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PubMedDate not supplied

[Importance of questioning and physical examination in pediatric clinical diagnosis].

In order to determine the certainty of the nosologic as well as the etiologic diagnosis of a complication that a group of physicians can achieve with the use of the interrogatory and physical examination in solving pediatric cases, a comparative survey was carried out with 36 pediatricians. Three clinical cases were chosen (A, B and C) in three different versions (1 = interrogatory, 2 = interrogatory plus physical examination, and 3 = the same plus clinical laboratory tests). Randomly, the physicians reached a diagnosis in all three cases in any one of its versions. Generally, through interrogatory, 66.6% of the physicians (24/36) reached a nosologic diagnosis, 8.3% (3/26) diagnosed the complication and 41% (15/36) the etiological. Together with the physical examination, the percentages increased to 67.5% (25/ 37), 18.9% (7/37) and 43.2% (16/37), respectively (p < 0.05). In Case A, the main nosologic diagnosis was reached by 71, 90 and 91% of the physicians, V = 1, 2 and 3 (p = ns). In Case B, the main nosologic diagnosis was reached by all of the physicians, and in C, 10, 21 and 90% (p < 0.05) of the physicians, respectively. No differences were found in determining the etiologic diagnosis in versions one and two of the three cases. Differences were found in V3 (p < 0.001). More physicians reached the diagnosis of the complications in Cases A and C. Having previous experience in similar cases allowed for a greater percentage of physicians to reach the main nosologic diagnosis (75%, 18/24 vs. 50%, 6/ 112, p = 0.03). The interrogatory and the physical examinations in pediatrics continue to be a useful tool, allowing for a certain diagnosis in 70% to 100% of the cases of common ambulatory pathology. Previous experience in similar cases is a determining factor in reaching a correct diagnosis.

Clinical Competence↗

PubMed1999

Treated ovarian cancer: comparison of MR imaging with serum CA-125 level and physical examination--a longitudinal study.

PURPOSE: To evaluate whether gadolinium-enhanced magnetic resonance (MR) imaging can demonstrate clinically occult tumors in women with treated ovarian cancer and to compare the diagnostic accuracy of MR imaging, serum CA-125 (ovarian cancer antigen) level, and physical examination. MATERIALS AND METHODS: From 1992 to 1997, a longitudinal study comparing MR imaging findings, CA-125 values, and physical examination results with eventual clinical outcome in 69 women with treated ovarian cancer was performed. Tumor presence was determined with surgery, by an elevated CA-125 value, or with follow-up of patients longitudinally to assess for tumor recurrence. Absence of tumor was accepted with a disease-free interval of at least 2 years. RESULTS: Twenty-three of 39 patients in clinical remission with a normal CA-125 level and physical examination result had subclinical tumor proved at laparotomy or clinical follow-up. Gadolinium-enhanced MR imaging correctly demonstrated residual tumor in 20 of 23 patients. In all 69 patients, MR images had a 91% sensitivity, 87% specificity, 90% accuracy, and 72% negative predictive value and were superior to serum CA-125 level (53%, 94%, 63%, and 38%, respectively) (P < .001) and physical examination (26%, 94%, 43%, and 29%, respectively) (P < .001) in the depiction of residual tumor. CONCLUSION: Gadolinium-enhanced MR imaging is a valuable clinical tool in patients with ovarian cancer. An abnormal MR examination with a normal CA-125 value is a strong indication of residual or recurrent tumor.

CA-125 Antigen↗

PubMed1979

[Results of the special physical examination of workers in a vanadium plant (author's transl)].

Special physical examinations were made in order to find out the actual status of damages to health that had broken out in a factory collecting V2O5 from iron sand; and the following results were found: 1. Pharyngitis and bronchitis were found in 25% of the workers exposed to vanadium, but neither pneumonia nor hepatitis was observed. 2. Among the subjective and objective symptoms, respiratory irritation and discoloration of the tongue were frequent. 3. Black spot-like pigmentations gathering in a zonal form 1-2 mm wide in the transitional part and oral mucosa of the upper lip were found. Prevalence rate of this sign was 14.3% in the workers exposed to vanadium. 4. The mean valus of total serum protein and the serum cholesterol in the exposed workers were lower than those in the controls. The difference in the values between both groups is statistically significant. 5. Both the mean values of vanadium concentrations in vurine and its creatinine ratios in the exposed workers were twice to three times those in the controls; however, these parameters decreased to about one third in two months by improving the health and environmental control-measures. 6. Draft items to be checked in special physical examinations of workers handling vanadium have been proposed.

