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At least 253 records · Page 14Linked to original sources
PubMed1993

Do the medical history and physical examination predict low lung function?

BACKGROUND: We sought to determine whether an abnormal respiratory history or chest physical examination could be used to identify men with low lung function. METHODS: We analyzed pulmonary function, physical examination, and questionnaire data from 4461 middle-aged male Vietnam-era army veterans. MAIN RESULTS: The study sample consisted of 1161 never smokers, 1292 former smokers, and 2008 current smokers. Clinical indicators of respiratory disease (respiratory symptoms, respiratory signs, or a history of respiratory disease), were present in 26.1% of the never smokers, 31.7% of the former smokers, and 47.2% of the current smokers. We defined low forced expiratory volume in 1 second as a value less than 81.2% of the predicted value. Seven percent of the never smokers, 8% of the former smokers, and 17.3% of the current smokers demonstrated low forced expiratory volume in 1 second. Among those with a clinical indicator for spirometry only 11% of the never smokers, 13% of the former smokers, and 21% of the current smokers actually had a low forced expiratory volume in 1 second. Among those without a clinical indicator 6% of the never smokers, 6% of the former smokers, and 14% of the current smokers actually had a low forced expiratory volume in 1 second. CONCLUSIONS: The use of clinical indicators as a basis for obtaining pulmonary function tests in middle-aged men misses many with low lung function, especially current smokers.

Adult↗
PubMed1985

Physical examination of psychiatric outpatients: medical and legal issues.

The nation's courts are increasingly defining standards for the practice of psychiatry, but they have not given substantial attention to whether a psychiatrist can be found liable for failure to perform or obtain a physical examination of an outpatient. The few court decisions on this issue involve obvious infractions against good medical care and do not provide useful clinical guidelines. The authors' review of the literature indicates that although psychiatric patients are less healthy than the general population, and the majority of psychiatrists feel physical examination of outpatients is important, psychiatrists rarely conduct such examinations and only a small percentage initiate them. The authors offer recommendations concerning physical examinations that they believe are consonant with good psychiatric outpatient care.

Adult↗
PubMed1996

History and physical examination in patients with herniated lumbar discs.

To outline the usefulness of the medical history and physical examination in the diagnosis of herniated lumbar discs, and to review the essential properties of a test, including sensitivity, specificity, and clinical value. None of the tests that are part of a history and physical examination of a patient with a disc herniation has a high diagnostic accuracy by itself. This is because positive and negative predictive values of common clinical indicators are limited. Confirmatory tests are necessary for a definitive diagnosis when making management decisions. Combining the results of history and physical findings will increase the predictive value of these basic diagnostic tools.

Humans↗
PubMed1962

Physical examination of well persons. what is "adequate" for detection of unsuspected disease?

In the examination of 500 "well" executives, the number of unknown diseases found averaged 5.4 per person. Almost half of these executives had newly detected disease that was potentially significant to their health. Treatment was necessary in more than 47.7 per cent of them. One out of five of the total significant unknown defects found was either a peptic ulcer or gallstones; one out of five was a rectal adenoma; and one out of five was either hypertension or cardiac disease. One-third of the executives were overweight. Diabetes was found in every 20th person; and malignant disease was detected in one of every 41 people. For an examination to be "adequate" for the detection of unknown disease, the general physical examination must be complete and thorough. A proctoscopic is necessary, and certain basic laboratory screening procedures should be completed in each individual. Complete and routine x-ray studies of the gallbladder and gastrointestinal tract should be done, since they are the most important single diagnostic procedure, in detecting early, major, unsuspected, and often asymptomatic diseases. Routine consultations with specialists are a valuable asset in disease detection. Repeated periodic examinations help in detection of new unknown disease that was not present or not noted in earlier examinations.

Early Diagnosis↗
PubMed2001

Efficacy of ultrasound B-scan compared with physical examination in follow-up of melanoma patients.

