PHYSICAL ENGLISH 의사와 환자 대화

Ok Miss CSA, now I would like to do physical examination on you, for that I need to untie your gown, is that ok with you? (Yes) Thank you.

 

If the patient is resistant, then say “Miss CSA I can understand your feeling but to clearly understand the disease I have to do this examination, it won’t take more than a minute. Don’t worry I am here to assist you. I will tell you whatever I am going to do.”

 

Head and neck

Now I would like to examine you your head and neck.

Now I would like to palpate some areas. Please let me know if it hurts.

EYE : Now I need to examine your eyes. (test the visual acuity by using Snellen’s chart, visual field, corneal reflex, EOM, fundus exam)

EAR : inspect, palpate the mastoid process, otoscopic examination

NOSE : inspection, tilt the patient’s head back slightly, insert otoscope.

THROAT : I need to look into your mouth for any ulcers and dental problems. Please open your mouth. Say “Ah”.

NECK : Now I would like to check for any swollen glands, let me press on this area. Let me check your thyroid. I am going to press very gently on this area.

Facial tenderness : Now I would like to check your sinuses. I am going to press on your forehead and sinuses. Please let me know if it hurts.

Now I need to examine your jaw joint.

 

 

Respiratory system (sitting position)

Now I would like to examine your chest. Is that OK with you? (시진)

Now I would like to palpate your chest. Let me know if it hurts you.

(identify areas of tenderness, look for PMI)

Now I am going to tap on your lungs to look for any fluid or excess air.

Now I would like to listen to your lungs, can you take some quick nice breath for me? (Can you take a deep breath in and out please?)

Now I am going to listen to your lungs from your back.

Can you please say “ninety-nine” repeatedly for me? (vocal fremitus)

Can you please say “ninety-nine” repeatedly for me? (do auscultation)

Can you please whisper “ninety-nine” repeatedly for me?

 

Cardiovascular system (Always examine in 3 positions)

OK Ma CSA now I would like to examine your heart in sitting position then lying down and again in sitting position.

I need to check your pulses. (in sitting position)

; observe for carotid pulse, auscultate for carotid bruits, check for dependent edema, palpate radial, posterior tibial and dorsalis pedis)

I am going to press on your legs. (check swelling)

I need to check your heart, could you please lie down for me? I pull out the leg extension to make it a little more comfortable for you.

 ; look for JVD

Now I am going to feel your heart. (PMI)

Now I would like to listen to your heart sounds. (supine position)

Ask the patient to sit up again.

Let me open your gown. Let me cover you.

Again auscultate all 4 areas.

Ask him to lean forward and listen at the base of the heart.

 

Abdomen

Now I am going to examine your abdomen. Could you please lie down and bend your knee?

Let me help you. I going to lift your gown and lower your pan.

Now I am going to check and listen to your bowel sounds.

Now I would like to tap on your belly.

 ; percuss in all four quadrants, the liver span, check for splenic dullness

Now I would to press on your belly first lightly then deeply. Please let me know if it hurts. (look at the patient’s face not on the abdomen)

Now I am going to press on your belly, please take a deep breath and please let me know if it hurts. (Murphy’s sign)

Palpate the aorta

Palpate the spleen

Now I would like to press in and then release. Tell me which one is more painful. (only abdominal pain case)

Now I would like to give few thumps on your back. Would you sit up   please? Let me know if you feel pain.

Now turn on to the left side please. I will extend your right leg. Let me know if you feel pain. (Psoas sign)

Raise your right leg with the knee flexed. I will rotate your leg internally. Let me know if you feel pain. (Obturator sign)

Now you can sit up. Let me tie your gown.

 

Neurologic examination

 

CNE

MSE

Motor

Now I would like to check your muscle tone, please relax your muscles.

 ; Flex and extend the patient’s fingers, wrist, elbow, ankle and knee

Now I would like to check your muscle strength/power.

Can you please pull in? (elbow)

Can you please push out? (elbow)

Can you please pull up and push down? (wrist)

Can you please squeeze my finger as tightly as you can?

Can you please spread out your fingers?

Can you please touch your little finger with your thumb?

Can you please pull in? (flexion at the hips)

Can you please push out your thighs? (extension of the hip)

Can you get your thighs closer to each other? (adduction at the hips)

Can you please move out your thighs one from the other?