Environmental Exposure↗

PubMed2005

Are pain location and physical examinations useful in locating a tear site of the rotator cuff?

BACKGROUND: Pain is the most common symptom of patients with rotator cuff tendinopathy, but little is known about the relationship between the site of pain and the site of cuff pathologic lesions. Also, accuracies of physical examinations used to locate a tear by assessing the muscle strength seem to be affected by the threshold for muscle weakness, but no studies have been reported regarding the efficacies of physical examinations in reference to their threshold. HYPOTHESIS: Pain location is useful in locating a tear site. Efficacies of physical examinations to evaluate the function of the cuff muscles depend on the threshold for muscle weakness. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The authors retrospectively reviewed the clinical charts of 160 shoulders of 149 patients (mean age, 53 years) with either rotator cuff tears (140 shoulders) or cuff tendinitis (20 shoulders). The location of pain was recorded on a standardized form with 6 different areas. The diagnostic accuracies of the following tests were assessed with various thresholds for muscle weakness: supraspinatus test, the external rotation strength test, and the lift-off test. RESULTS: Lateral and anterior portions of the shoulder were the most common sites of pain regardless of existence of tear or tear location. The supraspinatus test was most accurate when it was assessed to have positive results with the muscle strength less than manual muscle testing grade 5, whereas the lift-off test was most accurate with a threshold less than grade 3. The external rotation strength test was most accurate with a threshold of less than grade 4+. CONCLUSION: The authors conclude that pain location is not useful in locating the site of a tear, whereas the physical examinations aiming to locate the tear site are clinically useful when assessed to have positive results with appropriate threshold for muscle weakness.

Adolescent↗

PubMed1997

Physical examination of children and adolescents.

This article describes the differences in the physical examination of the child and adolescent from that of the adult. A system-by-system approach is used, and only variations in history and physical examination of the child and adolescent are given. It is vital that the nurse practitioner understand these differences when providing health care services to children and adolescents.

Adolescent↗

PubMed2003

Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome.

OBJECTIVES/HYPOTHESIS: To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea-hypopnea syndrome. The aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea-hypopnea index (AHI). STUDY DESIGN: Consecutive patients with obstructive sleep apnea-hypopnea syndrome who were evaluated in a public otorhinolaryngology center were studied. METHODS: Adult patients evaluated previously with polysomnography met the inclusion criteria. All subjects underwent clinical history and otolaryngological examination and filled out a sleepiness scale. Physical examination included evaluation of pharyngeal soft tissue, facial skeletal development, and anterior rhinoscopy. RESULTS: Two hundred twenty-three patients (142 men and 81 women) were included (mean age, 48 +/- 12 y; body mass index, 29 +/- 5 kg/m2; AHI, 23.8 +/- 24.8 events per hour). Patients were distributed into two groups according to the AHI: snorers (18.4%) and patients with sleep apnea (81.7%). Sleepiness and nasal obstruction were reported by approximately half of patients, but the most common complaint was snoring. There was a statistically significant correlation between AHI and body mass index (P <.000), modified Mallampati classification (P =.002), and ogivale-palate (P <.001). The retrognathia was not correlated to AHI, but the presence of this anatomical alteration was much more frequent in patients with severe apnea when compared with the snorers (P =.05). Other correlations with AHI were performed considering multiple factors divided into two groups of anatomical abnormalities: pharyngeal (three or more) and craniofacial (two or more) abnormalities. There was a statistically significant correlation between pharyngeal landmarks and AHI (correlation coefficient [r] = 0.147, P =.027), but not between craniofacial landmarks and AHI. The combination of pharyngeal anatomical abnormalities, modified Mallampati classification, and body mass index were also predictive of apnea severity. CONCLUSIONS: Systematic physical examination that was used in the present study indicated that, in combination, body mass index, modified Mallampati classification, and pharyngeal anatomical abnormalities are related to both presence and severity of obstructive sleep apnea-hypopnea syndrome. Hypertrophied tonsils were observed in only a small portion of the patients. The frequency of symptoms of nasal obstruction was high in sleep apnea patients. Further studies are needed to find the best combination of anatomical and other clinical landmarks that are related to obstructive sleep apnea.

