ABSTRACT
The physical examination, thoughtfully performed, should
yield 20% of the data necessary for patient diagnosis and management. [1]
The key to a
thorough and accurate physical examination is a systematic sequence of
examination. [2]
While
the patient’s history may provide clues to an underlying diagnosis, a thorough
physical exam can offer key evidence for pruning the cause list, which narrows
the diagnostic workup and can ultimately lead to an accurate diagnosis within a
shorter time span. A skilled physical exam provided a pivotal finding that
changed the patient’s diagnosis and treatment. Therefore, the physical exam
findings were critical to making and confirming an accurate diagnosis quickly. [3]
KEYWORDS
Examination, Cardiovascular System,
Knerr Repertory, heartbeat.
INTRODUCTION
Repertory
of Hering’s guiding symptoms of our Materia Medica by Calvin B. Knerr has a lot
of clinical rubrics especially associated to age, sex and pathology and
examination findings. Knerr’s repertory is full of concomitants,
cured and diagnostic rubrics. Knerr’s repertory
is especially used for clinical pathologies .The most useful but the
most neglected repertory in our clinical practice. [4]
INSPECTION
VOICE
AND LARYNX, TRACHEA AND BRONCHIA- Bronchia, heart: attacks in subjects with
cyanosis and cardiac disease -704p
RESPIRATION-
breathing rapid (accelerated hurried) - In pericarditis 730p.
HEART,
PULSE AND CIRCULATION
Ø blood anaemia 819p
Ø blood, cyanosis 821p
NECK
AND BACK
Ø neck carotids: subclavian aneurism at the
point of origin 870p
Ø neck carotids- visible throbbing 870p
Ø neck carotids-visible throbbings in heart
affections of old age 870p
Ø neck veins , distended 879p
Ø neck veins jugular distended 879p
Ø neck
veins jugular strong pulsations, venous murmur 879p [5]
PALPATION
HEART,
PULSE AND CIRCULATION,
Ø blood vessels hard 823p
Ø blood vessels , soft 824p
Ø Heartbeat, violent not synchronous with pulse
828p
Ø pericardium effusion depression between the
ribs less perceptible 840p
NECK
AND BACK –neck carotids- no pulse only a slight vibration 870p [5]
PERCUSSION
INNER CHEST AND LUNGS- lungs percussion sounds-
dull in heart disease 812p
HEART,
PULSE AND CIRCULATION,
Ø heart displaced –in dropsy of chest 829p
Ø heart displaced in by pleuritic exudation 829p
Ø heart displaced pushed down in emphysema 829p
Ø heart displaced pressed to right 829p [5]
AUSCULTATION
HEART,
PULSE AND CIRCULATION-
Ø heart beat – diminished 825p
Ø heart beat impulse diminished (pleuritic with
plastic exudation) 825p
Ø heartbeat, double stroke 825p
Ø heart beat violent in dropsy of chest 825p
Ø heartbeat ,dull 825
Ø heartbeat ,excessive impulse (enlargement of
right ventricle) 825p
Ø heartbeat, feeble in heart affection 825p
Ø heartbeat, feeble incomplete 825p
Ø heart beat feeble irregular 825p
Ø heartbeat, floundering (endocarditis) 825p
Ø Heart beat fluctuation when turning on side
825p
Ø heart beat fluttering 825p
Ø heart beat forcible, lifting hand lying on
chest 825p
Ø heart beat frequent ,each beat double one hard
and full other soft and small 826p
Ø heartbeat, frequency alternative with slowness
(enlargement of left ventricle) 826p
Ø heart beat almost inaudible 826p
Ø heartbeat , increased 826p
Ø heart beat increased with slow pulse 826p
Ø heart beat increased with loss of rhythm 826p
Ø heartbeat , increased from 70 to 96 826p
Ø heart beat increased 200/min 826p
Ø intermittent misses every 4th 826p
Ø heart beat intermittent in angina pectoris 826p
Ø heart beat hardly perceptible 826p
Ø heart beat not perceptible 826p
Ø heart beat rapid 8 to 10 times then slow 826p
Ø heart beat turbulent for a short period in
cardiac rheumatism 826p
Ø heart beat –tumultuous alternating with feeble
irregular beating (hydro pericardium)
826p
NECK
AND BACK
Ø neck carotids-bruit du diable in vessels 870p
Ø neck carotids-nun’s murmur 870p
Ø jugular murmur 879p
Ø jugular murmur in left 879p
INNER
CHEST AND LUNGS –
Ø sternum murmur ,upward from each side
(aneurism) 817p
Ø Lungs Auscultation Sounds, Vesicular murmur
feeble in cardiac dropsy 807p [5]
CONCLUSION
Poor physical exam skills are a noteworthy
threat to patient safety as they can lead to incorrect as well as missed
diagnosis, causing delays in timely implementation of life-saving treatments. Although technology has a high profile in
cardiology, clinical examination remains a central tool, especially for the
generalist. [6] A careful clinical examination can reveal much about
the condition of your patient's heart. In addition, noting the findings of a
full examination will greatly facilitate specialist referral. In an age of high
technology, skilled clinical examination has yet to be surpassed in terms of
convenience, safety, and value for money. [7]
REFERENCE
