Physical Examination

The questions in the table are general, and it is important to delve as deeply as necessary into the patient’s main symptom in order to take a diagnostic approach. When you can’t ask for specialized help, interrogation is the main tool available. Therefore, it is necessary to use all the time that is required to orientate yourself. If the patient is a child or an elderly person with dementia, the history is taken with the help of a family member or from what you yourself have witnessed. Try to remember important information, such as recent falls or a decrease in normal activities. It is also important to know the person’s recent contacts if an infectious disease is suspected. Currently, with the issue of the COVID-19 pandemic, this is one of the most important questions since it is a disease with a high rate of contagion. Remember that the therapy to be applied will be based on the diagnosis; therefore, we must be as precise as possible.

In the physical examination, we must go from the biggest to the most specific. The observation of the face and the position that the person adopts can take us closer to the diagnosis. If the patient has pained face or facies dolorosa or if he or she is held in a position that looks uncomfortable or out of the ordinary to relieve the pain, this is an antalgic position. Thus, when a patient complains of pain, for example, we first check his vital signs (heart rate, number of breaths per minute), and from there, we continue to palpate. When the patient cannot adequately express the intensity of the pain, a scale of numbers from 1 to 10 is used, where 1 is the lowest and 10 is the highest. If the patient cannot speak and has problems communicating, there is also the scale with facial expressions. Both are shown below.

MissLunaRose12, Own work, CC BY-SA 4.0

Robert Weis, Own work, CC BY-SA 4.0