体格检查英文版Word格式文档下载.docx

体格检查英文版Word格式文档下载.docx

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1.Introduceyourselftopatient,usuallylastnameandtitleandhavealittleconversationtorelaxthepatientandtojudgementalstate.

2.Washhandsbeforestartingexamination

Preferably,thisshouldbedoneinviewofthepatient.

3.Patientisseatedinachair

4.Palpateradial（wrist）Pulsesforatleast30secondsandrecord

Theexaminerplacesthepadofhisindex,middleandringfingersovertheradialartery.Ifproperlydone,theexaminershouldbeabletofeelthearterypulsatingundertheexaminer’sfingertips.Theradialpulsemaybemeasuredfor30seconds,thenthepulseperminutecanbefoundbymultiplyingbytwo.Attentionshouldalsobepaidtotherhythm.Theexaminershouldnotusehisthumbtopalpateanypulse.

5.Palpatebothradial（wrist）pulsessimultaneouslyforsymmetryforatleast30seconds

6.Measurerespiratoryratefor30secondsandrecord

Theexaminerunobtrusivelymeasurespatient’srespiratoryrate.Thismaybeaccomplishedbytheexaminerleavinghishandsonthepatient’swristsforanother30secondsaftermeasuringtheradialpulsessothepatientdoesnotrealizethattheexamineriswatchinghimbreathe.Thedepthandrhythmshouldalsobenoticed.Therespiratoryratecanalsobemeasuredduringthebackexam.

7.Measurebloodpressureonrightarm

Bloodpressuremaybemeasuredwiththepatientinasittingorlyingposition.Ineachposition,thearteryinwhichthebloodpressureistobemeasuredshouldbeattheleveloftheheart（atthelevelofthefourthintercostalspaceinthesittingposition;

atthelevelofthemiddleaxillarylineinthelyingposition）.Thepatient’sarmshouldberestingonasmoothtableorsupportedbytheexaminer,andslightlyflexedattheelbow.

8.Placecuffincorrectlocation2-3cmabovetheatecubitalcrease

Theexaminersecuresthebloodpressurecuffsnuglyovertheupper,armsothatonefingercanbeadmittedunderthecuff.Thecuffshouldbepositioned2～3cmabovetheantecubitalcreaseorelbowjoint.Putthemiddleofthecuffoverthebrachialartery.

9.Palpatebrachialartery

Theexaminercanlocatethebrachialarterywhichliesslightlymedialtothetendonofthebicepsmuscleintheantecubitalfossa.Themercurycolumnonthemanometerdialshouldbeproperlycalibratedwiththepointerat“0”beforethecuffisinflated（i.e.,alltheairshouldbepressedoutofthecuffbeforeitisinflated）.

Thestethoscopeisplacedfirmlyoverthebrachialartery.Theexaminersinflatesthecuffslowlybutsteadily.Untilthebrachialarterypulsedisappears.Thenhecontinuestoinflatecuff～（20～30mmHghigher,generallytoabout（160mmHg））.

10.Measurebloodpressureoverbrachialarterytwiceandrecordthelowerreading

Deflatethecuffslowlyattherateofabout（2mmHg）Persecond.Thenumberwheretheexaminerhearsthefirstpulsesoundisthesystolicpressure.Thepulsesoundwillwakenandthendisappear.Thenumberwherethepulsesounddisappearsisthediastolicpressure.Ifthedifferencebetweenweakeningofthesoundanditsdisappearanceis（20mmHg）orgreater,theexaminershouldrecordthesetwonumbers.Thecuffmustbecompletelyemptiedwiththepointerat“0”beforeitisreinflated.ThesameproceduremaybefollowedforasecondmeasurementofB.P.inthesameoroppositearm.Thelowerpressureisrecordedasthepatient’sbloodpressure.Afterfinishingthemeasurement,theexaminerdeflatesandrollsupthecuff,leansthemanometeroveralittlesothemercurycolumndisappears,closesthemercurycolumnswitch,putstheballooninorder,andclosesthemanometer.

B.HEADANDNECK

（头颈部）

Skull

11.Palpateandobservescalp（partinghair,andobservinghairdensity,color,lustreanddistribution）

Theexaminerpalpatestheentireskullusingbothhandsandsimultaneouslyexaminessymmetricalareas.Theexaminerpartsthehairtoobservethescalp,notinganyscaliness,deformities,lumps,tenderness,lesionsorscars.Theexamineralsoobservesthedensity,color,lustreanddistributionofthehair.

Eyes

12.Visualscreening:

（omitted）

cornea,sclera,conjunctivaandlacrimalpunctabygentlymovinglowereyelidsdown.

CorneaExamination-Withobliquelightinginspectthecorneaforopacities,foreignbodiesetc.Inspectlowerpalpebral,fornical,bulbarconjunctivaandsclera.Askthepatienttolookupasyoudepresslowereyelidwithyourthumbexposinglowerpalpebral,fornical,bulbarconjunctivaandsclera.Inspecttheconjunctivaandscleraforcolor,andnotethevascularpatternagainstthewhitescleralbackground.

