A. GENERAL EXAMINATION/VITAL SIGNS(一般检查)1. Introduce yourself to patient,usually last name and title and havea little conversation to relax the patient and to judge mental state.2. Wash hands before start ing exam in ati onPreferably, this should be done in view of the patie nt.3. Patie nt is seated in a chair4. Palpate radial (wrist) Pulses for at least 30 sec onds and recordThe exam iner places the pad of his in dex, middle and ring fin gers over theradial artery. If properly done, the examiner should be able to feel theartery pulsating under the examiner s fingertips. The radial pulse maybe measured for 30 sec on ds, the n the pulse perm inute can be found bymultipl ying by two. Atte ntio nshould also be paid tothe rhythm. Theexam iner should not use his thumb to palpate any pulse.5. Palpate both radial (wrist) pulses simultaneously for symmetry for at least 30 sec onds6. Measure respiratory rate for 30 sec onds and recordThe examiner unobtrusivelymeasures patient s re spiratory rate. This maybe accomplished by the examiner leaving his hands on the patient s wristsfor another 30 seconds after measuring the radial pulses so the patientdoes not realize that the exam iner is watch ing him breathe. The depth andrhythm should also be noticed. The respiratory rate can also be measured dur ing the back exam.7. Measure blood pressure on right armBlood pressure may be measured with the patie nt in a sitt ing or lyingpositi on. In each positi on, the artery in which the blood pressure is tobe measured should be at the level of the heart (at the level of the fourth in tercostal space in the sitt ing positi on; at the level of the middleaxillary line in the lying position). The patient s arm should be resting on a smooth table or supported by the examiner, and slightly flexed at the elbow.8. Place cuff in correct locati on 2-3 cm above the atecubital creaseThe exam iner secures the blood pressure cuff snu gly over the upper, armso that one fin ger can be admitted un der the cuff. The cuff should bepositi oned 23 cm above the an tecubital crease or elbow joint. Put themiddle of the cuff over the brachial artery.9. Palpate brachial arteryThe exam in er can locate the brachial artery which lies slightly medial tothe tendon of the biceps muscle in the antecubitalfossa. The mercury columnon the mano meter dial should be properly calibrated with the poin ter at“0” before the cuff is inflated (i. e. , all the air should be pressedout of the cuff before it is in flated).The stethoscope is placed firmly over the brachial artery. The exam inersin flates the cuff slowly but steadily. Un til the brachial artery pulsedisappears. Then he continues to inflate cuff 2.64.0kPa (20 30 mmHghigher, gen erally to about 21.3kPa (160mmHg).10. Measure blood pressure over brachial artery twice and record thelower read ingDeflate the cuff slowly at the rate of about 0.26kPa (2mmHg) Per sec ond.The number where the examiner hears the first pulse sound is the systolicpressure. The pulse sound will waken and then disappear. The number wherethe pulse sound disappears is the diastolic pressure. If the differe neebetwee n weake ning of the sound and its disappeara nee is 2.6kPa (20mmHg)or greater, the exam iner should record these two nu mbers. The cuff mustbe completely emptied with the pointer at“0” before it is reinflated.The same procedure may be followed for a sec ond measureme nt of B. P. i nthe same or opposite arm. The lower pressure is recorded as the patient s blood pressure. After finishing the measurement, the examiner deflates and rolls up the cuff, lea ns the mano meter over a little so the mercury colu mndisappears, closes the mercury colu mn switch, puts the ballo on in order,and closes the mano meter.B. HEAD AND NECK(头颈部)Skull11. Palpate and observe scalp (parting hair, and observing hair density, color, lustre and distributio n)The examiner palpates the entire skull using both hands and simultaneouslyexam ines symmetrical areas. The exam iner parts the hair to observe thescalp, noting any scali ness, deformities, lumps, ten der ness, lesi ons orscars. The examiner also observes the density,color, lustre anddistribution of the hair.Eyes12. Visual screening:(omitted )13.Observe corn ea, sclera, conjun ctiva and lacrimal pun cta by gen tlymoving lower eyelids dow n.Cornea Exam in ati on-With oblique lighti ng in spect the cornea for opacities, foreign bodies etc. Inspect lower palpebral, fornical, bulbar conjunctivaand sclera. Ask the patie nt to look up as you depress lower eyelid withyour thumb expos ing lower palpebral, forni cal, bulbar conjun ctiva andsclera.Inspect the conjunctivaand sclera for color, and note the vascularpatter n aga inst the white scleral backgro und.Lacrimal sac exam in ati on by digital compressi on for n asolacrimal ductobstructi on-Ask