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PubMed1986

Medical house staff performance in physical examination.

One hundred twenty patients admitted to the medical service and presented at one of two teaching conferences were examined to evaluate the nature of errors made in physical examination by house officers. The overall mean error rate per patient was 5.8% +/- 0.6% for residents and 6.4% +/- 0.6% for interns. The mean error rate for cardiac examination was significantly worse than for respiratory, abdominal, or thyroid examinations. An additional 40 patients selected for abnormal cardiac or neurologic findings were found to have a significantly higher mean error rate in those areas than did the first group of patients with less abnormal findings. Agreement in physical findings between investigators was significantly better than between investigators and house officers. Resident performance in physical examination correlated with estimates of relative time spent by attending physicians at the bedside reevaluating physical findings, but not with class-ranking and inservice examination scores. Educational implications are discussed.

Diagnostic Errors↗
PubMed1993

Consideration of women's health issues by housestaff performing admitting histories and physical examinations.

BACKGROUND: The author felt that issues related specifically to women's health were being overlooked by housestaff as they performed admitting histories and physical examinations. METHOD: A retrospective review of 120 patients' charts at a city and county teaching hospital was conducted during two periods (September 1988 through January 1989 and March 1992 through June 1992) to determine the frequency with which 46 housestaff considered women's health issues while performing admitting histories and physical examinations. The charts selected were those of women, 17 years old or older, who were admitted to the inpatient medical service, were interviewed and examined by an intern and a resident, and were able to give their own histories. To better gauge the results (i.e., the numbers of charts on which women's health issues were recorded compared with the numbers on which such issues should have been recorded), two non-gender-specific control issues (history of tobacco use and the performance of a rectal examination) were used. RESULTS: Histories of tobacco use and rectal examinations were noted on 97% and 72% of the charts for the first study period, and on 95% and 70% of the charts for the second period. In contrast, the histories of Pap smears for the patients with intact uteri were noted on 5% and 0% of the charts; mammograms for the patients age 50 and older, on 4% and 0%; self breast examinations for all age groups, on 4% and 0%; and breast examinations performed by housestaff, on 33% and 25%. CONCLUSION: Issues related to women's health promotion and disease prevention were rarely a part of the housestaff's admitting histories and physical examinations.

Adolescent↗
PubMed2001

Development and evaluation of a method for evaluating pediatric residents' knowledge and skill in performing physical examinations of the ankle and knee.

BACKGROUND: Pediatric residents need the knowledge and physical examination skills to evaluate common musculoskeletal injuries. The ankle and the knee are the 2 most common sites of musculoskeletal injury in young athletes. Methods for evaluating pediatric residents' knowledge and skills in examining the ankle and knee are needed. OBJECTIVES: 1) To describe the development of a method for evaluating pediatric residents' knowledge and skill in performing physical examinations of the ankle and knee, and 2) to report the reliability of this method. METHODS: A written test and a Clinical Skills Assessment Examination (CSAE) with a rating index were developed by the investigators to evaluate pediatric residents' knowledge and skills in examining the ankle and knee. Fifty-eight pediatric residents completed the written test and examined the ankle and knee of one standardized patient at the beginning of a required 1-month adolescent medicine rotation. Forty-eight residents repeated the evaluation at the end of the month. The investigators rated the residents' performance of the CSAE and then assessed interrater reliability using Cronbach's alpha. Test-retest correlation was calculated to assess the reliability of the written test. RESULTS: Test-retest correlation for the written test was 0.72, establishing its reliability. Interrater reliability for rating the CSAE of the ankle and knee was 0.98 and 0.90, respectively. CONCLUSION: Pediatric residents' knowledge and skills in examining the ankle and knee can be reliably evaluated using the written test and CSAE described in this article. These could be used to assess the effectiveness of current curricula in improving pediatric residents' knowledge and skill in evaluating ankle and knee complaints and to assist in the design of future curricula. musculoskeletal, evaluation methods, resident curriculum.

Adolescent Medicine↗
PubMed1981

Prospective evaluation of physical examination of the breast.

