Physical Diagnosis
Core concepts
Physical diagnosis moves from history to focused examination. Know vital signs, general inspection, palpation, percussion, auscultation, and region-specific maneuvers. Blood pressure technique matters: the cuff bladder should fit the arm circumference, the patient should be seated and rested, and the arm should be supported at heart level. Cardiac examination includes inspection, palpation, and auscultation at valve areas, with attention to murmur timing, location, radiation, and maneuvers. Pulmonary examination includes respiratory rate, symmetry, percussion note, tactile fremitus, and breath sounds. Abdominal examination follows inspection, auscultation, percussion, and palpation. Neurologic screening covers mental status, cranial nerves, motor, sensory, reflexes, and coordination.
Traps
A cuff that is too small falsely raises blood pressure; one that is too large may falsely lower it. Pulsus paradoxus is an exaggerated inspiratory fall in systolic pressure, classically in tamponade. Jugular venous pulsation is not carotid pulsation: JVP is nonpalpable, biphasic, and falls with inspiration. Do not auscultate the abdomen after palpation if you want to avoid altering bowel sounds.
Worked example and rule of thumb
A patient with hypotension, distended neck veins, and muffled heart sounds raises concern for cardiac tamponade. Pulsus paradoxus supports the diagnosis. Rule: inspect before palpating, and palpate before auscultating the abdomen; for the heart, use the bell for low-pitched sounds and the diaphragm for high-pitched sounds.
Exam focus
Questions often test technique errors and classic syndrome clusters rather than obscure findings.