BACKGROUND: The value of ultrasound B-scan for routine follow-up of melanoma patients still is not generally accepted. Therefore, the authors compared the efficacy of physical examination (PE) with ultrasound B-scan (UBS) for detection of regional tumor recurrence in melanoma patients. The aim of the current study was to evaluate whether early detection of metastases improves relapse-free and overall survival. METHODS: For a period of 4 years, 829 consecutive melanoma patients were followed prospectively. Physical examination of 3011 patients and concomitant UBS of in-transit routes and regional lymph node basins were performed. Suspicious lesions were diagnosed by fine-needle aspiration cytology and pathology. RESULTS: During the study period, 242 (90.6%) of 267 patients with melanoma recurrences were first recognized by PE or UBS within the routine follow-up program. The sensitivities of both methods differed significantly (P = 0.001). Metastases were detected by PE in only 61 of 242 recurrences (25.2%, 95% confidence interval [CI]: 19.9-31.2%), whereas UBS revealed 240 recurrences (99.2%, 95% CI: 97.3-99.6%). The specificity was 98.4% (95% CI: 97.8-98.8%) and 98.3% (95% CI: 97.7-98.7%), respectively. Survival of 103 patients who presented with a first nodal melanoma recurrence was followed and analyzed by multiple Cox regression. Overall survival was affected by the diameter of the largest metastasis (P = 0.001) and the number of metastatic lesions (P = 0.012). CONCLUSION: The study found that ultrasound B-scan was highly effective in the early detection of regional melanoma metastases compared with physical examination. Earlier detection of such metastases seemed to result in improved overall survival.

Adolescent↗
PubMed1989

Child sexual abuse. Physical examination.

Twenty-nine children were subjected to physical examination as part of a population-based study comprising 41 children, aged 0-17 years, all assumed to be victims of sexual abuse. The hymenal opening was measured with transparent test tubes of known diameters using a new, simple and reproducible method. The examination was in no case performed under anaesthesia. A dilated hymenal opening and/or other physical evidence of trauma or disease were found in 19/29 children. Examination results evaluated in the light of anamnestic information indicated that sexual abuse had occurred in 10 cases but in only 3 of these cases the suspect was convicted. Additional studies are required to shed light on age-related normal variations in genital anatomy.

Adolescent↗
PubMed1977

Conventional mammography, physical examination, thermography and xeroradiography in the detection of breast cancer.

From July 1, 1973, through January 15, 1975, at the Emory University Clinic independent physical examinations, conventional mammography, thermography and xeroradiography of the breast were carried out on 1,003 symptomatic patients by both physicians and radiologic technologists. One year after completion of the study there had been 360 breasts biopsied with 53 malignant and 307 benign lesions demonstrated. Seventy-three percent of the cancers were histologically Stage 0 or Stage I. The detection rate of the cancers by physician and technologist respectively were: 1) conventional mammography 87 and 74%; 2) xeroradiography 65 and 46%; 3) physical examination 62 and 51%; and 4) thermography 29 and 27%. In non-malignant breasts the physician and technologist designated cancer respectively in: 1) thermography 4 and 6%; 2) conventional mammography 6 and 6%; 3) xeroradiography 8 and 10%; and 4) physical examination 11 and 12%.

Adult↗
PubMed1991

Comparison of vibrotactile thresholds with physical examination and electrophysiological assessment.

Measurement of cutaneous vibrotactile thresholds may be useful for assessment of the functional integrity of the somatosensory system. To validate a rapid method of determining vibrotactile thresholds that uses a commercially available electromechanical device, vibrotactile thresholds were compared with standardized physical examination findings of sensory function and electrophysiological parameters in 79 patients referred to the Mount Sinai Hospital Neurophysiology Laboratory for clinical electrophysiological evaluation. A statistically significant monotonic association between graded physical examination of vibration perception and vibrotactile threshold was observed for all digits tested in the upper and lower extremities. Statistically significant associations were also observed between vibrotactile thresholds and a variety of electrophysiological measures of the median, ulnar, tibial, peroneal, and sural nerves. The strongest associations were observed between great toe vibrotactile thresholds and late response latencies measured in nerves in the lower extremities. Determination of vibrotactile thresholds may be useful in settings where quantitative measures of large fiber nerve function are desirable and electrophysiological study is not feasible.

Action Potentials↗
PubMed2005

[Estimated results of prophylactic physical examinations detecting cervical cancer in Center of Oncology in Bydgoszcz in years 2001-2003].

OBJECTIVES: Kujawsko-pomorskie province is a region with high morbidity and death-rate from uterine cervix cancer. One of the methods of improve this situation is to perform prophylactic physical examinations to find the least advanced stages as possible. DESIGN: The aim of the study was to estimate the results of prophylactic physical examinations for cervical cancer that took place in Center of Oncology in Bydgoszcz between 2001-2003. MATERIALS AND METHODS: Pap Smear with prophylactic examination for breast cancer were taken in 3 medical centers. First on, according to called "mobile", was localized in the health service center, second one in the bus with the mammography, reaching distant areas and third one was performing examinations locally. Cytologic examinations were rated Bethesda system and according to Papanicolau. There were 28372 women examined (age 30-60). 8996 medical examinations were performed by "mobile" device, 6726 in the second center and 12650 locally. 8237 examinations were performed in 2001 year, 9444 in 2002, and 10691 in 2003. RESULTS: Among all the Pap Smears the results were as following: I group--14267, II group--14017, III group--73, IV group--13, V group--2.43 (0.15%)intraepithelial dysplasia was found in them CIN I--23 (0.08%), CIN II--10 (0.035%), CIN III--10 (0.35%).21 (0.1%) cervical cancers were detected, 12 of them were praeinvasive cancers. 0.31% of the all Pap Smears were abnormal. CONCLUSIONS: (1) The number of abnormal Pap Smears and severe dysplastic lesions proves the usefulness of the prophylactic physical examinations. (2) The above programme shows the that the access to oncological care for women living in rural areas, has a social aspect and should have affect the health awareness of the potential patients.

