體格檢查英文版

1、A. GENERAL EXAMINATION/VITAL SIGNS（一般檢查）1. Introduce yourself to patient, usually last name and title and have a little conversation to relax the patient and to judge mental state.2. Wash hands before starting examination3. Patient is seated in a chair4. Palpate radial (wrist) Pulses for at least 30

2、 seconds and recordThe examiner placesthe padof his index, middleand ring fingers over theradialartery. Ifproperly done, the examiner should be able to feel the artery pulsating under the examinersfingertips. The radial pulse may be measured for 30 seconds, then the pulse perminute can befound by mu

3、ltiplyingby two.Attention shouldalso be paid to the rhythm.Theexaminershould not use his thumb to palpate any pulse.5. Palpate both radial (wrist) pulses simultaneously for symmetry for at least 30 seconds6. Measure respiratory rate for 30 seconds and recordThe examiner unobtrusively measures patien

4、ts respiratory rate. This may be accomplished bythe examiner leaving his hands on the patients wrists for another 30 seconds after measuringthe radial pulses so the patient does not realize that the examiner is watching him breathe. Thedepth and rhythm should also be noticed. The respiratory rate ca

5、n also be measured duringthe back exam.7. Measure blood pressure on right armBlood pressure may be measured with the patient in a sitting or lying position. In each position,精品the artery in which the blood pressure is to be measured should be at the level of the heart (atthe level of the fourth inte

6、rcostal space in the sitting position; at the level of the middle axillaryline in the lying position). The patients arm should be resting on a smooth table or supportedby the examiner, and slightly flexed at the elbow.8. Place cuff in correct location 2-3 cm above the atecubital creaseThe examiner s

7、ecures the blood pressure cuff snugly over the upper, arm so that one fingercan be admitted under the cuff. The cuff should be positioned 23 cm above the antecubitalcrease or elbow joint. Put the middle of the cuff over the brachial artery.9. Palpate brachial arteryThe examinercan locatethebrachiala

8、rterywhichlies slightlymedialtothetendonofthebiceps muscle in the antecubital fossa. The mercury column on the manometer dial should beproperly calibrated with the pointer at“0”before the cuff is inflated (i. e. , all the air should bepressed out of the cuff before it is inflated).The stethoscopeis

9、placedfirmlyoverthebrachialartery.Theexaminersinflatesthecuffslowly but steadily. Until the brachial artery pulse disappears. Then he continues to inflate cuff2.6 4.0kPa (20 30 mmHg higher, generally to about 21.3kPa (160mmHg).10. Measure blood pressure over brachial artery twice and record the lowe

10、r reading Deflate the cuff slowly at the rate of about 0.26kPa (2mmHg) Per second. The number where the examiner hears the first pulse sound is the systolic pressure. The pulse sound will waken and then disappear. The number where the pulse sound disappears is the diastolic pressure. Ifthe differenc

11、e between weakening of the sound and its disappearance is 2.6kPa (20mmHg) orgreater, the examiner should record these two numbers. The cuff must be completely emptiedwiththepointerat “0”beforeit is reinflated.Thesameproceduremaybefollowedfora感謝下載載精品second measurement of B. P. in the same or opposite

12、 arm. The lower pressure is recorded asthe patients blood pressure. After finishing the measurement, the examiner deflates and rollsup the cuff, leans the manometer over a little so the mercury column disappears, closes themercury column switch, puts the balloon in order, and closes the manometer.B.

13、 HEAD AND NECK（頭頸部）Skull11. Palpate and observe scalp (parting hair, and observing hair density, color, lustre and distribution)Theexaminerpalpatestheentireskullusingbothhandsandsimultaneouslyexaminessymmetrical areas. The examiner parts the hair to observe the scalp, noting any scaliness,deformitie

14、s,lumps,tenderness,lesionsorscars.Theexamineralsoobservesthedensity,color, lustre and distribution of the hair.Eyes12. Visual screening:（ omitted）13.Observe cornea, sclera, conjunctiva and lacrimal puncta by gently moving lower eyelidsdown.Cornea Examination-With oblique lighting inspect the cornea

15、for opacities, foreign bodies etc.Inspect lower palpebral, fornical, bulbar conjunctiva and sclera. Ask the patient to look up asyoudepresslowereyelidwithyourthumbexposinglowerpalpebral,fornical,bulbarconjunctivaandsclera.Inspecttheconjunctivaandscleraforcolor,andnotethevascular感謝下載載精品pattern agains

16、t the white scleral background.Lacrimal sac examination by digital compression for nasolacrimal duct obstruction-Ask thepatient to look up. Press on the lower lid close to the medial canthus, just inside the rim of thebony orbit. You are thus compressing the lacrimal sac. Look for fluid regurgitatio

17、n out of thepuncta into the eye. Avoid this test if the area is inflamed and/or tender(Figure 2-3).14. Observe sclera and bulbar conjunctiva by gently elevating upper eyelid while patient looks down,Instruct the patient to look down.Raisetheupper eyelid slightlyso that the eyelashesprotrude,andtheni

