A general physical exam would involve the inspection and palpation of the eyes, ears, nose, and throat. As you already know, you will be required to have several special instruments in order to carry out the examination correctly, as well as certain techniques to access the sensory functions. To get you started, we have briefly compiled the important things to check so you can get a better diagnosis of your patient.
Examination of the Eye
To inspect the eyes, you can start with getting the patient to do a series of facial expression such as squinting and moving the eyebrows symmetrically. Make note of any scaling or lesions present in the eye area. Ensure that the eyelids are able to meet together, and measure the palpebral fissure, which is the space between the open lids. Check the upper lid for droopiness. The eyelashes should be evenly distributed. Look at the eyes in general and try to identify if they may be protruding or sunken. The colours of the conjunctiva and sclera should also be noted. Assess for any drainage, swelling, redness, and asymmetry in front of the eyes. Do not forget the pupillary response.
Examination of the Ear
For the ears, you will need to assess the hearing as well as their appearance. It is recommended that you use an otoscope like the one that comes in the Heine Mini 3000 diagnostic set. But firstly, make sure that the ears are equal in size and the skin intact. The ears should be of the same colour as the face. You need to also move the pinna and push on the tragus. You need to check for any tenderness, and if there are any lesions, swelling, and drainage. To check the eardrum, use the otoscope. Try to identify any redness, swelling, discharge, or foreign bodies. The eardrum itself should be translucent with a pearly grey colour, and have a flat and intact structure. Leave the hearing test to be performed at the audiology department.
Examination of the Nose
A full nose examination will assess the function and airway resistance, which may be done by looking into the mouth and pharynx. Also look up the nostrils for lesions, swelling, symmetry, and discharge. Ensure that there is no inflammation and offensive smell. You need to also look at the nose externally by checking the symmetric or midline, as well as nasal patency. If needed, check the palpate sinuses below the eyebrows and cheekbones. In some cases, you may even need to check the patient’s sense of smell.
Examination of the Throat
This involve the thorough examination of the oral cavity. You may start with finding out whether the patient has a history of tobacco or alcohol use, and dental work. Then proceed with examining the mouth and the condition of the tongue. Do not neglect the hard palate, the buccal area, and the space between the cheek and gums. Also check the tonsils by pressing down the tongue with a depressor. You can use a mirror to examine the nasopharynx and larynx.
This is not a comprehensive list of steps and techniques to diagnose your patient. It is merely care guide to help give you a general sense. You will need to go back to your textbooks or refer to your mentor if you wish to get the start to finish information on conducting a thorough physical examination.