The reliability of physical examination of the breast was evaluated by determining the extent of agreement among four experienced breast surgeons who examined the same 100 patients. The consequences of disagreements among surgeons were assessed by determining the diagnostic accuracy of each examiner. Despite differences in the frequency with which each surgeon found abnormalities or masses, or recommended mammography or biopsy, the diagnostic accuracy of the surgeons was very similar, and most disagreements concerned the findings in patients who did not have breast cancer. Breast examination carried out by more than one surgeon may reduce the frequency with which biopsy is performed in patients who do not have breast cancer.

Biopsy↗
PubMed2002

Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume: using the prader orchidometer versus ultrasonography.

INTRODUCTION: The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy. The aim of this study was to prospectively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes. PATIENTS AND METHODS: This study included 68 boys with varicoceles, ranging in age from 8 to 19 years. Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography. The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography. A difference of more than 10% or 2 ml in each testicular volume was considered significant. RESULTS: The mean age of the boys was 13.5 +/- 2.3 years. On physical examination, a left unilateral varicocele was diagnosed in 46 boys (67.6%). The other 22 boys (32.4%) had bilateral varicoceles. Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys (8.7%) who were diagnosed by physical examination as having only left unilateral varicoceles (grade 3 in 3 patients and grade 2 in 1 patient). A different of more than 10% or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles (2.2%). The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test (r = 0.997 and p < 0.001 for the left testis; r = 0.998 and p < 0.001 for the right testis). CONCLUSIONS: Although the management of subclinical varicoceles remains controversial, these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles, especially in boys with high-grade left varicoceles. In contrast, scrotal ultrasonography, if considered the gold standard, did not show superiority over the Prader orchidometer in measuring testicular volumes.

Adolescent↗
PubMed1997

Are fourth-year medical students effective teachers of the physical examination to first-year medical students?

OBJECTIVE: To determine if fourth-year medical students are as effective as faculty in teaching the physical examination to first-year medical students. DESIGN: Stratified randomization of the first-year students. SETTING: A public medical school. PARTICIPANTS: All 100 first-year medical students in one medical school class were randomly assigned (controlling for gender) to either a faculty or a fourth-year student preceptor for the Physical Examination Module. MAIN RESULTS: The first-year students of faculty preceptors scored no differently on the written examination than the students of the fourth-year medical student preceptors (82.8% vs 80.3%, p = .09) and no differently on a standardized patient practical examination (95.5% vs 95.4%, p = .92). Also, the first-year students rated the two groups of preceptors similarly on an evaluation form, with faculty rated higher on six items and the student preceptors rated higher on six items (all p > .10). The fourth-year student preceptors rated the experience favorably. CONCLUSIONS: Fourth-year medical students were as successful as faculty in teaching first-year medical students the physical examination as measured by first-year student's performances on objective measures and ratings of teaching effectiveness.

Adult↗
PubMed2002

Painful shoulder: comparison of physical examination and ultrasonographic findings.

BACKGROUND: High frequency ultrasonography is an accurate non-invasive imaging technique for evaluating patients with painful shoulder. OBJECTIVE: To compare the clinical diagnosis established by a physical examination with high frequency ultrasonographic findings in patients with painful shoulder. METHODS: Thirty one consecutive patients with a first flare of shoulder pain were prospectively included in the study. All had a physical examination performed by two blinded rheumatologists. Ultrasonographic examination was carried out within one week of the physical examination by a third rheumatologist experienced in this technique who had no knowledge of the clinical findings. Ultrasonography was considered the optimal diagnostic technique. RESULTS: Clinical assessment showed low accuracy in the diagnosis of periarticular shoulder lesions. CONCLUSION: Ultrasonography should be used wherever possible to improve diagnosis and treatment of painful shoulder.

Adult↗
PubMed2000

The accuracy of physical examination to detect abdominal aortic aneurysm.

