d. Cardiovascular System. The heart is listened to with a stethoscope to
measure the rate, character, and regularity of the heartbeat, as well as to detect any
abnormal sounds. Status of the heart and blood vessels is determined by indirectly
measuring blood pressure and by directly measuring central venous or arterial pressure.
Circulation and pulses in various parts of the body, especially the extremities, may be
checked. By looking at blood vessels in the retina with an ophthalmoscope, the physician
can infer the condition of the blood vessels in the rest of the body.
e. Respiratory System. The respiratory system is evaluated for respiratory rate,
adequacy of ventilation and gas exchange membranes, clear lung fields, and symmetry of
the chest. The physician can learn a lot about the chest and estimate the size and location
of the heart and lungs by auscultation (listening) and by percussion (tapping and
thumping). Arterial blood may be drawn to be analyzed for blood gases.
f. Gastrointestinal (GI) System. The GI tract is examined for intactness of
mucosal membranes, adequacy of digestive process, and regular elimination of solids.
Because portions of the digestive tract cannot be seen directly, X-ray procedures, such as
a GI series, or gallbladder series are often ordered. Feces may also be examined for the
presence of blood or pathogens. The physician may explore the rectum with a gloved
finger. The patient is often in the Sims' position for this examination.
g. Neurologic System. The neurologic examination evaluates normal reflexes,
adequate motor and sensory innervation, development of intellectual and psychological
processes. It may consist of assessing the patient's orientation to time and place,
assessing sensation by stimulating various parts of the body, and assessing the patient's
sense of balance or ability to control body movements. A percussion hammer is used to
test reflexes in various parts of the body. In addition, the pupils are checked with a
flashlight for reflex. The pupils should quickly contract when a bright light is shined into the
eye. The pupils should be round, regular, and of equal size. This is reported as PERRLA
(pupils equal, round and reactive to light and accommodation). Accommodation is
adjustment, especially of the eye, to variation in distance.
h. Genitourinary System. Genitourinary evaluation is to determine adequacy of
urinary control and elimination, patency of membranes and passages, and appropriate
development of reproductive organs. A vaginal or pelvic examination is done to discover
any signs of irritation, growths, displacement, or other abnormal conditions in the pelvic
organs or external genitalia. A rectal examination is usually included in the physical
examination of a man over 35 years old. This exam aids in discovering cancer of the
rectum or prostate gland while it is still in an early stage.
i. Endocrine System. The physician may palpate (use hands and fingers to
examine) the sex glands and the thyroid gland to determine size and detect any growths.
The adequacy of hormonal activity is assessed by observing certain characteristics of
body function, growth, and development.