Adolescent↗

PubMed1986

[The data base of physical examination for airline pilots].

A data-base system which record new type physical examination of airline crew is now making in Ministry of Transportation. But old type physical records which had submitted for 15 years are still kept. In this report, the authors studied about the data base system which records old type physical examination data. The file structure of data base, data type of each items, interface of old type and new type record are discussed. Finally, to avoid all technical difficulties, the stimulation of generating large scale data base which uses 108,000 data was also studied.

Aerospace Medicine↗

PubMed2005

Limited value of patient history and physical examination in diagnosing deep vein thrombosis in primary care.

BACKGROUND: Properly ruling in or out deep vein thrombosis (DVT) is important because of the risk of developing pulmonary embolism if untreated and the risk of bleeding when treated with anticoagulants. In primary care, the diagnosis in suspected DVT is non-specific and the physician has to decide which patients to refer for further diagnostic work-up on the basis of patient history and physical examination alone. OBJECTIVE: To quantify which (combination of) items from patient history and physical examination contribute to the diagnosis of DVT in primary care. METHODS: A cross-sectional study design was chosen and the setting was all primary care physicians adherent to three local hospitals. 1325 consecutive patients consulting their primary care physician with symptoms suggestive of DVT were included. RESULTS: We studied 1325 patients with suspected DVT. The prevalence of thrombosis (assessed by means of compression ultrasonography) in these patients was 29%. Multivariate regression analysis of 17 candidate predictors resulted in nine independent predictors of DVT: male gender, duration of symptoms, malignancy, immobilization, leg trauma, pain when walking, oedema, calf circumference and dilated veins. The predictive value of the combination of the nine independent variables was low, reflected in the ROC area (as a combination of the sensitivity and specificity) of this model of 0.68. The low discriminative value was also exhibited in the numbers of DVT in the different risk categories. For example, in the low-risk group, the probability of DVT was still 15%. The diagnostic performance of patient history and physical examination was similar (and thus poor) in all clinically relevant subgroups. CONCLUSION: Patient history and physical examination in patients suspected of DVT are of limited value for the primary care setting to identify patients with a low or high probability of DVT and thus in the decision to refer for further diagnostic work-up.

Cross-Sectional Studies↗

PubMed1975

Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients.

To evaluate the relative importance of the medical history, the physical examination, and laboratory investigations in the diagnosis and management of medical outpatients some physicians recorded their diagnosis and a prediction of the method of managementafter reading the patient's referral letter, again after taking the history, and againafter performing the physical examination. These diagnoses and predictions were compared with the diagnosis and method of management which had been adopted two months after the patient's initial attendance. A diagnosis that agreed with the one finally accepted was made after reading the referral letter and taking the history in 66 out of 80 new patients; the physical examination was useful in only seven patients, and the laboratory investigations in a further seven. In only one of six patients in whom the physician was unable to make any diagnosis after taking the history and examining the patient did laboratory investigations lead to a positive diagnosis.

Clinical Laboratory Techniques↗

PubMed2001

Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates.