BACKGROUND: Abdominal palpation during physical examination is an important means of detecting abdominal aortic aneurysm (AAA), but limited information is available on its accuracy. METHODS: Two hundred subjects (aged 51-88 years), 99 with and 101 without AAA as determined by previous ultrasound, each underwent physical examination of the abdomen by 2 internists who were blinded to each other's findings and to the ultrasound diagnosis. RESULTS: The overall accuracy of abdominal palpation for detecting AAA was as follows: sensitivity, 68% (95% confidence interval [CI], 60%-76%); specificity, 75% (95% CI, 68%-82%); positive likelihood ratio, 2.7 (95% CI, 2.0-3.6); negative likelihood ratio 0.43 (95% CI, 0.33-0.56). Interobserver pair agreement for AAA vs no AAA between the first and second examinations was 77% (kappa = 0.53). Sensitivity increased with AAA diameter, from 61% for AAAs of 3.0 to 3.9 cm, to 69% for AAAs of 4.0 to 4.9 cm, 72% for AAAs of 4.0 cm or larger, and 82% for AAAs of 5.0 cm or larger. Sensitivity in subjects with an abdominal girth less than 100 cm (40-in waistline) was 91% vs 53% for girth of 100 cm or greater (P<.001). When girth was 100 cm or greater and the aorta was palpable, sensitivity was 82%. When girth was less than 100 cm and the AAA was 5.0 cm or larger, sensitivity was 100% (12 examinations). Factors independently associated with correct examination findings included AAA diameter (odds ratio [OR], 1.95 per centimeter increase; 95% CI, 1.06-3.58); abdominal girth (OR, 0.90 per centimeter increase; 95% CI, 0.87-0.94); and the examiner's assessment that the abdomen was not tight (OR, 2.68; 95% CI, 1.17-6.13). CONCLUSIONS: Abdominal palpation has only moderate overall sensitivity for detecting AAA, but appears to be highly sensitive for diagnosis of AAAs large enough to warrant elective intervention in patients who do not have a large girth. Abdominal palpation has good sensitivity even in patients with a large girth if the aorta is palpable.

Abdomen↗
PubMed1988

Selective management of abdominal stab wounds. Importance of the physical examination.

The treatment of patients with anterior abdominal stab wounds remains controversial. We reserve celiotomy for patients who have clinical findings of peritonitis or hemorrhage. Repeated physical examination is the most important element of observation. Recently, 330 patients with stable abdominal stab wounds presented over a 12-month period. These patients were followed up with serial physical examinations and laboratory measurements. Of the 330 patients, 107 patients (32%) required celiotomy for the repair of a life-threatening injury (group 1); 28 patients (8%) underwent nontherapeutic celiotomies (group 2); 19 patients (6%) had negative explorations (group 3); and 176 patients (53%) were observed and discharged (group 4). There were three missed injuries in group 4. Serial physical examination can be a reliable technique in the management of abdominal stab wounds and is comparable to other approaches.

Abdominal Injuries↗
PubMed1981

Determination of mortality risk in obstructive pulmonary syndromes: physical examination compared with measurement of forced expired volume in one second.

A standardised physical examination based on four clinical signs was compared with the FEV1 with regard to ability to determine five-year mortality risk in subjects with varying degrees of obstructive airway disease. Both evaluation methods identified low, intermediate, and high risk groups within the population studied. Individuals with no positive physical signs, or with an FEV1 of 70% of predicted or more had mortality not significantly greater than that predicted on the basis of standard mortality tables. There was no difference between the FEV1 and the physical examination in ability to predict mortality.

Adult↗
PubMed1999

The value of electrodiagnostic consultation for patients with upper extremity nerve complaints: a prospective comparison with the history and physical examination.

OBJECTIVES: To determine whether electrodiagnostic testing changes diagnostic certainty compared with a detailed history and physical examination, and whether interactions between medical information, the extent of testing, and diagnostic certainty imply a need for advanced medical knowledge on the part of the tester. DESIGN: Prospective observation. SETTING: University orthopedic department and small community hospital electrodiagnostic laboratories. PATIENTS: Two hundred fifty-five consecutive referrals for upper extremity nerve complaints. OUTCOME MEASURES: Diagnosis, diagnostic confidence, and severity of neurologic lesion were coded after standardized history and physical and after electrodiagnostic testing. RESULTS: Electrodiagnostic testing substantially altered 42% of diagnoses, confirmed 37%, and did not clarify 21%. The extent of testing correlated with the size of the differential diagnosis, the number of previous hospitalizations, and the number of other medical problems. Confidence in final diagnoses correlated positively with severity of the lesion, but negatively with the size of the differential diagnosis and the number of painful body areas. Hospitalizations and medical problems also tended towards negative correlations. CONCLUSIONS: This study, in which all electrodiagnostics, histories, and physical examinations were performed by a single physician, suggests that electrodiagnosis substantially alters clinical impressions in a large percentage of patients. The complex relationship between clinical information, the extent of testing, and final diagnostic certainty suggests that specialized medical knowledge is required for accurate electrodiagnosis.

