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The
clinical
examination
involves
the
study
of:
Vital
signs
including
height,
weight,
body
temperature,
blood
pressure,
pulse,
respiration
rate,
and
hemoglobin
oxygen
saturation
General
appearance
of
the
patient
and
specific
indicators
of
disease
(nutritional
status,
presence
of
jaundice,
pallor
or
clubbing)
Skin
Head,
eye,
ear,
nose,
and
throat
(HEENT)
Cardiovascular
(heart
and
blood
vessels)
Respiratory
(large
airways
and
lungs)
Abdomen
and
rectum
Genitalia
(and
pregnancy
if
the
patient
is
or
could
be
pregnant)
Musculoskeletal
(including
spine
and
extremities)
Neurological
(consciousness,
awareness,
brain,
vision,
cranial
nerves,
spinal
cord
and
peripheral
nerves)
Psychiatric
(orientation,
mental
state,
evidence
of
abnormal
perception
or
thought).
It
is
to
likely
focus
on
areas
of
interest
highlighted
in
the
medical
history
and
may
not
include
everything
listed
above.
The
treatment
plan
may
include
ordering
additional
medical
laboratory
tests
and
medical
imaging
studies,
starting
therapy,
referral
to
a
specialist,
or
watchful
observation.
Follow-up
may
be
advised.
Depending
upon
the
health
insurance
plan
and
the
managed
care
system,
various
forms
of
"utilization
review",
such
as
prior
authorization
of
tests,
may
place
barriers
on
accessing
expensive
services.
The
medical
decision-making
(MDM)
process
involves
analysis
and
synthesis
of
all
the
above
data
to
come
up
with
a
list
of
possible
diagnoses
(the
differential
diagnoses),
along
with
an
idea
of
what
needs
to
be
done
to
obtain
a
definitive
diagnosis
that
would
explain
the
patient's
problem.
On
subsequent
visits,
the
process
may
be
repeated
in
an
abbreviated
manner
to
obtain
any
new
history,
symptoms,
physical
findings,
and
lab
or
imaging
results
or
specialist
consultations.
Institutions
Color
fresco
of
an
ancient
hospital
setting
The
Hospital
of
Santa
Maria
della
Scala,
fresco
by
Domenico
di
Bartolo,
1441–1442
Contemporary
medicine
is
in
general
conducted
within
health
care
systems.
Legal,
credentialing
and
financing
frameworks
are
established
by
individual
governments,
augmented
on
occasion
by
international
organizations,
such
as
churches.
The
characteristics
of
any
given
health
care
system
have
significant
impact
on
the
way
medical
care
is
provided.
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