MODULE FOR BASIC PRINCIPLES AND PHYSICAL

DIAGNOSIS IN PEDIATRICS (MD 204)

MODULE 2: BASIC PHYSICAL EXAMINATION MANEUVERS

AILYN T. ISAIS-AGDEPPA, MD, DPPS

Faculty, College of Medicine
College of Medicine Bldg., University of Northern Philippines
Vigan City, 2700 Philippines
Telefax: (077) 722-2810
E-mail: cmed_aisais-agdeppa@unp.edu.ph
URL: https://unp.edu.ph
 MODULE 2 : BASIC PHYSICAL EXAMINATION
MANEUVERS

OBJECTIVES:
At the end of module 2, the student should be able to:

1. Discuss and demonstrate the basic physical examination maneuvers.

a. Inspection
b. Palpation
c. Percussion
d. Auscultation

2. Explain the importance of using the proper techniques in basic physical examination for
patient diagnosis and management.

THE BASIC PHYSICAL EXAMINATION MANEUVERS

Physical examination is the process of evaluating objective anatomic findings through the use of
observation, palpation, percussion, and auscultation. The information obtained must be
thoughtfully integrated with the patient's history and pathophysiology. The physical examination,
thoughtfully performed, should yield 20% of the data necessary for patient diagnosis and
management.

The sequence of the 4 basic physical examination maneuvers vary depending on the organ
system being examined.

INSPECTION
Observation and inspection are fundamental to any clinical examination. General observations
begin at the first point of contact with any patient and continue throughout the clinical encounter,
even while just observing the child on caregiver’s lap, the patient playing inside the clinic or
speaking to you. Inspection is more goal-directed and it is limited to what one can observe
visually while examining specific body parts like skin, eyes or ears, sometimes with the help of a
specialized equipment. It is the most repeated of the four physical examination methods

Inspect each body system using vision, smell, and hearing to assess normal conditions and
deviations. Assess for color, size, location, movement, texture, symmetry, odors, and sounds as
you assess each body system.

Is the patient active? Comfortable? Unusually sleepy? Frail looking? Well-kempt?

Does the patient has unusual skin color? Skin lesions? Unusual body movement?
Does the patient has any peculiar smell? Fruity scent? Maple syrup smelling urine?
PERCUSSION

Percussion includes tapping one’s hands on a patient’s body to produce sound vibrations. It is
done to determine:
 The size, consistency, and borders of body organs
 The presence or absence of fluid or gas in body areas

Percussion of a body part produces a sound, like playing a drum. The sound is a sign of the type
of tissue within the body part or organ.
 Lungs sound hollow on percussion because they are filled with air.
 Bones, joints, and solid organs such as the liver sound solid.
 The abdomen sounds like a hollow organ filled with air, fluid, or solids.

Here are a few at-home percussion practice ideas for you to try:
Percuss two glasses—one filled with water, the other empty. Compare the sounds.
Percuss a wooden door and listen for the difference when you percuss a concrete wall.
Percuss your thigh. Puff your cheeks and percuss them. Compare the sounds.

Types of
percussion Direct
percussion
This technique reveals tenderness; it's commonly used to assess an adult's sinuses.

o ▪ Using one or two fingers, tap directly on the body part.

o ▪ Ask the patient to tell you which areas are painful, and watch his face for signs of
discomfort.

Indirect percussion (ADAPTED FROM BATE’S GUIDE TO PHYSICAL EXAMINATION

AND HISTORY TAKING)
BASIC PERCUSSION TECHNIQUE:
https://youtu.be/P4Ryk5IKf_4

Percussion Notes
With your plexor or tapping finger, use the lightest percussion that produces a clear note. A thick
chest wall requires heavier percussion than a thin one.

When comparing two areas, use the same percussion technique in both areas. Percuss or strike
twice in each location. It is easier to detect differences in percussion notes by comparing one area
with another than by striking repetitively in one place.

Learn to identify five percussion notes. You can practice four of them on yourself. These notes
differ in their basic qualities of sound: intensity, pitch, and duration. Train your ear to distinguish
these differences by concentrating on one quality at a time as you percuss first in one location,
then in another. Review the table below.

PERCUSSION NOTES:
https://youtu.be/FvqiDcIlvjk

PALPATION
Palpation is a method of feeling with the fingers or hands during a physical examination. This is
to examine the size, consistency, texture, location, and tenderness of an organ or body part.

Palpation requires you to touch the patient with different parts of your hands, using varying
degrees of pressure. Since you will be touching the patient, keep your fingernails short and your
hands warm. Wear gloves when palpating mucous membranes or areas in contact with body
fluids. Palpate tender areas last.