BACKGROUND: Although adolescent alcohol consumption has been found to be positively correlated with self-reported health problems, few studies have examined other health indicators. This study compared adolescents with alcohol use disorders (AUDs) and a community reference group on self-reported health problems, serum liver enzymes, and physical examination findings. The relevance of negative emotionality to understanding these health problems was also investigated. METHODS: The subjects were adolescents with AUDs recruited from clinical programs and classified as having DSM-IV alcohol dependence (n = 71) or alcohol abuse (n = 57) and reference adolescents without AUDs recruited from community sources (n = 131). The assessment of health status included self-reported health problems in 15 areas; serum liver enzyme assays, including gamma-glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase; and physical examination findings. Negative emotionality was determined by systematically combining scores from the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the Child Behavior Checklist, and the Multidimensional Personality Questionnaire. RESULTS: Adolescent AUDs were associated with more self-reported health problems, higher gamma-glutamyl transpeptidase and alanine aminotransferase levels, and more physical examination abnormalities. Negative emotionality was highly correlated with self-reported health problems, mediated the relationship between AUDs and self-reported health problems, and was not correlated with serum liver enzyme levels or physical examination abnormalities. CONCLUSIONS: These results indicated that AUDs during adolescence were associated with health problems, including modest but demonstrable liver injury. Self-reported health problems were probably best understood, in this context, as a negative emotionality manifestation.

Adolescent↗

PubMed2005

Relationship of physical examination findings and self-reported symptom severity and physical function in patients with degenerative lumbar conditions.

BACKGROUND AND PURPOSE: Limited data are available to assist clinicians in clinical decision making. The purpose of this study was to examine the relationships of symptom provocation during physical examination (PE) procedures and self-report of symptom severity and function in patients with degenerative lumbar conditions. SUBJECTS: Twenty-four men and 50 women with chronic low back pain (CLBP) (>6 months duration) were recruited from a university hospital (median age=64.2 years, mean=66.8, SD=12.4, range=55.7-97.8). METHODS: Demographic information, medical history, PE findings, and data from 2 self-report measures of symptom severity and function (Lumbar Spinal Stenosis [LSS] questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were collected. RESULTS: Patients had moderate symptoms of degenerative lumbar conditions (mean LSS symptom score=2.67, SD=0.71) and reported some difficulties with low back function (mean LSS function score=1.99, SD=0.61). The most frequent physical examination findings were a positive quadrant test (70%), followed by lower-extremity muscle weakness (64%), abnormal reflexes (62%), and active lumbar extension (61%). Patients who were symptomatic during the quadrant test, patients who had pain with lateral flexion, and patients who had lower-extremity weakness had higher self-reported LSS symptom severity (t=-3.06, P=.003; t=-2.96, P=.004; and t=-3.2, P=.002, respectively). Pain with lumbar extension was moderately correlated with LSS symptom severity (Spearman rho=.31, P=.007). No lumbar PE procedure was associated with decreased condition-specific function. The quadrant test was the strongest predictor of symptom severity (beta=.54, r(2)=.21, P=.0009). DISCUSSION AND CONCLUSION: The association between PE findings and self-reported symptom severity in this sample is consistent with the pathoanatomy of degenerative spinal conditions and indicates that movement that narrows the foraminal space contributes to symptom severity. The quadrant test distinguished those subjects with clinically meaningful low back symptom severity but was not predictive of impaired function. This study illustrates the potential benefit of identifying clinical PE measures that are reflective of condition severity and back-specific function in patients with similar clinical syndromes.

Activities of Daily Living↗

PubMedDate not supplied

Use of residual volume as a marker for enteral feeding intolerance: prospective blinded comparison with physical examination and radiographic findings.

High gastric residual volumes (RVs) are a frequent cause for cessation of total enteral nutrition (TEN). This study was designed to determine the RV that indicates intolerance or inadequate gastric emptying and to compare the RV findings in a blinded fashion with those findings obtained on physical examination and radiography. Twenty healthy normal volunteers (HNV), 8 stable patients with gastrostomy tubes (GTP), and 10 critically ill patients (CIP) were evaluated prospectively for 8 hours while receiving TEN. No subjects were clearly intolerant (ie, vomiting, aspiration). Of the total RVs recorded, 13.1% were greater than or equal to 150 mL in the CIP group, whereas only 2.4% of the RVs were greater than or equal to 150 mL in the HNV group. None of the RVs in the GTP group were greater than or equal to 150 mL. Objective scores on physical examination failed to correlate with RV (p = .397), as did objective scores on radiography (p = .742). However, objective scores on physical examination were significantly related to scores on radiography (p = .016). Abnormal physical examination findings were found in 4 out of 11 patients (GTP + CIP) with RVs less than 100 mL and in 6 out of 7 with RVs greater than or equal to 100 mL. Abnormal radiographic results were found in 6 out of 11 patients with RVs less than 100 mL, in 7 out of 7 patients with RVs greater than or equal to 100 mL, and in 4 out of 20 HNVs. There was no difference in RVs obtained from the supine or right lateral decubitus positions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2005

Head and neck physical examination: comparison between nonapneic and obstructive sleep apnea patients.

