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M105 & CM106 ()

Medical History & Methods of Physical Examination


() 2013/2/25
18,26,41,78 10,25,42,91,103

( = =+)
, etc.

Identifying data
, etc.
Chief complain

when ()where ()how (
) ex: Chest (where) pain (how) for 2 hour (when)
History of present illness ( chief complain )
( chief complain )
, etc.



Past medical history ( chief complain )


()
Family history
(ex:
, etc.)
Personal and social history

, etc.
Review of system
()

1
Problem list



Physical Examination

palpation ()percussion ()auscultation


()
General survey
Acromegaly
Hypopituitary dwarfism/gigantism/
Cushing syndrome
Anorexia Nervosa
Marfans syndrome
Vital sign


The skin()
Macule: flat, 5 mm
Patch: flat, > 5 mm
Papule: elevated, 5 mm
Nodule: elevated, spherical, > 5 mm
Plaque: elevated, flat-topped, > 5 mm
Vesicle: fluid-filled, raised, 5 mm
Bulla: fluid-filled, raised, > 5 mm
Blister: a common term for vesicle or bulla
Pustule: discrete, pus-filled, raised
(
) ()

head, eyes, ears, nose, throat


Acromegaly
Myxedema
Nephrotic syndrome
Cushings syndrome

2
Parotid gland enlargement
Parkinsons disease
The eye Harrison eye
diseases scattered hemorrhage, yellow exudate,
neovascularization( p.348) p.13
A-V nicking
vein artery vein vein
vein
The Ear

Neck
Lymph node

Trachea and thyroid gland
Carotid a. and jugular v.
int. jugular v. ACXVY
jugular venous pluse (pressure) (JVP)
JVP

JVP( P pulse) JVP


45 3~4
JVP beats twice(a v)
JVP ( P pressure)

1.

2. JVP
int. jugular v.
JVP


a
c
x
v
y JVP
av xy a v x y
c

3

1. JVP
2. JVP EKG
a
a
JVP JVP

The Thorax and Lungs

Inspection
Palpation
Percussion
Auscultation: breath soundsadventitious soundstransmitted
voice
Breath soundsbronchial bronchovesicular sound
vesicular sound
Adventitious soundsCrackles
wheezes and rhonchipleural friction rib

Transmitted sound

Barrel chest

Pectus excavatum
Pectus carinatum

Breast
Palpation Tenderness nodules

4
Heart

Inspection()
Palpation ()
Percussion()

Auscultation()<=

AAortic murmur area(


)
PPulmonary area
TTricuspid area
MMitral area()


1. (bell)(diaphragm)
2. S1 S2
S1 &
*<=
S2 (A2)(P2)
A2 P2
0.03 0.06
S3S4 S3 S4

3. S2 A2 P2
Wide splitting P2 P2

5

=>=>=>
Stroke volume

Fixed splitting

Paradoxical splittingA2 P2

abdomen

*

()

Inspection

6
Male Genitalia

Inspection
Palpation
Female Genitalia

(Mons pubis)

(urethral meatus)
(vaginal introitus)

()
The Anus, Rectum, and Prostate

The Peripheral Vascular System




1.
2.
(deep vein thrombosis)(filariasis)
Nervous System


Muscle power
0 =
1 =
2 =
3 =
4 =
5 =
Deep tendon reflex
4+
3+
2+
1+
0

7

Inspection
Palpation
Percussion
Auscultation

1.
2.
3. Physical examination
4. differential diagnosis
5.
6. differential diagnosis
7. 1~6
8.
9.