Types of
palpation Light
palpation

▪ Use this technique to feel for surface abnormalities.

 ▪ Depress the skin ½ to ¾ inch (about 1 to 2 cm) with your finger pads, using the lightest
touch possible.
▪ Assess for texture, tenderness, temperature, moisture, elasticity, pulsations, and masses.

Deep palpation
▪ Use this technique to feel internal organs and masses for size, shape, tenderness, symmetry,
and mobility.
▪ Depress the skin 1½ to 2 inches (about 4 to 5 cm) with firm, deep pressure.
▪ Use one hand on top of the other to exert firmer pressure, if needed.
AUSCULTATION
Auscultation is done using a stethoscope. The chest and abdomen are the areas commonly
auscultated and the sound is evaluated as to:
 Frequency
 Intensity
 Duration
 Number
 Quality

Getting ready
▪ Provide a quiet environment.
▪ Make sure the area to be auscultated is exposed (a gown or bed linens can interfere with
sounds.)
▪ Warm the stethoscope head in your hand.
▪ Close your eyes to help focus your attention.
How to auscultate
▪ Use the diaphragm to pick up high-pitched sounds, such as first (S1) and second (S2) heart
sounds. Hold the diaphragm firmly against the patient's skin, using enough pressure to leave
a slight ring on the skin afterward.
▪ Use the bell to pick up low-pitched sounds, such as third (S3) and fourth (S4) heart sounds.
Hold the bell lightly against the patient's skin, just hard enough to form a seal. Holding the
bell too firmly causes the skin to act as a diaphragm, obliterating low-pitched sounds.
▪ Listen to and try to identify the characteristics of one sound at a time.
SAMPLE AUSCULTATION SOUNDS:
https://youtu.be/2NvBk61ngDY
https://depts.washington.edu/physdx/heart/demo.html
END OF MODULE CHALLENGE:

INSPECTION

USING YOUR INSPECTION SKILLS, DESCRIBE VIVIDLY AND OBJECTIVELY IN

10 SENTENCES THE ABOVE PICTURE.
1.
2.
3.
4.
5.
6.
7.
8.
10.
USING YOUR INSPECTION SKILLS, GIVE 10 CLINICAL SIGNS FOUND ON
THIS PATIENT. 1.
2.
3.
4.
5.
6.
7.
8.
10.

PERCUSSION
IDENTIFY THE UNDERLYING STRUCTURES IN THE FOLLOWING NUMBERS AND
DESCRIBE THE PERCUSSION SOUND YOU WILL ELICIT IN THE FOLLOWING AREAS:
1.
2.
3.
4.
5.
6.
7.

AUSCULTATION
IDENTIFY THE AREAS OF AUSCULTATION IN A

CARDIOVASCULAR EXAM? IDENTIFY 3 NORMAL LUNG

SOUNDS

ENUMERATE AT LEAST 3 ADVENTITIOUS LUNG SOUNDS

PALPATION
Using a deep palpation technique, identify the liver edge of an adult household/family member,
and describe how many centimeters below the right costal margin of your adult subject/patient.
COMPOSE A MAXIMUM 2-MINUTE (30 SECONDS PER ITEM) VIDEO OF YOURSELF
(HALF BODY THEN ZOOM TO YOUR HAND PERFORMING PERCUSSION
TECHNIQUES AS DESCRIBED IN THIS MODULE. USE PROPER POSITION OF HANDS
AND FINGERS. ELICIT THE BASIC PERCUSSION NOTES BY PERCUSSING ITEMS
FOUND IN YOUR HOMES LIKE THE TABLE, ETC. A DISTINCT PERCUSSION SOUND
SHOULD BE HEARD IN YOUR VIDEO.

1. FLAT
2. DULL
3. RESONANT
4. TYMPANITIC

GIVE 5 KEYPOINTS THAT YOU HAVE LEARNED FROM THIS MODULE:

REFERENCES
1. Bickley, L., Szilagyi, P., Hoffman, R., & Soriano, R. Bates' guide to physical
examination and history taking.
2. LexisNexis UK. (1990). Clinical Methods: The History, Physical, and Laboratory
Examinations. 3rd edition (3rd ed.).
3. Mayer, B. (2007). Health assessment made incredibly visual. Lippincott Williams
& Wilkins.
4. https://blog.goreact.com/2019/05/22/physical-examination-methods-training-
students/
5. https://youtu.be/P4Ryk5IKf_4
6. https://youtu.be/FvqiDcIlvjk
7. https://youtu.be/2NvBk61ngDY
8. https://depts.washington.edu/physdx/heart/demo.html