Understanding Physical Examinations & Medical History
Understanding the Physical Examination Process
A physical examination is a routine test where a doctor assesses your overall health. It involves several techniques and instruments to evaluate your condition and identify potential health issues.
Key Verbs and Vocabulary:
Here are some common words and their translations, useful for understanding medical discussions:
- Can: Poder (to be able to)
- Be: Ser (to be)
- Have: Tener/Haber (to have)
- With: Con (with)
- To: A, Para (to, for)
- But: Pero, Sino (but)
- Way: Manera, Como (way, how)
- When: Cuando (when)
- Which: Cual, Que (which)
- Blood: Sangre (blood)
- How: Como, De manera (how)
- May: Puede que (may, might)
- The: La, El (the)
- Then: Luego, Despues (then)
- There: Hay, Alli (there)
- Your: Su, Tu (your)
- Involve: Implica (involve)
- Such: Tanto, Como (such, as)
- Or: O (or)
- Also: Tambien (also)
- On: Como, Comparacion (on, as)
- Any: Cualquier (any)
- Pain: Dolor (pain)
- Perform: Llevar a cabo (perform)
- By: Por (by)
- Disease: Enfermedad (disease)
- An: Una (a, an)
- Of: De (of)
- Various: Diferentes (various)
- Around: Alrededor (around)
- Offer: Ofrecer (offer)
- Screening: Examen (screening)
- About: Como, Sobre (about)
- Should: Deberia (should)
- Undertake: Tomar (undertake)
- Taking: Tomar (taking)
- Drug: Medicamentos (medication)
- Asking: Pedir (asking)
- Arm: Brazos (arms)
- Leg: Pierna (leg)
- Joints: Articulacion (joints)
- Chest: Pecho (chest)
- Head: Cabeza (head)
- Neck: Cuello (neck)
- Veins: Vena (veins)
- Tongue: Lengua (tongue)
- Limbs: Extremidades (limbs)
- Inside: Adentro (inside)
- Conducted: Llevado (conducted)
- Look: Fijarse (look)
- Sample: Examen (sample)
- Spleen: Bazo (spleen)
- Kidneys: Riñones (kidneys)
- Liver: Higado (liver)
- Each: Cada (each)
- Earlier: Anteriormente (earlier)
- Height: Altura (height)
- Weight: Peso (weight)
- Make: Hacer, Formar, Tomar (make)
- Measure: Medir (measure)
- Used: Usar (used)
- Assist: Ayudar (assist)
- Fact: Hecho (fact)
- Only: Solo, Solamente (only)
- Experiencing: Experimentar (experiencing)
- Health: Salud (health)
- Good: Bueno (good)
- Always: Siempre (always)
- Ensuring: Asegurar (ensuring)
- Wrong: Malo, Equivocado (wrong)
- Appearance: Apariencia (appearance)
- Brief: Breve (brief)
- Become: Hacerse, Convertirse (become)
- Record: Registro (record)
- Body: Cuerpo (body)
- Several: Varias (several)
- Looking: Observacion (looking)
- Feelings: Sentimientos (feelings)
- Touching: Tocar (touching)
- Hands: Manos (hands)
- Allow: Permitir (allow)
- Tapping: Golpetear (tapping)
- Lungs: Pulmones (lungs)
- Heart: Corazon (heart)
- Stomach: Estomago (stomach)
- Scrapping: Raspado
Examination Techniques:
Doctors use these primary techniques during a physical exam:
- Visual Examination: Observing the patient’s appearance.
- Palpation: Feeling with hands to assess organs and tissues.
- Percussion: Tapping on the body to assess underlying structures.
- Auscultation: Listening to sounds within the body (e.g., heart, lungs) using a stethoscope.
Instruments Used:
Common instruments include:
- Thermometer
- Blood pressure cuff
- Stethoscope
- Ophthalmoscope (for eyes)
- Speculum (for various body openings)
- Otoscope (for ears)
What to Expect During a Physical Exam:
The doctor will:
- Record your medical history.
- Check your vital signs (temperature, blood pressure, pulse).
- Measure your height and weight.
- Ask about any pain (on a scale of 1-10).
- Perform a range of examinations on different parts of your body.
The Importance of Communication:
Effective communication is crucial for accurate diagnosis. Be prepared to discuss:
- Your complete medical history.
- All your symptoms, even if they seem minor.
- How your symptoms affect your daily life and work.
- The severity of your pain (on a scale of 1-10).
- When your symptoms started.
- Any medications you are taking.
Honesty with your doctor is essential, as it often forms the basis for diagnosis.
Common Questions Your Doctor May Ask:
- How long have you had the symptom(s)?
- How bad is the symptom(s)?
- Have you had the symptom(s) before?
- Are the symptoms constantly present, or do they come and go?
- How do your symptoms affect your work or home life?
Questions are based on:
- Duration
- Severity
- Location
- Causes
- Associated symptoms
- Timing
- Past medical history
- Medications
- Allergies/Adverse reactions
- Smoking, drug, and alcohol history
- Obstetrics/Pregnancies
- Screening tests
Recommendations for an Ill Person at Home:
Assess the severity of the illness. If the condition is severe, take the person to the emergency room (ER).
Preparing Your Medical History:
Consider the following:
- Current medications
- Allergies
- History of previous hospitalizations
- Illnesses
- Previous surgeries
- Relevant family medical history
During a Stressful Situation:
It’s easy to forget details. Try to remember:
- The doctor’s name.
- Any directions for follow-up or home care.
- Information about the illness or injury.
- Any prescribed medications or treatments.
Key Words:
- Breathing: Respirar
- Sick: Enfermo
- True: Real
- Illness: Enfermedad
- Little: Un poco, Menos
- Might: Puede que
- Bleeding: Sangrado
- Poisoning: Envenenamiento
- Good: Bien
- Even: Aun
- Where: Donde
- Before: Antes
- Hear: Oir