Physical examination of a patient is important to make diagnosis besides knowing common symptoms,patients history and lab exams.Usually the first step to diagnose any disease is to know common symptoms,secondly to take patients history,and then to perform physiacl exam.Finally to have lab exams if required.

Physical exam includes different techniques including inspection,palpation,percussion,auscutlation and smell.Most exams include palpation by which the doctor examines relevant parts of the body for signs suchas swelling,tenderness or enlargement of organs.In some cases percussion of the chest or other parts of the body maybe performed by tapping with the fingers and then listening to the sound produced.

INSPECTION:Visual inspection usually referes to observation with unaided eye.Its the search for physical signs by observing the patient with your eyes and sense of smell.

General visual inspection:The initial step in physical exam is inspection of the person as a whole noticing the patient's tone & pattern of speech,movement and overall body form & proposition,facial expressions,skin type,specific behaviors and signs of pain or tremor.

Close visual inspection:Also called focussed inspection concentraes on a single anatomic region.Proper visual inspection of the body surface requires a uniform white light source to avoid distortion.

PALPATION:Palpation is an act of feeling parts of body with hands.Palpation is employed to every part of the body accessible to examining fingers like bones,joints,superficial blood vessels,nerves & ducts and accumulation of body fluids,pus & blood.

Methods of palpation:

Light palpation:Always begin palpation with a light touch.Gently sliding fingertips over the skin surface will often detect subtle or mobile masses that are undetected by forceful palpation.

Deep palpation:Firm pressure is applied to displace the superficial tissues allowing the palpation for deeper lesions.This is useful especially in abdomen,but is also useful in the neck, breast and large muscle masses.Firm palpation over nerves and tender structures is avoided whenever possible.

Bimanual palpation:In this technique the tissue is examined between the fingers of two hands.Its useful for the soft tissues suchas the breasts,intraloral,pelvic and abdominal examinations & exam of muscles and joints.

PERCUSSION:Percussion is the act of tapping with the fingers to elicit a sound to get an idea about the condition of internal organs.There are three different percussion methods;bimanual percussion method(or indirect percussion method),direct percussions and sonorous percussions.Most physicians apply bimanual method for percussion of both the thorax and abdomen.

AUSCULTATION:Auscultation is a procedure of listening to sounds within the body by using a stethscope.This technique is usually used to examine heart and lungs.From the lungs the stethscope conveys breath sounds,voice sounds aswellas crackles and friction rubs.The heart generates the normal heart sounds,murmurs,rhythm disturbances and pericardial rubs and knocks.Auscultation of the abdomen reveals bowel sounds and murmurs from aneurysm and stenotic arteries.The skull can be auscultated for the bruit of an arteriovenous fistula.

Smell:It has a little importance in physical exam and physicians seem to regard the use of nose for diagnosis as indelicate.Odors may provide immediate and valuable clues.e.g.,

Breath:Odors on the breath from acetone,alcohol and some poisons may lead quickly to a diagnosis.

Sputum:Foul-smelling sputum suggests bronchiectasis or lung abscess.

Urine:An ammoniated odor in the urine may result from fermentation within the bladder.