From the Guidelines
A proper physical examination involves assessing various vital signs and physical characteristics, including heart rate, blood pressure, respiratory rate, height, weight, and body mass index, as well as performing specific examinations such as lung and peripheral edema assessments, and evaluating for signs of heart failure, as outlined in the American College of Cardiology/American Heart Association task force report 1. The physical examination is a crucial component of patient evaluation, providing essential information about the patient's overall health and potential underlying conditions.
- Key components of the physical examination include:
- Vital signs: heart rate, blood pressure, respiratory rate, and temperature
- Anthropometric measurements: height, weight, and body mass index
- Specific examinations: lung examination, peripheral edema assessment, and evaluation for signs of heart failure
- Assessment of mobility and ability to perform daily activities The American College of Cardiology/American Heart Association task force report 1 provides a comprehensive outline of the key elements to be included in the physical examination, emphasizing the importance of accurate and thorough assessment. The physical examination should be performed in a systematic and thorough manner, with attention to detail and consideration of the patient's individual needs and circumstances, as emphasized in the report 1. In clinical practice, the physical examination is an essential tool for diagnosing and managing various conditions, and its importance cannot be overstated.
- The examination should be tailored to the individual patient's needs, taking into account their medical history, symptoms, and other relevant factors.
- The use of standardized terminology and definitions, as outlined in the report 1, can help ensure consistency and accuracy in documentation and communication. Overall, a proper physical examination is a critical component of high-quality patient care, and its importance should not be underestimated.
From the Research
Physical Exam Description
A proper physical (PR) exam description includes various components, such as:
- Medical history
- Laboratory tests
- Physical examination, including digital rectal examination (DRE) 2, 3, 4, 5, 6
- Assessment of rectal bleeding, which is a common symptom of various benign and malignant conditions 2, 3, 4
Digital Rectal Examination (DRE)
DRE is an essential tool in evaluating the rectum and assessing for pelvic fracture-associated urethral injury 5
- It involves examining the rectum, entire circumference, and assessing sphincter tone 6
- The best position for performing a DRE is still debated, with studies suggesting that the lateral position may allow for a more thorough examination of the entire circumference of the rectum 6
- A high-riding or nonpalpable prostate is a contraindication to urethral catheterization and an indication for urethrography, with a definition of high-riding prostate being more than 6.2 cm from the anal verge 5
Rectal Exam Findings
Rectal exam findings can be abnormal in a significant proportion of patients, with studies showing that:
- 59.5% of patients with rectal bleeding had abnormal rectal digital examination findings 2
- 52% of patients with normal rectal exams had abnormal findings at endoscopy, highlighting the importance of colonoscopy in evaluating patients with intermittent rectal bleeding 4
- DRE can be unreliable in the pelvic fracture trauma setting, with a high false-positive rate for nonpalpable prostate 5