INTRODUCTION TO

PHYSICAL DIAGNOSIS
Dr. Ashenafi Nega MD
March 17,2020
Agenda
 Components of clinical methods
 Interviewing technique.
 History taking.
 Physical examination-basics.
Components of clinical
methods
 History taking
 Physical examination: regional
 Diagnostic tests
 Case analysis
 Diagnosis
 Treatment
 Follow up
Objectives
 To know the basic interview technique.
 To understand the basic components of
patient history.
 To understand the basic components
and steps in physical examination.
Interview technique
Requirements
 Comfortable place

 Ventilation

 Adequate light

 Introduction

 Comfort the patient/client and establish

a good relationship.
 Remember: “a patient is a person not

simply a case”.
Building Rapport
 Begin with a non-medical interaction.
 Create an atmosphere that is open and
supportive.
 Practice “active listening”.
 Discuss a detailed agenda of what will
occur.
 Answer questions using simple terms the
patient can understand.
Communication Skills
 Maintain good eye contact.
 Use active listening and watch the
patient’s nonverbal cues.
 Have warm and accepting body
language.
 Rely on open ended questions.
 Avoid interrupting.
 Use summaries and reflections.
Non verbal skills
 Maintain an appropriate eye contact.
 Listen carefully.
 Stay as close to the patient as is
culturally acceptable.
Verbal Skills
 Phrase your questions politely and
respectfully.
 Use words that the patient understands.
 Make your questions specific.
 Avoid double questions at a time.
 Keep your questions free of moral
judgments.
 Avoid leading questions.
 Ask patient permission in special
circumstance (sexual history).
Special verbal skills
 Facilitation
 Direction
 When a patient is confused
 To start out ideas
 Summarizing and checking out the facts.
 Empathy: when dealing with feeling.
 Reassurance: Shows accepting feelings and
need not last long.
 Expressing partnership: commitment to
help.
Adapting the interview to specific
situations
 Interview across a language barrier: find an
interpreter. Ideally a neutral person who
understands the language & culture.
 Interviewing a confused person: talk to a
well informed family member.
 Interviewing the disruptive, angry patient:
stay calm, appear accepting & DO NOT be
confrontational. SECURITY!
 Sensitive topics: sexual history, mental
health history, history of substance abuse,
family violence
Components of the history
1. Socio-demographic
 Identification
 Full name
 Age, sex
 Address, Marital status
 Religion, occupation (Current and previous)
 Educational status
 Historian
 Referral paper if any.
2. The chief complaint
 Definition: The main reason that brought
the patient/ client to the health care
provider.
 Components:
 Type of complaint/s,location,main symptom
 Duration
 Principles
 Should be short and clear
 Use patient’s own words
The chief complaint
 Example 1.
 Cough of two months duration

 Example 2.
 Shortness of breathing of three months and
leg swelling of two weeks duration
3. History of Present
Illness(HPI)
 Importance:
 Detailed narration of the chief complaint.
 Is the most important element to reach at
the diagnosis and to consider the
differential diagnosis .
HPI
 Components:
 Details of the chief complaint
 Date of onset
 Mode or circumstances of onset
 Course and duration-maintain chronology
 Associated symptoms

 E. g: For pain
 Character,
location, type, radiation,
exacerbating and relieving factors, position
dependency
HPI
 Negative and positive statements
 Helps to rule in or rule out differentials
 Chronic illness relevant to the chief
complaint-HTN, DM, STI, HIV
 Mode of arrival
 Tells you severity and urgency
4. Past Illness
 Accidents, operations, any chronic illness
and blood transfusion during adult and
childhood.
 Duration or date of event.

 Severity

 Treatment history and out come.

MEDICATION S
Previous Admissions: When, Where,
Reason and out come. Maintain chronologic
order.
5. Review of symptoms( functional
inquiry)
 Purpose:
 Double check or reminder on points that
may have been missed in the HPI.
 Is a check list.
 Components:
 General- fever, weakness, weight change
 System systematically
Review of symptoms( functional
inquiry)
 HEENT: head ache, trauma, ear
discharge, sneezing, tearing, difficulty of
swallowing
 Lymphoglandular system(LGS): breast
pain, lump, discharge, thyroid function
assessment, lumps in the armpits,
groin,etc
 Respiratory: Cough, shortness of
breathing, chest pain, wheezes
 CVS: dyspnea, orthopnea, paroxysmal
nocturnal dyspnea(PND), palpitation
Review of symptoms( functional
enquiry)
 GIS: vomiting, nausea, pain, diarrhea
 GUS:
 Urinary symptoms: dysuria, urgency,flank
pain
 Genital symptoms: discharge, menstrual
cycle
 LOC: muscular pain, swelling, joint
 Integumentary: discoloration, ulcer, rash
 CNS: memory, loss of consciousness,
seizures, vision, weakness of limbs, etc
6. Personal /Social history
 Developmental
 Education
 Marital status
 Income, living condition
 Habits social activity
7. Family history
 Family status
 Parents, siblings, spouse and children’s
health situation.
 If dead ask for the presumed cause of
death
 Familial diseases: diseases with known
inheritance pattern/s ( Mendelian or
polygenic).
8. Nutritional History
 Dietary intake and preference
 Type
 Quality
 Amount
9. Immunization History
 Vaccines in the EPI( Expanded Program
in Immunization)
 Polio, DPT, BCG, Measles, Hepatitis B, H.
influenzae
 Others : Meningitis, Influenza,
pneumococal, rubella, etc
Physical Examination
 Requirement:
 Illumination
 Good exposure
 Position
 Explanation
 Meticulous and gentle
 Goal: To obtain clinical information that
advances diagnosis and is not merely a
token repetitive exercise of going through
a set of given tasks.
Physical Examination
 Instruments Required
The five senses!!!!!
Stethoscope
Reflex hammer, monofilament, tuning
fork
Ophtalmoscope/ otoscope
Physical Examination
 Techniques:
 Inspection
 Palpation
 Percussion
 Auscultation
Physical Examination
 General appearance:
 Healthy looking, sick looking, distressed
 Consciousness
 Nutritional status
 Vital signs:
 BP
 Pulse rate
 Temperature
 Respiratory Rate ± Oxygen saturation( SaO₂)
 Anthropometric measurements, BMI
Systemic/ Regional
Examination
 HEENT
 Lymphoglandular System(LGS)
 Respiratory
 CVS
 Abdomen
 GUS
 Integument
 Musculoskeletal
 CNS
Systemic/Regional
Examination
 Head: the hair, scalp, face skull and skin.
 Eyes: visual acuity, visual field, eyebrows,
eyelids, lacrimal apparatus, conjunctivae,
sclerae, cornea, lens, iris, pupils and retina.
 Ears: the auricle, the canal and drum,
auditory acuity and Air & Bone conduction
 Nose: asymmetry/deformity, obstruction,
septum/turbinates, sinus tenderness
 Throat(& mouth): the lips, the oral mucosa,
the gums and teeth, the tongue, the
pharynx
Winding up
 Summary: subjective and objective.
 List of problems
 Diagnosis(clinical impression) and
differential diagnosis.
 Plan of action : Diagnostic; lab tests,
imaging studies AND Therapeutic.
References
 HUTCHISON’S Physical Diagnosis
 Bates’ Physical Diagnosis
 The “ Green Book”: pocket guide.
 THANK
YOU