Essay On Physical Examination
3. The physical examination
The physical examination starts with observation of the patient’s demeanour and gait as he walks into the clinic. Some physical signs, e.g. tremor, are obvious even before any formal physical examination is carried out. In some cases evidence of cognitive impairment, dysphasia, dysphonia or dysarthria is obvious from the patient’s speech while he is reporting his symptoms.
A full neurological examination is time-consuming and may make the patient tired or irritable and uncooperative. The examination should therefore be tailored to the condition of the individual patient and the clinical circumstances. However, in all cases a brief assessment of the patient’s cognitive function, and examination
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In this method the examiner compares the patient’s visual fields with his own fields. (The confrontation method assumes that the examiner’s visual fields are normal). Each eye is tested separately. The test is carried out with the patient sitting opposite to the examiner and continuously looking into one of the examiner’s eyes while covering the other eye. The examiner moves an object (usually a hat pin) in front of the patient’s eye and maps out the visual field by asking the patient to tell him as soon as he sees the object. The object is moved methodically from different directions in order to examine the whole visual field. The visual fields can also be measured with manual or computer controlled perimetry – a method in which the patient’s visual field is plotted as a bright object is moved on a screen from the periphery into the visual field.
Examination of the optic fundus may reveal evidence of optic atrophy, papilloedema or other pathology. Optic atrophy is characterised by a very pale, small optic disc with well-defined margins. The retinal vessels usually appear normal. In the early stages of papilloedema the margins of the optic disc are blurred, the physiological cup is full, and the retinal veins are engorged and non-pulsatile. Later there are also extensive retinal
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