Adult↗
PubMed1999

Physical examination of the elbow.

A carefully executed, thorough physical examination of the elbow will permit reproducible results to be recorded over time. It also provides a working diagnosis or contributes to the determination of a correct diagnosis in a majority of presenting patients.

Elbow↗
PubMed1991

The reliability of physical examination in the evaluation of penetrating extremity trauma for vascular injury: results at one year.

All cases of penetrating extremity trauma (PET) seen at an urban trauma center were prospectively studied to determine the accuracy and safety of physical examination as the sole mode of evaluation for vascular injury. All patients with PET producing obvious or "hard" signs of vascular injury underwent immediate surgery. All asymptomatic proximity wounds were observed in hospital for 24 hours before discharge to outpatient followup. Patients with non-proximity wounds were discharged immediately. Patients with shotgun wounds and thoracic outlet injuries also underwent arteriography. Of 2,674 trauma patients evaluated during the 1-year study period, 310 (11.6%) had 366 penetrating extremity wounds, most (71%) occurring in the lower extremities. Gunshots caused most (82%) of the wounds, followed by stabs or lacerations (14.5%), and shotguns (3%). Clinically occult wounds in proximity to major limb vessels were the most common (78%) category of clinical presentation, followed by asymptomatic non-proximity wounds (16%), and wounds producing hard signs (6%). There were two missed vascular injuries, both in the asymptomatic proximity group (0.7% false negatives). Every patient taken immediately to surgery for hard signs had major arterial injury requiring repair, for a 100% positive predictive value for physical examination. No mortality or morbidity were related to protocol management. These results to date support prior reports of a negligible incidence of significant vascular injury following clinically occult proximity PET, and further suggest that the overall predictive value of physical examination of PET for vascular injury approaches 100%.

Adolescent↗
PubMed1987

Shortcomings of physical examination and impedance plethysmography in the diagnosis of lower extremity deep venous thrombosis.

Accuracy in the diagnosis of lower extremity deep venous thrombosis (DVT) by physical examination and impedance plethysmography (IPG) is reviewed. Physical examination proved unreliable in distinguishing patients with and without acute disease. Swelling in the leg was, however, more prevalent in patients with DVT. The sensitivity and specificity of IPG were less than those reported by other groups. Venography remains the most reliable diagnostic procedure in our institution.

Humans↗
PubMed2004

Careful physical examination is essential in the preoperative assessment of children for dental extractions under general anesthesia.

BACKGROUND: Physical examination is routinely carried out for the preoperative assessment of children, but is it of value in day stay community dental surgery? METHODS: A prospective survey of new diagnoses made on children presenting for community dental extractions and compared with children having nondental surgery. RESULTS: Five of 216 children for dental extractions were seen with new diagnoses made, with a variety of conditions including patent ductus arteriosus, aortic stenosis, ventricular septal defect and obstructive sleep apnea. No new diagnoses were made in 294 nondental children in the same period. CONCLUSIONS: Physical examination provides a useful adjunct to the history in children undergoing community dental extraction. There is potentially significant morbidity undiagnosed in apparently fit children presenting for dental surgery.

Adolescent↗
PubMed2005

Importance of physical examination in the absence of a mammographic abnormality for the detection of early-stage breast cancer.

PURPOSE: A recent trial called into question the efficacy of breast self-examination. We studied the characteristics and outcome of women in whom physical examination (PE) was their sole method of breast cancer detection. PATIENTS AND METHODS: From 1970 to 1998, 1752 women with stage I/II breast cancer underwent breast-conserving surgery and radiation. Two hundred sixty patients (15%) had abnormal PE finding as their sole method of cancer detection at the time of diagnosis, 723 (41%) had only mammographic findings, and 762 (43%) had both. RESULTS: Detection by PE was associated with younger age, larger tumor size, positive axillary nodes, and use of chemotherapy. For women < 40 years of age, PE was the sole method of detection in 40% of cases. The patients for whom PE was the sole method of detection had equivalent 10-year locoregional control and overall survival (OS) compared with patients whose cancer was detected by mammography. Detection by PE was not an independent predictor for outcome on multivariate analysis. The use of tamoxifen (P = 0.0089) was the sole predictor for improved locoregional control. Tumor stage (P = 0.0001), nodal status (P = 0.039), age (P = 0.0112) and lymphovascular invasion (P = 0.0399) were negative predictors of OS. CONCLUSION: Although associated with younger age, larger tumors, and more frequent node positivity, in this study detection by PE did not confer worse outcome. This may be because of the increased use of chemotherapy in these patients. Physical examination remains an important method of detection of breast cancer, particularly for younger women for whom mammography is less sensitive and not performed as frequently.