18、nspectscleraandbulbar conjunctiva. Be gentle so patient doesnttear (Figure 2-4).15.Check crn upper division: raised eyebrows, wrinkle forehead or forced eyelid closingNerve is the facial nerve.Upper facial nerve-To test the upper division, the examiner observes the patients foreheadand palpebral fis

19、sure, then asks patient to raise his eyebrows, wrinkle his forehead and closehis eyes. When the patient closes his eyes tightly, the examiner attempts to pry them open todetermine the strength. If one side of peripheral upper facial nerve is impaired (nuclear orbelow nuclear) the patients ability to

20、 wrinkle forehead decreases and the patient cantclosehis eye on the affected side. If one side of central nerve is impaired, the patients ability toclose his eyes and wrinkle forehead will not be influenced because the upper facial musclesare controlled by both sides of the corticocerebral motor are

21、a.16. Evaluate extraocular muscle function in both eyes in 6 directions (left, upper left, and lower left, right, upper right, lower right)The examiner positions himself in front of the patient and requests that, without moving the感謝下載載精品patient s head, the patients eyes follow examiners finger or a

22、 pencil in six directions. Fingeror pencil should be 3040 cm away from patients head. The usual format is from mid left, toupper left and then down and then to the right (Figure 2-5).17.Observe pupillary direct response to lightTheexaminerasksthepatienttolook forwardand shinesa penlightor thelightof

23、theophthalmoscope into each pupil in turn. He should avoid shining the light into both pupilssimultaneously and should ask the patient not to focus on the light source.When observing the direct pupillary response to light, the examiner will shine the light intoone eye and inspect for pupillary const

24、riction in the same eye. The pupillary constriction isreversed as soon as the light moves away. Use the same method to check the other eye.18.Observe pupillary consensual response to lightWith the same method as obove, the examiner shines the light into one eye and inspects forpupillary constriction

25、 in the opposite eye OR observes pupillary dilation in opposite eye aslight is extinguished.19.Check for convergence and accommodationThe examiner, positioned in front of the patient, asks the patient to look into the distance andthenathisfinger.Theexaminersfingerstartsfrom1meteraway,the examinerwil

26、limmediately move 5 cm away from the bridgeof the patients nose. The examiner is observingthepatient s eyesfor:a)pupillaryconstriction,andb)convergence(thecoordinatedmovement of both eyes toward fixation at the same near point as the patient focuses on anear object). Accommodation includes convergen

27、ce and pupillary constriction as the patientfocusesonthe nearobject.Theaccommodationwillvanishwhencranialnerve isdamaged.感謝下載載精品Ears and Temporomanaibular joint30. Observe and palpate the auricles and observe postauricular regions bilaterallyThe examiner pulls and palpates the auricles (outer ears),

28、 palpates the preauricular(in front of)andposteriorauricularregions(behindtheears)bilaterally.Tendernessusuallyindicatesinflammation.31. Palpate temporomandibular joint for tenderness and swelling (omitted)Thetemporomandibularjoint(TMJ)is anteriortotheexternalauditorycanaloftheear.Examine for swelli

29、ng and tenderness.32. Feel the movement of the TMJ with index fingers inside patients ears or over jointTo palpatetheTMJjoint,theexaminerpressesbothsidessimultaneouslywithoneor twofingers and asks the patient to open and close his mouth, or the examiner places his indexfinger in the patients ear and

30、 gently pulls forward (anteriorly), asking the patient to open andclose his mouth. (omitted)Nose38. Inspect and palpate external nose for malformation and inflammationBegin by examining the external nose. The examiner faces the patient. Observe skin color andshape of nose any palpate for and loss of

31、 structure or tenderness from bridge, to tip, to wingsof nose.39. Observe nasal vestibule without otoscopeA view of the nasal cavities is obtained by tilting the patients head back and elevating the tipof the nose with the thumb. The examiner should use a light. The nasal vestibule contains thenasal

32、 hairs, or vibrissae. Pay attention to any folliculitis, fornicles, or deviated nasal septum.40. Turn the tip of the nose upwards and insert the tip of the speculum to inspect nasal感謝下載載精品vestibuleandanteriorpartofnasalcavityforulcer, crust,swelling,discharge,atrophyorperforation41.Test patency by i

33、nhaling through each nostril separately while the opposite nostril isheld occluded (omitted)42. Palpate and/or percuss maxillary sinus for swelling and tendernessExaminationof the paranasalsinusesisdonemore indirectlythanotherotolaryngealprocedures. The examiner cannot see into any of the sinuses. P

34、alpation and percussion maybe usedoverthemaxillarysinuses.Simultaneousfingerpressureoverbothmaxillaewilldemonstrate differences in tenderness.43. palpate and /or percuss frontal sinus for swelling and tendernessThe frontal sinuses are palpated at the inner part of the upper border of the bony orbit