Lacrimalsacexaminationbydigitalcompressionfornasolacrimalductobstruction-Askthepatienttolookup.Pressonthelowerlidclosetothemedialcanthus,justinsidetherimofthebonyorbit.Youarethuscompressingthelacrimalsac.Lookforfluidregurgitationoutofthepunctaintotheeye.Avoidthistestiftheareaisinflamedand/ortender（Figure2-3）.

14.Observescleraandbulbarconjunctivabygentlyelevatinguppereyelidwhilepatientlooksdown,

Instructthepatienttolookdown.

Raisetheuppereyelidslightlysothattheeyelashesprotrude,andtheninspectscleraandbulbarconjunctiva.Begentlesopatientdoesn’ttear（Figure2-4）.

crnⅦupperdivision:

raisedeyebrows,wrinkleforeheadorforcedeyelidclosingNerveⅦisthefacialnerve.

Upperfacialnerve-Totesttheupperdivision,theexaminerobservesthepatient’sforeheadandpalpebralfissure,thenaskspatienttoraisehiseyebrows,wrinklehisforeheadandclosehiseyes.Whenthepatientcloseshiseyestightly,theexaminerattemptstoprythemopentodeterminethestrength.Ifonesideofperipheralupperfacialnerveisimpaired（nuclearorbelownuclear）thepatient’sabilitytowrinkleforeheaddecreasesandthepatientcan’tclosehiseyeontheaffectedside.Ifonesideofcentralnerveisimpaired,thepatient’sabilitytoclosehiseyesandwrinkleforeheadwillnotbeinfluencedbecausetheupperfacialmusclesarecontrolledbybothsidesofthecorticocerebralmotorarea.

16.Evaluateextraocularmusclefunctioninbotheyesin6directions（left,upperleft,andlowerleft,right,upperright,lowerright）

Theexaminerpositionshimselfinfrontofthepatientandrequeststhat,withoutmovingthepatient’shead,thepatient’seyesfollowexaminer’sfingerorapencilinsixdirections.Fingerorpencilshouldbe30～40cmawayfrompatient’shead.Theusualformatisfrommidleft,toupperleftandthendownandthentotheright（Figure2-5）.

pupillarydirectresponsetolight

Theexaminerasksthepatienttolookforwardandshinesapenlightorthelightoftheophthalmoscopeintoeachpupilinturn.Heshouldavoidshiningthelightintobothpupilssimultaneouslyandshouldaskthepatientnottofocusonthelightsource.

Whenobservingthedirectpupillaryresponsetolight,theexaminerwillshinethelightintooneeyeandinspectforpupillaryconstrictioninthesameeye.Thepupillaryconstrictionisreversedassoonasthelightmovesaway.Usethesamemethodtochecktheothereye.

pupillaryconsensualresponsetolight

Withthesamemethodasobove,theexaminershinesthelightintooneeyeandinspectsforpupillaryconstrictionintheoppositeeyeORobservespupillarydilationinoppositeeyeaslightisextinguished.

forconvergenceandaccommodation

Theexaminer,positionedinfrontofthepatient,asksthepatienttolookintothedistanceandthenathisfinger.Theexaminersfingerstartsfrom1meteraway,theexaminerwillimmediatelymove5cmawayfromthebridgeofthepatient’snose.Theexaminerisobservingthepatient’seyesfor:

a）pupillaryconstriction,andb）convergence（thecoordinatedmovementofbotheyestowardfixationatthesamenearpointasthepatientfocusesonanearobject）.Accommodationincludesconvergenceandpupillaryconstrictionasthepatientfocusesonthenearobject.TheaccommodationwillvanishwhencranialnerveⅢisdamaged.

EarsandTemporomanaibularjoint

30.Observeandpalpatetheauriclesandobservepostauricularregionsbilaterally

Theexaminerpullsandpalpatestheauricles（outerears）,palpatesthepreauricular（infrontof）andposteriorauricularregions（behindtheears）bilaterally.Tendernessusuallyindicatesinflammation.

31.Palpatetemporomandibularjointfortendernessandswelling（omitted）

Thetemporomandibularjoint（TMJ）isanteriortotheexternalauditorycanaloftheear.Examineforswellingandtenderness.

32.FeelthemovementoftheTMJwithindexfingersinsidepatient’searsoroverjoint

TopalpatetheTMJjoint,theexaminerpressesbothsidessimultaneouslywithoneortwofingersandasksthepatienttoopenandclosehismouth,ortheexaminerplaceshisindexfingerinthepatient’searandgentlypullsforward（anteriorly）,askingthepatienttoopenandclosehismouth.（omitted）

Nose

38.Inspectandpalpateexternalnoseformalformationandinflammation

Beginbyexaminingtheexternalnose.Theexaminerfacesthepatient.Observeskincolorandshapeofnoseanypalpateforandlossofstructureortendernessfrombridge,totip,towingsofnose.

39.Observenasalvestibulewithoutotoscope

Aviewofthenasalcavitiesisobtainedbytiltingthepatient’sheadbackandelevatingthetipofthenosewiththethumb.Theexaminershouldusealight.Thenasalvestibulecontainsthenasalhairs,orvibrissae.Payattentiontoanyfolliculitis,fornicles,ordeviatednasalseptum.

40.Turnthetipofthenoseupwardsandinsertthetipofthespeculumtoinspectnasalvestibuleandanteriorpartofnasalcavityforulcer,crust,swelling,discharge,