[The elderly patient].

Many elderly have mild physical disorders. It is difficult to differentiate between the physiological symptoms of ageing and disorders in the elderly patient. Many disorders present as non-specific signs or symptoms in the elderly.

[Meningeal irritation].

Diagnosing meningitis requires the information from both history-taking and physical examination in its entirety. In adults with a history that makes meningitis a possibility, specific tests used to diagnose meningeal irritation, such as for Kernig or Brudzinski signs or nuchal rigidity, probably do not affect the reliability of the diagnosis. In small children and the elderly, Kernig and Brudzinski signs are also probably of little or no diagnostic value.

[Physical examination of the knee after trauma].

The practice guideline 'Traumatic knee complaints' from the Dutch College of General Practitioners is aimed at differentiating between intra-articular and extra-articular lesions. The diagnosis is based mainly on a combination of patient history and a limited physical examination of the knee. Specific tests for hydrarthrosis, injuries to the collateral or cruciate ligaments, and meniscal pathology have only a low diagnostic accuracy.

[Examination of the shoulder].

Examination of the active and passive range of motion of the shoulder joint is of major importance when diagnosing shoulder disorders. Abduction and external exorotation movements of the shoulder joint can be judged reliably. Limitations in the range of abduction indicate subacromial pathology and limitations in the range of external exorotation indicate glenohumeral pathology.

[Physical examination of patients with acute abdominal pain].

Reliable physical examination of patients presenting with acute abdominal pain and tenderness is necessary for identifying serious causes on the one hand, and for preventing further unnecessary imaging on the other. If acute appendicitis or peritonitis is suspected, positive palpatory findings like rigidity and guarding are helpful diagnostic indicators, whereas negative palpatory findings have little value in excluding these conditions. Physical examination is of limited predictive value in diagnosing cholecystitis.

[Auscultation of the abdomen].

Normal bowel sounds vary considerably in intensity, pitch and frequency. Due to the wide range of physiological variation, the clinical significance of abdominal bowel sounds is limited. There is no clear evidence that very high-pitched bowel sounds have clinical pertinence.

[Physical examination of the lungs in suspected pneumonia].

Physical examination of the lungs is easy to perform, but the interobserver agreement is poor due to lack of standardisation in the findings. The use of an electronic stethoscope with computerised analysis of the lung sounds might improve diagnostic accuracy. General signs such as fever and an accelerated respiratory and pulse rate increase the probability of a pneumonia.

[Examining the lymph nodes].

Enlarged lymph nodes occur frequently and imply a benign or systematic disorder. In primary care, only 1% of patients with an unexplained lymphadenopathy have a malignancy. In the case of unexplained lymphadenopathy the most important diagnostic dilemma is whether biopsy should be applied.

[Physical examination of the heart].

Although almost every doctor daily carries out physical examination of the heart, there is little reliable research into the value of the conclusions. Inspection and palpation of the apex beat and percussion of the left heart border are important in diagnosing enlargement of the heart. If the dullness falls within the mid-clavicular line, cardiac enlargement is almost certainly excluded.

[Physical diagnostic examination of dehydration].

Dehydration is an important cause of morbidity and mortality for children and the elderly. Acute loss of weight is the most reliable measure of dehydration. In addition, a range of physical diagnostic findings are used for measuring dehydration; separate clinical findings have very little predictive value.