Adult↗
PubMed2001

Electrophysiological studies and physical examinations in entrapment neuropathy: sensory and motor functions compensation for the central nervous system in cases with peripheral nerve damage.

We performed electrophysiological studies and objective physical examinations in 60 patients with carpal tunnel syndrome and 21 patients with cubital tunnel syndrome. Compared with our normal data, the sensory nerve conduction velocity across the wrist was defined as abnormal in 97% of the carpal tunnel syndrome patients, the corresponding value of the amplitude of the sensory nerve action potential was 58% and the value of the two point discrimination test was 28% while the value of the Semmes-Weinstein monofilament test was defined as abnormal in 64% of the cases. In cubital tunnel syndrome patients, motor nerve conduction velocity across the elbow was defined as abnormal in 91%, the amplitude of the M-wave was 96%, manual muscle testing was 63% and their side pinch strength was defined as abnormal in 24% of the cases. The functions of recognition are preserved in the cases with moderate damage of peripheral nerve due to the cancellation of synaptic occlusion. Motor performance also compensated in the central nervous system. Therefore the sensitivity of the objective physical examination is less than that of electrophysiological study of peripheral nerve itself. For entrapment neuropathy electrophysiological findings are more sensitive than the objective physical examinations.

Adolescent↗
PubMed2004

Rapid screening of cardiac patients with a miniaturized hand-held ultrasound imager--comparisons with physical examination and conventional two-dimensional echocardiography.

BACKGROUND: Rapid screening of cardiac patients with a hand-held ultrasound imager (SonoHeart [SH]) could provide valuable clinical information. HYPOTHESIS: Whether the use of this device yields additional information to a carefully conducted physical examination and comparable findings to those of conventional two-dimensional echocardiography (2-D) during inpatient rounds is not well established and is the subject of this study. METHODS: In all, 100 consecutive telemetry patients underwent rapid screening with 2-D and color Doppler SH during inpatient rounds. SonoHeart findings were compared with results from conventional 2-D and physical examination conducted by an attending cardiologist. RESULTS: All patients had interpretable images. Mean scanning time with SH was 5.0 +/- 1.2 min; 2-D and SH findings were comparable. The parameters studied included chamber sizes, left ventricular (LV) systolic function, presence of LV hypertrophy (LVH), wall motion abnormalities (WMA), pericardial effusion (PE), and valvular regurgitations. Mild to moderate valvular regurgitation and LV systolic dysfunction were reliably diagnosed by SH in a number of patients whose symptoms were unrelated to the abnormalities detected. CONCLUSIONS: Rapid screening with SH provides accurate and valuable information that would otherwise be undetected during physical examination. Its introduction into clinical practice may redefine the initial approach to patients with cardiovascular disease.

Cardiovascular Diseases↗
PubMedDate not supplied

Chest pain in children: diagnosis through history and physical examination.

INTRODUCTION: Chest pain is a common complaint in the pediatric age group and can be a physically and emotionally distressing symptom. Although chest pain in children rarely indicates serious cardiac problems, chest pain is perceived as "heart pain" to most children and their families and presents a diagnostic challenge to health care providers. METHODS: A prospective study was conducted to identify specific factors in history taking and physical examination that permit accurate diagnosis of the cause of pediatric chest pain. Fifty children (ages 5-21 years; mean, 13 years), referred to the cardiology clinic with the chief complaint of chest pain, underwent systematic history taking, physical examination, and electrocardiogram testing. RESULTS: The following diagnoses were made: 38 children (76%) had musculoskeletal/costochondral chest pain, 6 children (12%) had exercise-induced asthma, 4 children (8%) had chest pain resulting from gastrointestinal causes, and 2 children (4%) had chest pain resulting from psychogenic causes. DISCUSSION: All the children in this study had noncardiac causes of their chest pain. This finding supports previous research suggesting that chest pain in children is rarely of cardiac origin. This article reviews the causes of pediatric chest pain and suggests an approach to its evaluation and management.

Adolescent↗