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Physical examination continues... - Coggle Diagram
Physical examination continues...
GI System
Most abdominal aortic aneurysms are palpable as a pulsatile mass
however, only their lateral width can be assessed during physical examination.
The abdomen is palpated to check for weak abdominal muscles, which are common among elderly people and which may result in hernias.
The anorectal area is examined externally for fissures, hemorrhoids, and other lesions.
Female reproductive system
Regular pelvic examinations, with a Papanicolaou (Pap) test every 2 to 3 yr until age 65, are recommended.
For pelvic examination, patients who lack hip mobility may lie on their left side.
Musculoskeletal System
Joints are examined for tenderness, swelling, subluxation, crepitus, warmth, redness, and other abnormalities.
Active and passive range of joint motion should be determined.
Feet
Common age-related findings include hallux valgus, medial prominence of the 1st metatarsal head with lateral deviation and rotation of the big toe
Patients with foot problems should be referred to a podiatrist for regular evaluation and treatment.
Diagnosis and treatment of foot problems, which become common with aging, help elderly people maintain their independence.
Neurologic System
However, nonneurologic disorders that are common among elderly people may complicate this examination.
Symmetric findings unaccompanied by functional loss and other neurologic symptoms and signs may be noted in elderly patients.
Neurologic examination for elderly patients is similar to that for any adult.
Cranial nerves
Eye movements, when tracking an examiner’s finger during evaluation of visual fields, may appear jerky and irregular.
In many elderly people, sense of smell is diminished because they have fewer olfactory neurons, have had numerous upper respiratory infections
Elderly people often have small pupils; their pupillary light reflex may be sluggish
Visual and hearing deficits may result from abnormalities in the eyes and ears rather than in nerve pathways
Muscle strength
The clinician may easily straighten a patient’s elbow despite the patient’s effort to sustain a contraction.
Sarcopenia (a decrease in muscle mass) is a common age-related finding.
Elderly people, particularly those who do not do resistance training regularly, may appear weak during routine testing.
Arm function can be tested by having patients pick up an eating utensil or touch the back of their head with both hands.
Mental status
The examiner must make sure that patients can hear; hearing deficits that prevent patients from hearing and understanding questions may be mistaken for cognitive dysfunction.
Orientation may be normal in many patients with dementia or other cognitive disorders.
Patients who are disturbed by such a test should be reassured that it is routine.
With aging, information processing and memory retrieval slow but are essentially unimpaired.
A mental status examination is important.