly or seriously ill people who appear confused, the doctor asks for the date, who they are and where they are at the moment. It uses it to check - in technical terms - the orientation to time, person and place. Fully oriented means that the patient knows who he is and where he is, and can also name the date and day of the week.

Body Mass Index: Measure of the nutritional status

Next, the doctor asks for or measures your height and weight. By dividing the weight in kilograms by the size in meters squared, he calculates the so-called body mass index (BMI). It serves as an objective unit of measurement for nutritional status (EZ), thus states, for example, whether a patient is very overweight (obese) is.

However, the BMI can only be used as a guide. For example, according to the BMI, people with strong muscles (such as bodybuilders) are prematurely overweight. For this reason, the waist circumference should be measured for a more precise assessment of abdominal fat: For values ​​over 102 centimeters for men or 88 centimeters for women, doctors assume a significantly increased risk of secondary diseases. Another measure of the fat distribution is the ratio of the waist circumference to the hip circumference.

Examination of the head

Now the doctor turns to the patient's head. Depending on the situation, he first looks for current or previous external signs of injury or facial asymmetries. Then the doctor gently moves the patient's head in all directions, provided that this is possible without any problems. A painful restriction of movement of the head forwards towards the chest can indicate a reflex tension in the neck muscles when the meninges are irritated. In the technical language this is called Meningism. If present, the meningism must definitely be further clarified. The doctor will immediately check whether there are any other abnormal body signs. Accompanying complaints such as headache, vomiting, fever and drowsiness are alarm signs.

If there are indications of an ear, nose and throat disease, the doctor will also check whether knocking on the sinuses is causing pain.

Examination of the eyes

A look into the eyes follows: Are the position and position normal? Is there a yellowing of the whites of the eyes? The doctor will check whether the pupils are responding normally by shining a flashlight into each eye one at a time. Both pupils should be round and the same size, so isokor. Slight differences, less than half a millimeter, are still considered normal, then one speaks of a physiological anisocoria.

In addition, the doctor tests the Convergence reaction of the eyes. Both eyeballs move inwards and the pupils constrict. This happens, for example, when someone first looks into the distance and then quickly turns their gaze to a nearby object, such as a book. Due to the close-up convergence, the object is focused and only perceived once (instead of double images). It is normal for the reaction to weaken with age. But there are also pathological changes in the eyes and nerves that can influence this. If necessary, the doctor will call in a specialist, such as an ophthalmologist, and if a neurological disease is suspected, a specialist in neurology.

Examination of the mouth

In the mouth, the doctor pays attention to inflammation, a coated tongue or peculiarities of the teeth and the mucous membrane.

Examination of the neck

The mobility of the neck was checked when the head was examined. Painful stiffness of the neck, which also makes it difficult to turn the head, can occur with changes in the cervical spine. The medical history and clinical findings can provide clues here. The doctor inspects, among other things, the position of the cervical spine and the contours of the neck. He also pays attention to possible swellings. When touching, hardening and pain points on muscles and vertebrae can be noticed.

The doctor then palpates the lymph nodes on the neck and the thyroid gland on the front of the neck. He also asks the patient to swallow to see if it shifts. However, it is not always possible to feel the thyroid gland with certainty, whether it is of normal size or enlarged.

Next, the doctor places the stethoscope on the neck arteries (Carotids). If these blood vessels show calcifications, pathological (pathological) Flow noises can be heard. The doctor also pays attention to the neck veins: they are usually not filled if the patient is in an inclined position (45 degrees elevated upper body), for example. However, if they are filled in this position, this can indicate that the transport of blood in the upper body towards the heart is being hindered. In pronounced cases, the vessels are clearly visible even when sitting or standing. Overcrowded neck veins and other protruding veins on the upper body can indicate chest disease. Depending on the severity, there are other symptoms, sometimes it is an emergency.

Examination of the lungs

Also the chest (thorax) the doctor first looks at it as a whole to check for deformations or other abnormalities. He also checks that the breathing rate, breathing type and breathing depth are normal. Then he pats the back on the right and left on an imaginary line above the lower tip of the shoulder from top to bottom. The patient sits upright if possible. When you breathe in, the lungs expand, so the lower lung borders move deeper. The doctor will also check this when tapping the lungs.

The sound that is made when you tap it gives clues to the organs below. This is how the Knocking sound over the air-filled lungs differently than over the liver, which becomes clear when the doctor taps the lungs on the front right of the chest during the examination. The normal knocking sound above the lungs is known as sonorous. If the knocking sounds muffled, the doctor speaks of a hyposonic knocking sound. This indicates a reduced air content in the lungs, as occurs, for example, with fluid retention or pneumonia. A loud and hollow sounding noise (hypersonic knocking sound), on the other hand, indicates an increased air content in the lungs, for example in the context of pulmonary emphysema.

After the percussion, the stethoscope is used. While the patient breathes in and out deeply with his mouth open, the doctor uses the stethoscope to listen to the breathing sound over the entire lungs. He describes the normal (physiological) breathing noise in the central parts of the lungs as "bronchial breathing". In addition, there is the so-called "vesicular breath murmur", which arises mainly when inhaling through the unfolding of the alveoli. Oxygen exchange takes place in them. A vesicular breathing sound should be audible over all relevant parts of the lungs.

Ambient breathing noises, on the other hand, are noticeable noise phenomena and can indicate pathological changes. Examples are dry and damp Rattling noiseswhich occur, among other things, with pneumonia, bronchitis or pulmonary edema.

Examination of the heart

The doctor now turns back to the front of the patient and places the stethoscope on certain points above the heart around the Heart sounds to judge. These heart sounds are caused by the contraction of the heart muscles and the closure of the heart valves. In healthy adults, the examiner hears two heart tones that regularly (rhythmical) and appear in quick succession. Additional Heart murmurs occur mainly in diseases of the heart valves. The doctor can classify the noise more precisely and usually conclude the underlying heart damage. There are also other heart murmurs.

Examination of the abdominal organs

For the examination of the abdomen, the patient should lie on their back as relaxed as possible. The doctor palpates the entire abdomen. He pays attention to whether he can feel anything unusual (pathological resistance), whether the patient feels pain in a certain area or whether he involuntarily fends off the examination by tensing the abdominal wall. Doctors also try to feel the edge of the liver and spleen to see if these organs are enlarged. Nowadays, however, it is easier and more accurate to determine the size of organs using ultrasound.

Listening to the abdomen with the stethoscope is also used to assess the intestinal noises. Possible vascular noises in the abdomen may also be heard in slim patients.

In addition, the doctor gently palpates or taps the kidney bearings to check whether they are more sensitive to pain, for example in the context of an inflammation.

Examination of arms and legs

On the arms and legs (extremities) the doctor assesses whether these are warm, cold or swollen (edematous