35、byfinger pressure directed upward toward the floor of the sinus where the sinus wall is thin.Tenderness may be elicited in this way. Swelling caused by tumors or retained secretions maycause adownwardbulge in thefloorofthe frontal sinus.The frontalsinusesmayalsobepercussed.Mouth, lips, Pharynx44. Ob

36、serve lips, buccal mucosa, teeth, gums and tongueThe examinerinspectsthelips,all surfacesofthetongue,gums,roofof mouth,andthebuccal mucosa (the tissue lining the cheeks) by asking the patient to open his mouth and byshining a light into the area to be examined. The examiner may use a tongue depresso

37、r to aidinspection.Lips-The healthy lips are wet and red in color, This is caused by a rich capillary network.Buccal mucoss-To examine the buccal mucosa it is necessary to shine a light into the patients感謝下載載精品mouth. The healthy buccal mucosa is pink and smooth. The duct of the parotid gland openson

38、to the buccal mucosa opposite the upper second molar.Teeth-There are 32 teeth in the full adult dentition. The teeth are inspected for evidence ofcavities and malocclusion.Gums-The gums should be inspected for the presence of swelling, bleeding or pigmentation.Tongue-The tongue is inspected for its

39、shape, motion and ulceration.45. Observe the floor of mouthInspectthemouthforpigmentation,hemorrhageormasses(ask patienttotouchtipoftongue to roof of mouth).Generally, palpation is not done in a normal exam. However, if a mass is found on the floor ofthe mouth, palpation is important. If neoplasms a

40、re suspected, they are detectable only bypalpation.Also,thesubmaxillary,salivaryductsmaycontaincalculithatarebestfeltbypalpation. Bimanual examination, using one gloved finger inside the mouth and the otherhand outside, is best.46. Inspect the posterior structures of the mouth for congestion, swelli

41、ng or pus, positionof uvula, and elevation of the palate.Press a tongue blade, positioned over middle 1/3 of tongue, firmly down to inspect tonsils,anterior and posterior tonsillar pillars, and posterior pharynx. The examiner can observe theelevation of the palate as the patient saysThe conscious pa

42、tient should not be gagged.“ah ”. Simultaneously, hoarseness can be detected.47. Observe midline protrusion of the tongue (cr n )The examiner asks patient to stick out his tongue and observes midline protrusion, atrophyand fibrillation.感謝下載載精品48.Show teeth, puff out cheeks or purse lips (lower divis

43、ion of cr n ) ( omitted)49.Test contractionof masseter (jaw)muscle or forcedopening of mouthagainstresistance (motor division cr n ) (omitted)50.T est for facial sense of pain and touch (must check at least 2 out of 3 sensory divisionsfor cr n) ( omitted )51. Expose neck correctly to observe appeara

44、nce and skin of neck The patient sits upright.Ask patient to expose neck entirely when the neck is to be examined. All clothing should be removed as far as the axillae, which allows the whole neck to be seen in relationship to the thorax and permits inspection and palpation of the supraclavicular fo

45、ssae.Observe the appearance of the skin of the neck. The examiner should observe the neck for symmetry and pay attention to its appearance. Abnormal lumps and pulsations may be seenin this area. Generally, the thyroid cartilage will show convexity in a male. The examiner inspects the skin of the nec

46、k for erythema, spider angioma, infections, ulcers or scars.Facial and cervical lymph nodesPalpate lymph nodes bilaterally. The examiner may be positioned in front of or behind thepatient andexamine thelymph nodeswith thepadsofhisindex and middlefingers.Thisshouldbedoneslowlyandcarefullyto makecerta

47、inthatthere aren tanyabnormalitiespresent.Itis better ifthe examinermoves theskinovertheunderlyingtissueratherthanmove his fingers over the surface of the skin. The examiner may have the patient position hishead with his neck slightly flexed forward. The examiner palpates all nodes bilaterally.For p

48、alpation oflymph nodes,be sure to keeptheskinandmuscles relaxed.Ifthelymph感謝下載載精品nodesareenlarged,notetheirlocation,size,number,hardness,mobility,tenderness,adhesion, fusion, swelling, fistula or scars (Figure 2-14).52. Palpate preauricular nodes (front of ears)53. Palpate post-auricular nodes (back

49、 of ears)54. Palpate occipital nodes (base of skull)55.Palpate submaxillary nodes (by bending finger under patients jaw)56.Palpate submental nodes (by bending finger under patients chin)57. palpate anterior cervical nodes (superficial group under mastoid and in front of sternomastoid muscle)58. Palp

50、ate posterior cervical nodes (behind sternomastoid muscle)59. Palpate supraclavicular nodes (by bending finger above patients collarbone)Thyroid gland60. Palpate and/or move thyroid cartilage with two fingers checking for malformation and movability61. Palpate thyroid in correct anatomical location

51、in front of or behind the patient withboth hands.The lateral lobes of the thyroid curve posteriorly around the sides of the trachea andthe esophagus. In addition, they are partially covered by the sternomastoid muscle.There areseveral different techniques for examining the thyroid gland. Many examiners will palpate thethyroidglandbothin