Anatomical Basis of Physical Examination

Surface Anatomy & General Principles - Body Blueprint Basics

• Core Idea: Relate surface features (bony points, muscles) to deep structures. Vital for diagnosis.
• Anatomical Position: Standard reference: erect, eyes forward, palms anterior, thumbs lateral.
• Fundamental Planes:
  • Sagittal: Divides body into left/right. Median plane is central.
  • Coronal (Frontal): Divides body into anterior/posterior.
  • Transverse (Axial): Divides body into superior/inferior.
• Key Directional Terms: Superior/Inferior, Anterior/Posterior, Medial/Lateral, Proximal/Distal, Superficial/Deep.
• Examination Pathway:

> ⭐ The Sternal Angle (Angle of Louis), at **T4/T5** vertebral level, is a key landmark for the **2nd** rib, aortic arch, and tracheal bifurcation.

Head, Neck & Neurological Examination - Cranial Command Central

• Head: Inspect scalp, face. Palpate sinuses, TMJ, salivary.
• Neck: Inspect JVP (30-45°), masses. Palpate nodes, thyroid, trachea. Carotid bruits.
• Cranial Nerves (CN):
  • I: Smell. II: Vision, fundus. III,IV,VI: EOM, pupils. V: Facial sensation, mastication.
  • VII: Facial muscles, taste. VIII: Hearing (Rinne, Weber). IX,X: Gag, palate. XI: Trapezius, SCM. XII: Tongue movement.

⭐ Bell's Palsy (CN VII LMN): ipsilateral full face paralysis (incl. forehead). UMN spares forehead. 📌 Oh Oh Oh To Touch And Feel Very Good Velvet, Ah Heaven! (CN mnemonic)

Thoracic & Cardiovascular Examination - Heart & Lung Listening Posts

Heart Sounds (Auscultatory Areas): 📌 Mnemonic: "All Physicians Take Money"

• Aortic: 2nd R ICS, parasternal
• Pulmonic: 2nd L ICS, parasternal
• Erb's Point: 3rd L ICS (S1, S2 equal)
• Tricuspid: 4th L ICS, parasternal
• Mitral (Apex): 5th L ICS, MCL

Lung Sounds (Auscultatory Areas):

• Apices: Supraclavicular
• Anterior: 2nd-4th ICS
• R Middle Lobe/Lingula: 4th-6th ICS ant./axillary
• Posterior (Lower Lobes): Triangle of auscultation (T3-T10)

⭐ Erb's point (3rd L ICS) is crucial for assessing aortic regurgitation murmurs (early diastolic).

Abdominal & Pelvic Examination - Gut Instincts & Organ Maps

• Sequence: Inspection → Auscultation → Percussion → Palpation (IAPP).
• Inspection: Shape, distension (📌 5Fs: Fat, Fluid, Flatus, Feces, Fetus), scars, pulsations, peristalsis.
• Auscultation: Bowel sounds (normal: 5-30/min); vascular bruits (renal, aortic, iliac).
• Percussion: Tympany (gas), dullness (fluid/organ); shifting dullness (ascites); liver span (6-12 cm MCL); Traube's space.
• Palpation:
  • Light: Tenderness, guarding.
  • Deep: Organomegaly (liver, spleen, kidneys), masses, rebound tenderness.
  • Signs: Murphy's (cholecystitis), McBurney's (appendicitis), Rovsing's.
• Pelvic: PR/PV for tone, masses, tenderness (prostate/cervix).

⭐ Courvoisier's Law: Jaundice + palpable, non-tender gallbladder suggests malignancy (e.g., pancreatic cancer), not gallstones.

Musculoskeletal & Peripheral Vascular Examination - Motion & Flow Check

• MSK Exam:
  • Look: Deformity (Scoliosis, Lordosis), Swelling, Wasting, Gait abnormalities.
  • Feel: Temperature, Tenderness (Joint line, Bony), Crepitus, Swelling characteristics.
  • Move: Active & Passive ROM. Muscle Power (MRC 0-5). Key tests: Lachman (ACL), McMurray (Meniscus).
• PVS Exam:
  • Look: Skin color (Pallor, Rubor), Trophic changes (Hair loss, Ulcers), Varicose veins.
  • Feel: Temperature, Peripheral pulses (Rate, Volume, Character), CRT (<2s), Edema. Allen's test.
  • Listen: Arterial bruits.
  • Tests: ABI (Normal 0.9-1.3), Buerger's test (Peripheral arterial insufficiency).

⭐ Radio-femoral delay is a key sign in Coarctation of Aorta.

High‑Yield Points - ⚡ Biggest Takeaways

• Surface anatomy is fundamental for accurate palpation and auscultation of internal structures.
• Dermatomal patterns are essential for localizing spinal cord or nerve root lesions.
• Referred pain mechanisms (e.g., diaphragmatic irritation to shoulder) involve shared central pathways.
• Understanding lymphatic drainage pathways is crucial for evaluating metastatic spread or infections.
• Palpation of arterial pulse points (e.g., carotid, femoral) assesses circulatory status.
• Percussion sounds (resonant, dull, tympanic) depend directly on the density of underlying tissues.
• Auscultation areas for heart sounds are determined by sound projection, not direct valve anatomy.