Can you please kick out? (quadriceps)

Can you please pull in? (hamstrings)

Can you please move your ankle up?

Can you please move your ankle down?

 

Now I would like to check the flexibility of your spine, please lean over at the waist, and try to touch your toes.

I am going to take your right leg and see how far we can raise it, keep the knee straight. Does it hurt? When? Where? Ok. Good. This time, left leg. How far will this one go? (SLR test)

 

Coordination and gait

Now I would to check your balance and movements.

Can you please strike your hand on the thigh, raise the hand, turn it over and then strike it back down as far as possible. (rapid alternating movement)

Can you please touch your nose with index finger and then my finger alternately.

Can you place your right heel on the left knee and run it down the shin to the big toe?

Can you please stand up for me and get your feet together? Close your eyes, don’t worry I will assist you if you fall.

Can you please walk few steps for me?

Can you please walk few steps for me?

; get out of the chair, walk across the room, turn and come back.

Can you please walk heel to toe in a straight line for me?

 

Reflexes

Miss CSA, now I would like to check your reflex. First let me begin with your arms, Then let me check your legs. Please relax your muscles.

Let me hold your arms. Let it go quite relaxed.

Sit in a chair so that you can swing your leg.

If the reflexes are exaggerated, test for ankle clonus.

I want you to lie down on the bed with your legs stretched out. I am going to stroke(scratch) the sole of your foot to see which way your big toe will turn. (Babinski)

 

Sensory

Now I would like to check your sensory perception in different areas of the body.

Close your eyes and say ‘yes’ each time you feel me touching with this cotton wool.

I have this sharp needle with blunt end. I want you to say sharp or dull each time you feel me touch. (touch, pain)

I am going to test you with this vibrating fork. (vibration)

I am going to press it on the ankle(wrist, elbow) bone. I want you to tell me whether you feel it vibrating and say stop when you feel it’s stopped.

I will grasp your big toe and move your toe upward and downward. Close your eyes. I want you to tell me ‘up’ or ‘down’ each time I move it.

I will place an object in your hand. Guess what it is. (stereognosis)

I will draw a number in your palm. Could you identify the number?

I will touch your finger pads in two places simultaneously and sometimes I will touch one point. Could you identify ‘one touch’ or two?

 

Special tests

Kernig sign

Brudzinski sign

Neck stiffness

Knee joint : Drawers test, McMurray’s test.

Shoulder ROM

Homan’s sign : forceful dorsiflexion of the foot will cause pain in the calf

Pulse : I am going to check the pulses in your leg. I’ll press on the blood vessels here behind the knee, behind the ankle bone, and at the top of the foot.

Now I am going to press your spine.

Now I am going to tap your back.

 

Position changes

Would you lie down? Let me help you.

Would you lie on your back?

Will you roll over your belly(abdomen)?

Would you roll over on your left side? Would you lie on your left side?

Could you please stand up for me?

 

Questions for urinary system

1.    Can you feel that you want pass urine?

2.    Can you hold when you want to pass urine?

3.    Do you ever feel that you must pass urine immediately?

4.    Do you have any difficulty in starting the flow of urine?

5.    How would you describe your urine flow?

6.    Do you have pain during urination?

7.    How does your bladder feel after you passed urine?

8.    Urine amount, color, blood

9.    Discharge form your urinary tract

10. Fever, back pain,

 

Questions for thyroid disease

1.    Do you often get constipated?

2.    Has your skin been really dry lately?

3.    Have you been losing your hair?

4.    Do cold or hot temperature ever bother you very badly?

 

Questions for psychiatric cases

FAWSIM FSH ADH Thyroid, counselor

How have you been feeling lately?

Has your appetite changed recently?

Has your weight changed recently?

Have your sleep patterns changed recently?

Have your interests changed recently?

How is your concentration(memory)?

Do you have any plans for the future?

Have you been thinking about hurting/killing yourself? Do you really have a plan to do like that?

Do you feel ever like hurting anyone? (homicide)

Do you feel safe at home? (abuse)

Do people ever tell you they think you have extremely unrealistic ideas about yourself?

Do people ever tell you they think you are hearing of seeing things that others don’t?

Thyroid questions as above

Would you like to talk things over with a counselor?