What is the process for examining each bodily system in a comprehensive medical examination?

Comprehensive Medical Examination: A Systematic Approach to Each Body System

A comprehensive medical examination should follow a structured approach that systematically evaluates each body system to ensure thorough assessment of physiological function and anatomical status, prioritizing detection of conditions that impact morbidity, mortality, and quality of life.

General Principles of Medical Examination

• Begin with proper preparation of the examination environment, ensuring privacy, comfort, and appropriate equipment 1
• Establish rapport with the patient through empathetic communication and active listening before beginning the physical examination 1
• Document demographic data (name, date of birth, gender, ethnicity/race) and identify other healthcare providers involved in the patient's care 2

Comprehensive History Taking

Chief Complaint and Present Illness

• Document the patient's primary concern and detailed history of present illness 2
• Assess the patient's self-evaluation of their current health status and any recent symptoms 2

Medical History

• Record past medical conditions, previous surgeries, and hospitalizations 2
• Document all current medications including prescription drugs, over-the-counter medications, and supplements 2
• Note allergies and adverse reactions to medications 2

Family History

• Identify pertinent familial diseases, especially those with genetic predisposition 2
• Document family history of conditions that might predispose to malignancies, neurologic diseases, osteoporosis, and cardiovascular disease 2

Social History

• Assess occupation, tobacco use, alcohol consumption, and illicit drug use 2
• Evaluate family and living situation as appropriate to identify social determinants of health 2
• Document sexual history in an open, non-judgmental manner 2

Review of Systems

• Perform a comprehensive review of all body systems to identify symptoms not mentioned in the chief complaint 2
• Include directed questions about common symptoms related to each body system 2

Physical Examination by System

Vital Signs

• Measure and record complete vital signs: temperature, pulse, respiratory rate, blood pressure, height, weight, and BMI 2
• Consider orthostatic blood pressure measurements when indicated 2

General Appearance

• Assess overall body habitus, noting any evidence of wasting, obesity, or abnormal fat distribution 2
• Evaluate general state of health, level of consciousness, and apparent age versus chronological age 3

Skin Examination

• Inspect skin for color, texture, turgor, lesions, rashes, and abnormal pigmentation 2
• Examine for specific findings such as acanthosis nigricans, lipodystrophy, or injection sites 2

Head and Neck Examination

• Inspect head for shape, symmetry, and any abnormalities 2
• Palpate thyroid gland for size, symmetry, and nodules 2
• Examine lymph nodes for enlargement, tenderness, or abnormal consistency 2

Eye Examination

• Assess visual acuity with current correction at distance and near 2
• Perform refraction when indicated 2
• Evaluate visual fields by confrontation 2
• Conduct external examination of eyelids, lashes, lacrimal apparatus, and globe position 2
• Assess pupillary function, including size, response to light, and relative afferent pupillary defect 2
• Evaluate ocular alignment and motility using cover/uncover test and assessment of versions and ductions 2
• Perform slit-lamp biomicroscopic examination of anterior segment structures 2
• Measure intraocular pressure, preferably with contact applanation method 2
• Examine fundus including vitreous, retina, vasculature, and optic nerve through dilated pupils 2

Ear Examination

• Inspect external ear for deformities, lesions, or discharge 3
• Perform otoscopic examination to visualize tympanic membrane and ear canal 3
• Assess hearing through whispered voice test or audiometry when indicated 3

Nose and Sinus Examination

• Inspect external nose for symmetry and deformity 3
• Examine nasal mucosa, septum, and turbinates for inflammation, discharge, or obstruction 3
• Palpate sinuses for tenderness 3

Mouth and Throat Examination

• Inspect oral mucosa, gums, teeth, tongue, and pharynx 3
• Evaluate for dental health, oral lesions, and signs of infection 2

Respiratory System Examination

• Observe respiratory rate, rhythm, and effort 3
• Inspect chest for shape, symmetry, and use of accessory muscles 3
• Palpate chest for tactile fremitus and chest expansion 3
• Percuss chest for resonance and diaphragmatic excursion 3
• Auscultate lungs for breath sounds, adventitious sounds, and voice transmission 3

Cardiovascular System Examination

• Inspect for jugular venous distention and visible pulsations 3
• Palpate precordium for thrills, heaves, and point of maximal impulse 3
• Auscultate heart for rate, rhythm, and heart sounds, including murmurs, gallops, and rubs 3
• Assess peripheral pulses and examine for signs of peripheral vascular disease 2

Abdominal Examination

• Inspect abdomen for contour, symmetry, visible masses, and pulsations 3
• Auscultate for bowel sounds and bruits 3
• Percuss for tympany, dullness, and liver span 3
• Palpate for tenderness, masses, organomegaly, and abdominal aorta 3

Genitourinary Examination

• For males: examine external genitalia, including penis and testicles for abnormalities 2
• For females: perform pelvic examination when indicated 3
• Consider prostate examination in appropriate male patients 2

Musculoskeletal Examination

• Assess gait, posture, and overall mobility 3
• Examine joints for deformity, swelling, tenderness, and range of motion 3
• Evaluate muscle strength, tone, and symmetry 3
• Assess for joint stability and signs of inflammation 3

Neurological Examination

• Evaluate mental status, including level of consciousness, orientation, memory, and cognition 3
• Assess cranial nerve function 3
• Test motor function, including strength, tone, and coordination 3
• Evaluate sensory function, including light touch, pain, temperature, vibration, and proprioception 3
• Assess deep tendon reflexes and pathological reflexes 3

Lymphatic System Examination

• Palpate major lymph node groups for enlargement, tenderness, or abnormal consistency 3

Psychiatric Assessment

• Screen for depression, anxiety, and other mental health conditions 2
• Evaluate cognitive function, especially in older adults 2

Special Considerations for Specific Populations

Diabetic Patients

• Perform comprehensive foot examination including visual inspection, vascular assessment, and neurological testing 2
• Screen for diabetic retinopathy through dilated fundus examination 2
• Assess for signs of neuropathy, nephropathy, and cardiovascular complications 2

Elderly Patients

• Consider assessment for functional and cognitive performance 2
• Evaluate for frailty, fall risk, and need for assistive devices 2
• Screen for elder abuse and neglect 3

Laboratory and Diagnostic Testing

• Order appropriate laboratory tests based on history, examination findings, and clinical suspicion 2
• Consider age-appropriate screening tests according to current guidelines 2
• Interpret test results in the context of the patient's clinical presentation 3

Common Pitfalls to Avoid

• Rushing through the examination and missing subtle but important findings 4
• Focusing only on the chief complaint while neglecting a comprehensive systems review 3
• Failing to adapt the examination approach to the patient's condition, especially in emergency or critical care settings 4
• Overreliance on diagnostic tests without proper clinical correlation 3
• Neglecting to consider the patient's cultural background and preferences during the examination 1