Physical Examination

Department of Physical
Diagnostics
What Is Physical Diagnosis

 Diagnosis
 Data collecting
 Data analyzing
 Determination of the nature of the
illness
 Aspects of Diagnosis
 Symptomatic diagnosis (inquiry of symptom)
 Physical diagnosis ( physical examination)
 Laboratory diagnosis (laboratory examination)
 EKG diagnosis
 Sonographic examination
 X-ray diagnosis (roentgenology, CT)
 Nuclear medicine
 Others: pulmonary function, endoscopy, etc
Classification of Clinical Diagnosis
 Based on criteria:
 Etiologic diagnosis
 Virus
hepatitis
 Rheumatic heart disease

 Pathologico-anatomic diagnosis
 Aortic regurgitation
 Liver cirrhosis

 Pathophysiologic diagnosis
 Shock
 Uremia
Inquiry of History
 How to interview
 Techniques and skills
 What to interview
 Content of questioning
 How to take a record
 The formula of the record
Preparation of Interview

 Your clinic or work place

 Your suit

 Your assistant
Contents of Questioning
 Biographic information
 Source and reliability
 Chief complaints
 Present illness
 Past medical history
 Personal history
 Marital history
 Menstrual and obstetric history in women
 Family history
Biographic Information
 Name  Work place
 Sex  Occupation
 Age  Date of entrance
 Native place  Date of record-
 Birth place taking
 Nationality
 Marriage
 Address
Source and Reliability of Information

 Accounting person

 Reliability
Chief Complaint
 Main discomfort and its duration
 Make sure to be:
 Concise Persisting headache for 3 days
 Sequential

 Make sure to avoid using:

 Onset time of the disease
 Diagnostic terms

 Dialects
Present Illness
 Further description of the main complaint, including the
whole disease process
(1) onset and duration
(2) predisposing factors
(3) characters of the main symptom
(4) accompany symptoms
(5) progression and evolvement
(6) managements and effects
(7) effects on daily life
Past Health
 Past health status
 Past illness
 History of injury
 History of surgery
 History of allergy
 History of blood transfusion
 History of vaccination
 Systemic review
Personal History
 Homeplace, inhabitation place,
epidemic disease or travel experience
to epidemic area
 Smoking and alcohol intake
 Work
 Housing condition
 Lifestyle
 Sex history
Marital & Childbearing History

 Marriage age

 Health status of the spouse

 Marital attachment
 Menstrual history and obstetrical
history

 Formula for recording menses

intermenstrual period (day) LMP or

Menarche age
Menopause age
Menstrual cycle

 Menses: volume, color, leukorrhea, dysmenorrhea

 Obstetrical: number of pregnancy and delivery, history
of operative delivery, difficult labor, abortion
 Family History

 Health status of three sequential generations

 Causes of death
 Existing the same disease?
 Hereditary diseases?
 Infectious diseases?
Tips for a Successful Interview
 Be kind and accessable
 Start from the main complaint
 Start from easier questions to more
complicated ones
 Inductive or forcing questions should be
avoided
 One question shouldn't be asked repeatedly
 Medical terms should be used cautiously
Question types to avoid
 Suggestive questions:

 Do you feel the pain in your left arm when

you get it in your chest?
 Instead:
 When you get the pain in your chest, do
you notice it anywhere else?
Question types to avoid

 Multiple questions:
 Have you had night sweets, fever, or chills?
 How many brothers and sisters do you have,
and has any one of them ever had asthma,
heart disease, or tuberculosis?
Question types to avoid
 Leading or biased questions:

 You haven’t used any recreational drugs,

have you?”

 You don’t have diabetes, do you?

Avoid medical jargon

 Have you experienced dysuria?

 Do you have nocturnal paroxysmal

dyspnea?
Trust between patient and doctor

 “ I can’t believe it!”

 “It’s impossible”
 “Have you REALLY not experienced
nausea? That is outrageous!”