Adult↗
PubMed2005

Fine tuning the history and physical examination: correlations with miscellaneous techniques.

It may be unusual to think of a physical examination as a technique, but what better "instruments" do we have than our eyes, our ears, and our hands? Therefore, I will describe several "techniques" that I felt should be included in this journal, but that do not warrant an article of their own. This article will cover some parts of the routine physical examination, correct positioning of cats and consequences of bad positioning, radiographic techniques that will help diagnose heart failure more consistently, examination of dogs with lower airway disease, and examination of cats with aortic thromboembolism (ATE). Several "pearls" that may get lost in the other information is sprinkled throughout the article.

Animals↗
PubMed1990

Assessment of clinical skills using videotapes of the complete medical interview and physical examination.

Complete medical interviews and physical exams were performed on two stimulated patients by a class of medicine interns. These interviews and examinations were videotaped and were then scored using a rating scale developed by the authors. This system of videotaping and rating complete interviews and physical examinations is called the The Northwestern Evaluation & Training System (NETS). Selected findings are presented and discussed. It is shown how the NETS can be used for educational feedback to the individual student and for quality assurance feedback to training programs regarding the effectiveness of their instruction in interview and physical examination skills.

Clinical Competence↗
PubMed2006

Pilot study to evaluate 3 hygiene protocols on the reduction of bacterial load on the hands of veterinary staff performing routine equine physical examinations.

Reduction factors (RFs) for bacterial counts on examiners' hands were compared when performing a standardized equine physical examination, followed by the use of one of 3 hand-hygiene protocols (washing with soap, ethanol gel application, and chlorohexidine-ethanol application). The mean RFs were 1.29 log10 and 1.44 log10 at 2 study sites for the alcohol-gel (62% ethyl alcohol active ingredient) protocols and 1.47 log10 and 1.94 log10 at 2 study sites for the chlorhexidine-alcohol (61% ethyl alcohol plus 1% chlorhexidine active ingredients) protocols, respectively. The RFs were significantly different (P < 0.0001) between the hand-washing group and the other 2 treatment groups (the alcohol-gel and the chlorhexidine-alcohol lotion). The use of alcohol-based gels or chlorhexidine-alcohol hand hygiene protocols must still be proven effective in equine practice settings, but in this study, these protocols were equivalent or superior to hand washing for reduction in bacterial load on the hands of people after they perform routine physical examinations.

Animals↗
PubMed1980

XXYY syndrome discovered on routine physical examination.

The XXYY syndrome, an uncommon disorder of chromosome number, was discovered on routine physical examination of a 20-year-old patient. Despite numerous earlier contacts with physicians, including several visits during adolescence, insufficient consideration had been given to his apparent abnormalities. This case is presented to review the syndrome and to emphasize the importance of careful evaluation of pubertal development during the routine physical examination of an adolescent.

Adult↗
PubMed2004

The quality of research on physical examination for abdominal aortic aneurysm.

A review of nursing literature revealed no studies regarding physical examination or other interventions (except unit based) for abdominal aortic aneurysms (AAA). The physician literature was explored, revealing an excellent meta-analysis in 1999 of studies before that date with regard to physician accuracy in physical examination for AAA. These are reviewed for quality and recommendations made for nursing research and the role of the Society for Vascular Nursing in teaching nurses.

Aortic Aneurysm, Abdominal↗
PubMed1996

Diagnosis of ligament rupture of the ankle joint. Physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma.

We prospectively enrolled 160 consecutive patients with inversion trauma of the ankle in a diagnostic protocol that included physical examination within 2 days and at 5 days after trauma, arthrography, stress radiography, and ultrasonography. 135 patients had pathological lateral ligament laxity on the later physical examination or lateral ligament rupture diagnosed on arthrography and they were operated on 122 of these patients had ligament ruptures. At clinical follow-up after a minimum of half a year, all of the patients who were not operated on had stable joints without signs of previous ligament ruptures. Delayed physical examination at 5 days after the injury led to the highest overall sensitivity (96%) and specificity (84%) for the detection of a ligament rupture. Additional diagnostic procedures, at a considerable cost, yielded little additional information.

Adolescent↗