We are immersed in a world of technology—robotic surgery, genetic manipulation, molecular biology, et cetera.
Yet, my plea is simple and direct: Do not forget the basics of physical examination, for many times, they more quickly and efficiently lead to the clinical diagnosis than the newer diagnostic modalities.
An example: Jugular venous pressure
Clinicians often do not recognize the importance of jugular venous pressure (JVP) assessment.
It is NOT necessary to calculate the JVP in cm of water or mm of mercury. What is important is to determine whether the JVP is elevated or not elevated.
JVP should be assessed in every patient who has:
• Dyspnea: increased JVP suggests right heart failure of any etiology; tension pneumothorax
• Abdominal pain: increased JVP suggests acute right heart failure with hepatic congestion
• History of chest irradiation: increased JVP suggests constrictive pericarditis
• Indwelling central line: increased JVP suggests superior vena cava syndrome
• Peripheral edema: increased JVP suggests right heart failure of any etiology, constrictive pericarditis, or restrictive cardiomyopathy
• Chest pain: increased JVP suggests acute pulmonary embolism; acute myocardial infarction complicated by right ventricular infarction, rupture of the free wall of the heart, or rupture of the ventricular septum; or dissection of the aorta complicated by pericardial tamponade
• Ascites: increased JVP suggests constrictive pericarditis or right heart failure of any etiology
Our guest blogger, Dr. Morton A. Diamond (AKA, The Professor), is Professor and Medical Director of the physician assistant program at Nova Southeastern University in Fort Lauderdale, Florida. He is the author of the F.A. Davis title, Davis’s PA Exam Review: Focused Review for the PANCE and PANRE, and also of Medical Insights: From Classroom To Patient, a Jones & Bartlett publication. He has written tens of thousands of test items over his career and was a leading item writer for the National Commission on Certification of Physician Assistants. He also has forgotten more words than you and I have ever known and enjoys stumping his publisher with them as often as possible.