PhysicalExamination

基本檢查方法2024/1/141Whatisphysicalexamination?Itisafundamentalexaminingmethod,itisproceededbythesenseorganssuchaseyes,ears,noseandhandsorsimpletools–stethoscopeandplexor.2024/1/142Thebasicmethodsofphysicalexaminationinspection視診palpation觸診percussion叩診auscultation聽診olfactoryexamination嗅診2024/1/143Inspection

2024/1/144InspectionIncludesageneralviewofthepatient’s1.mentalstatus意識狀態

2.development發育3.nutrition營養

4.posture體位5.bodymovement姿勢6.gait步態7.facialexpression表情8.complexion面容2024/1/145無力型（瘦長型）超力型（矮胖型）正力型（勻稱型）2024/1/146pallorexophthalmusCyanosis(lips)moonfacespiderangiomabarrelchestGastrictypeAbdomenalrespiratorymovementanemiaHyperthyroidismmitralfacecushingsyndromelivercirrhosispulmonaryemphysemapylorusobstructionNormal，men，childrenInspection

2024/1/147palpation2024/1/148PalpationMainlyusedinabdominalexamination

mass:

1.location部位2.size大小

3.contour邊緣4.consistency質地/邊界

5.mobility活動度6.tenderness壓痛

7.pulsation波動感2024/1/149Palpation2024/1/1410ThemethodsofpalpationLightpalpation淺部觸診法DeepPalpation深部觸診法deepslippingpalpation深部滑行觸診bimanualpalpation雙手觸診法deeppresspalpation深壓觸診法ballottement沖擊觸診法2024/1/1411Themethodsofpalpationlightpalpation淺部觸診法

abdominalmuscletensity

abdominaltenderness

2024/1/1412DeepPalpationDeepPalpation

deepslippingpalpation---deepmassbimanualpalpation---liver,spleen,kidney3.deeppresspalpation---tendernesspoint2024/1/1413bimanualpalpationliverandspleen2024/1/1414DeeppresspalpationtendernesspointCholecysticpoint:Murphy’ssignAcutecholecystitistendernesspoint2024/1/1415

Cholecysticpoint:Murphy’ssignAppendixpoint:McBurneypoint

acuteappendicitisReboundtenderness：acuteperitonitisBallottement：沖擊

liverenlargement,

splenomegalywithmassiveascitesDeepPalpation2024/1/1416Notice:Patientinsupineposition仰臥位Askpatientflexhisthighsandknees放松、屈膝Tellpatientrelaxhisabdomenalmuscles腹部放松Doctorstandsattherightsideofpatient站右側Warmhand,useyourpalmaraspectoffinger,examininggentlyandlightly,fromsuperficialtodeep.手腦并用2024/1/1417Percussionlungs---margin界heart---sizeandshape大小、形狀liver---uppermargin上界Ascites腹水---shiftingdullness移動濁音2024/1/1418PercussionmethodsTherearetwomethodsthatmaybeusedforpercussion

1

Indirectpercussion

2

Directpercussion

2024/1/1419Indirectpercussion2024/1/14202024/1/1421DirectpercussionThismethodcanbedonebystrikingchestwiththepalmaraspectofrighthandorthetipsofallofthefingersheldfirmlytogether,mainlyusedtoexaminemassivefluidinthoraciccavity.2024/1/1422DirectPercussion2024/1/1423

Resonance清音

Dullness濁音

Tympany鼓音

Flatness實音

Hyperresonanc過清音

PercussionSounds2024/1/1424Auscultation

therearetwomethodsofauscultation:

directauscultationwiththeear;

indirectauscultationwiththestethoscope.2024/1/14252024/1/1426bythesetwomethodswecanlistentothesounds

producedfrom

heartlungsandabdomenorthe

bloodvesselnote2024/1/1427

Twoprincipaltypeofstethoscope

thebell鐘型聽診器

ismoresuitabletolistentothelowpitchedrumblesuchasthemurmurofmitralstenosis

2024/1/1428Twoprincipaltypeofstethoscopethediaphragm膜性聽診器

ismoresuitabletolistentothehighpitchedtones

themurmurofaorticregurgitation,breathsoundandbowelsond2024/1/1429OlfactoryexaminationSmellingtoidentifytheunusualodorwhichproducedfrompatientsuchastheodorofsweat汗sputumpusfluid膿vomitus嘔吐物Stool便Urinebreath2024/1/1430嗅診酸性汗液：風濕熱、水楊酸、阿司匹林狐臭味：腋臭患者惡臭痰液：支氣管擴張、肺膿腫（厭氧菌感染）惡臭膿液：氣性壞疽糞便嘔吐物：長期劇烈嘔吐、腸梗阻爛蘋果味嘔吐物：胃壞疽腐敗性臭味糞便：消化不良、胰腺功能不良2024/1/1431腥臭味糞便：細菌性