STUDY OBJECTIVES: The purpose of this study was to apply a systematic physical examination, used to evaluate obstructive sleep apnea (OSA) patients, in nonapneic patients. DESIGN: Study was prospective. SETTING: Patients were seen in the sleep laboratory and department of otorhinolaryngology. PATIENTS OR PARTICIPANTS: Nonapneic patients (n = 100) were involved in the study. INTERVENTIONS: Physical examination to evaluate facial skeleton, pharyngeal soft tissue, rhinoscopy, and body mass index. Data were compared with a previously published study (2003) on a group of OSA patients (n = 223). MEASUREMENTS AND RESULTS: Skeletal examination detected retrognathism in 6%, class II occlusion in 12%, and high-arched hard palate in 11%. The modified Mallampati classification showed 54% in class I to II and 46% in class III to IV. Only 1% of nonapneic patients had tonsils of degree III to IV. Oropharynx evaluation showed web palate in 38%, posterior palate in 19%, thick palate in 10%, thick uvula in 10%, long uvula 15%, voluminous lateral wall in 11%, and tongue edge crenations in 28%. Anterior rhinoscopy detected significant septal deviation in 1% and turbinate hypertrophy in 31% of patients. CONCLUSIONS: The head and neck physical examination, considering both skeletal and soft tissue alterations, illustrated significant differences between nonapneic and OSA patients. Body mass index, modified Mallampati classification, tonsils hypertrophy, and high-arched hard palate previously related to the presence of sleep apnea in the literature showed different outcomes in nonapneic patients. Nonapneic patients had less alterations in nasal anatomy (severe septal deviation and enlarged turbinate). Skeletal parameters, such as retropositioned mandible and angle class II occlusion, were less frequent in nonapneic patients.

Adolescent↗

PubMed2003

Value of ultrasonography compared with physical examination for the detection of locoregional metastases in patients with cutaneous melanoma.

In several studies the early detection of locoregional metastases in patients with cutaneous melanomas has been shown to be of prognostic value. Physical examination alone often fails to detect locoregional metastases or cannot unambiguously classify palpable lymph nodes. This study aimed to evaluate the usefulness of high resolution ultrasonography for the early detection of locoregional metastases and to compare the sensitivity and specificity of ultrasound and physical examination. A prospective study was performed between January 1997 and June 1999 in 1395 patients (721 men and 674 women) with invasive cutaneous melanoma, treated and followed up at the Department of Dermatology and Allergology, Ludwig-Maximilian-University, Munich, Germany. A total of 2650 physical and ultrasound examinations of lymphatic drainage areas were performed, and lesions suspicious for metastases were excised and diagnosed by histopathology. The results of physical and ultrasound examinations were compared. Of the 2650 ultrasound examinations, metastases were suspected in 153, whereas 290 of the 2650 physical examinations were suspicious for metastatic disease. A total of 168 patients with suspicious lesions underwent surgery; histopathological examination revealed 112 melanoma metastases and 56 other diagnoses, including one second malignancy, one neurinoma, one haemangioma and 54 reactive lymph nodes. Ultrasonographic diagnosis of melanoma metastases had a sensitivity of 92.2% and a specificity of 98.2%, whereas diagnosis by physical examination had a sensitivity of only 51.3% and a specificity of 90.9%. Thus ultrasound examination was found to be highly effective and superior to physical examination for the early detection of locoregional melanoma metastases.

Adolescent↗

PubMedDate not supplied

Cancer patients use unconventional medical therapies far more frequently than standard history and physical examination suggest.

