Medicine ClinicalThe Physical Exam: Reading the Body Like a Detective
Medi stands in a bright exam room holding a stethoscope, leaning forward attentively to listen to a patient's back while pointing to a labeled diagram of the four exam techniques on a whiteboard behind her.
- Identify the four techniques of the physical exam — inspection, auscultation, palpation, and percussion — and state what each detects.
- Explain the difference between a sign (what the clinician observes) and a symptom (what the patient reports).
- Compare findings from different exam techniques to explain how combining them builds stronger evidence for a diagnosis.
- Predict which exam technique a clinician would use first for a given body system.
- Identify at least one specific finding from each technique and name the condition it may suggest.
Key terms
- Inspection
- Looking carefully at the body for visible findings before touching.
- Auscultation
- Listening to internal sounds with a stethoscope, such as the heart or lungs.
- Palpation
- Pressing and feeling the body to detect tenderness, organs, or stiffness.
- Percussion
- Tapping the body and judging whether the returning sound is hollow or dull.
- Sign
- An objective finding a trained observer can see, hear, feel, or tap.
Four Ways to Collect Body Data
The physical exam uses four core techniques, each gathering a different kind of evidence. Inspection looks for visible clues like rashes or swelling. Auscultation listens for internal sounds such as heart murmurs or lung crackles. Palpation presses to feel tenderness, stiffness, or enlarged organs. Percussion taps the body and reads whether the sound is resonant or dull, revealing whether a space holds air or fluid.
Reading the Sounds
Auscultation and percussion each carry meaning. A harsh whooshing murmur signals turbulent blood flow that can point to a valve problem, while crackles suggest fluid in the air sacs. On percussion, healthy air-filled lung sounds resonant and hollow, whereas fluid or solid tissue sounds dull and flat. A drum-like tympanic note is normal over the gas-filled stomach but a warning when heard over the lung.
Combining Findings Into Evidence
No single finding proves a diagnosis. Clinicians cluster the data: a visibly swollen ankle that feels warm and tender, paired with the patient's reported pain, together point toward inflammation or infection. Signs are objective findings any trained observer can detect, while a symptom is the patient's own report. Combining several techniques builds stronger, more complete evidence than any one method alone.
Worked examples
Decide which exam technique produced a crackling lung sound.
- Identify how the finding was gathered: it was heard through a stethoscope.
- Match listening through a stethoscope to its technique, which is auscultation.
- Interpret the meaning: crackles suggest fluid in the air sacs of the lung.
Answer: Auscultation produced the crackling sound, hinting at fluid in the lungs.
Activity
Drag each clinical finding into the correct exam technique that produced it.
Practice
Decide which technique reveals a dull thud when tapping over chest fluid.
Explain why combining auscultation and percussion gives stronger evidence than either alone.
Common mistakes to avoid
- One exam technique is enoughEach technique detects different physical properties, so combining them builds far more complete evidence.
- A patient's report is a signA patient's report is a symptom; a sign must be something the clinician can observe or measure directly.
Check your understanding
A clinician presses on a patient's abdomen and the patient winces in pain. The patient also says 'it has hurt since this morning.' Which part of this scenario is a SIGN?
A student suggests skipping auscultation and just tapping (percussing) the chest to check for fluid in the lungs. Why is using BOTH techniques better than either alone?
When examining the abdomen, clinicians listen BEFORE they press. What is the main reason for this order?
Recap
The physical exam gathers data through inspection, auscultation, palpation, and percussion, each detecting a different physical property. Findings the clinician observes are signs, the patient's reports are symptoms, and clustering several findings together turns scattered observations into structured evidence that no single technique could provide alone.
Reflect
Why might a clinician trust a finding more when two different techniques both point to it?