Inspection, Auscultation, Palpation, Percussion ... 4 pillars of history taking

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Physical examination is an integral part of history taking. But the more important part is taking it correctly.

The four pillars of physical examination—inspection, auscultation, palpation, and percussion—play a big role in following the correct sequence and examining a patient well. If we do it right during our clinical rotation, it is one of the best sources for understanding a patient’s examination.

Inspection:- allows for a visual assessment of the patient’s physical and mental state, which can provide valuable insights into their health.
Visualize scars, surgical marks, clothing, limping, etc.

Auscultation:- assess various systems like the circulatory, respiratory, and digestive systems.
Notice bowel sounds, heart murmurs, palpitations etc.

Percussion:- evaluating the size, consistency, and borders of organs, as well as assessing the presence or absence of fluid
Evaluate organ size, organ consistency, presence of fluid, etc.

Palpations:- assess various aspects like size, consistency, texture, tenderness, and location of organs or body parts.
Check for regular or irregular border, rough or consistent surface, etc.

:lotus:What are your take on importance of inspection, auscultation, palpation and percussion?? What other aspects we should keep in mind while doing a physical examination ?? :lotus:

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  1. Inspection
  • Importance: The first step, often underestimated, but extremely valuable.
  • What it reveals: General appearance, skin color, swelling, visible deformities, gait, posture, respiratory movements, etc.
  1. Palpation
  • Importance: Helps detect texture, tenderness, temperature, size, consistency, and mobility of underlying structures.
  • What it reveals: Lymph nodes, organomegaly, masses, tenderness, thrill, crepitus.
  1. Percussion
  • Importance: Assesses the density of underlying tissues.
  • What it reveals: Organ borders (like liver, heart), presence of fluid (e.g., pleural effusion), air (e.g., pneumothorax), or solid masses.
  1. Auscultation
  • Importance: Provides direct information about the functioning of organs—especially the heart, lungs, and abdomen.
  • What it reveals: Heart murmurs, breath sounds (wheezes, crepitations), bowel sounds.

Other things to keep in mind while doing physical examination are:

  • patient comfort and safety
  • systematic approach
  • bilateral comparison
  • integration with history
  • use of clean hands and equipment
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Yes these are four pillers as :

  1. Inspection
  • Visual examination of the patient
  • Observing:
    • Skin lesions, rashes, or discoloration
    • Abnormalities in shape, size, or symmetry
    • Posture, gait, or movement
    • Facial expressions, body language
  1. Palpation
  • Using touch to examine the patient
  • Assessing:
    • Texture, tenderness, or temperature of skin
    • Masses, lumps, or abnormalities
    • Pulses, thrills, or vibrations
    • Joint mobility, swelling, or crepitus
  1. Percussion
  • Tapping on the body to assess underlying structures
  • Used to evaluate:
    • Lung density (e.g., dullness or resonance)
    • Abdominal organs (e.g., liver or spleen size)
    • Cardiac borders or abnormalities
  1. Auscultation
  • Listening to sounds from the body
  • Assessing:
    • Heart sounds (e.g., murmurs, rhythm, or rate)
    • Lung sounds (e.g., breath sounds, wheezes, or crackles)
    • Abdominal sounds (e.g., bowel sounds or bruits)
    • Vascular sounds (e.g., bruits or thrills)

These 4 pillars are essential components of a thorough physical examination, helping healthcare professionals gather valuable information about a patient’s condition.

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