BACKGROUND: Studies with questionnaires have suggested that many cancer patients utilize unconventional medical therapies (UMT). There are few data evaluating directed questions about the use of UMT. This study was performed to determine if careful directed questioning about UMT reveals a higher rate of utilization compared to standard history and physical examination. MATERIALS AND METHODS: A prospective evaluation of 196 consecutive patients presenting for initial consultation at the University of Pennsylvania was performed. Each patient underwent standard history and physical examination, including questions regarding prescription and over-the-counter medications. At the completion of standard questioning, patients were asked an explicit set of directed questions regarding the utilization of UMT. The median age of the patient population was 61 years (range = 28-80 years). Cancer diagnoses included breast (19%), lung (28%), prostate (26%), and other (27%). Females constituted 32% of the patient population. RESULTS: Initially, only 13 patients (7%) revealed they were using UMT during a standard history and physical. Evaluation of the remaining 183 patients with directed questioning revealed an additional 66 patients (36%) were utilizing these therapies. Of the 79 patients taking UMT, 84% were identified by directed questioning and 16% by standard history and physical examination (P < 0.0005). Forty-one patients (52%) were using > or = 2 of these therapies (mean = 2.5; range 1-17 therapies). A total of 48 different UMT were used by this patient population. Patients utilizing multivitamin supplementation were significantly more likely to be using an UMT than those who were not (68% vs. 31%; P < 0.0001). Females were more likely to use UMT than males (49% vs. 35%; P = 0.08). CONCLUSIONS: The addition of explicitly directed questioning to the standard history and physical examination significantly increases the oncologist's ability to identify cancer patients who utilize UMT. Some of these therapies may interact with conventional cancer treatments and/or cause significant side effects; consequently, it is important for oncologists to detect those patients utilizing these therapies.

Adult↗

PubMed1978

Psychiatrists and physical examinations: a survey.

Alumni from the 1965-1974 psychiatric residency classes at the Los Angeles County-University of Southern California Medical Center were surveyed about their individual practices regarding physical examinations. Ninety-eight of 155 alumni returned the anonymous questionnaire. None of the respondents routinely performed physical examinations on new outpatients. The 61% who had inpatient practices usually delegated the hospital admission physical examination.

Ambulatory Care↗

PubMed2006

Teaching foundational physical examination skills: study results comparing lay teaching associates and physician instructors.

BACKGROUND: The purpose of this pilot study was to determine differences in the physical exam skills of first-year medical students learning physical exam exclusively from standardized physical examination teaching associates (SPETAs) or physician faculty. METHOD: In all, 144 first-year medical students were randomized to receive SPETA or physician-led physical examination instruction. Students participated in an OSCE assessment immediately following the end of the curriculum block. RESULTS: SPETA-trained students performed equivalently to physician faculty trained students across all stations with a mean of 82.9% versus 81.2% (p = .226). Students taught by SPETAs performed significantly better on the abdominal OSCE with a mean score of 88.8%, while physician faculty taught students had a mean score of 85.4% (p = .03). CONCLUSION: Findings from this study suggest that SPETAs can effectively teach foundational physical examination skills to medical students at a similar and sometimes better performance level as physician faculty.

Education, Medical, Undergraduate↗

PubMed2004

Does morphine change the physical examination in patients with acute appendicitis?

The objective of this study was to determine if judicious dosing of morphine sulfate can provide pain relief without changing important physical examination findings in patients with acute appendicitis. We conducted a prospective, randomized, double-blind crossover design. Patients scheduled for appendectomy were randomized to two groups. Group A received 0.075 mg/kg intravenous morphine sulfate and 30 minutes later received placebo. The sequence of medication was reversed in group B. Patients were examined by a surgical resident and an EM attending before and after receiving medication. Six explicit physical examination findings were documented as absent, indeterminate, or present. Physicians were also asked if they felt overall examination findings had changed after medication. Patient's visual analog scale (VAS) was recorded before each medication and at study completion. Thirty-four patients were enrolled and full data were available for 22 patients. Neither morphine nor placebo caused a significant change in individual examination findings. Three patients in both groups were judged to have a change in their examination after medication. The median change in VAS was 20 mm after morphine and 0 mm after placebo (P =.01). In this pilot study, patients with clinical signs of appendicitis were treated with morphine and had significant improvement of their pain without changes in their physical examination.

Adult↗