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A physical examination provides objective cues (Muhrer, 1991 and Paley et al., 2011) which assist in narrowing and stratifying the diagnosis possibilities, with the end result being a working diagnosis on which subsequent treatment plans are based (Epstein et al., 2008 and Muhrer, 2014). A good physical examination is thought to add to the diagnostic power of the history by about 19.5% to 39% (Patel et al., 2019).
An integrated ear, nose and throat examination was deemed appropriate given the findings of history (Halthorn, 2018 and Cooper et al., 2001). The mnemonic JACCOL was used as a framework to identify non-specific signs of pathology which might need further attention and investigation (Murray and Baillon, 2013).
Vital signs are an integral component of any physical examination as they are objective indicators of the patient’s medical status, indicative of their systemic health and central to the detection of patient deterioration (Green, 2015 and Mok et al., 2015). A full set of observations was undertaken. Of note was a temperature recording of 38.0 degrees Celsius, suggestive of an infectious process (Murher, 1991). All other readings were within normal limits, so according to the sepsis risk stratification tool there was low risk for sepsis (NICE, 2018).
The examination did not reveal any stigmata of respiratory or cardiac pathology. Lucy was warm to touch, not clammy, had good skin turgor indicating good hydration. Skin inspection did not reveal a diffuse erythematous rash or viral exanthem, which could be indicative of adenoviruses or echovirus (Gottlieb et al., 2018 and Muhrer, 2019). There was no evidence of jaundice, anaemia, conjunctivitis, cyanosis or oedema (Bickley, 2013 and Innes et al. 2018). Chest examination were normal with vesicular breath sounds and no abnormal sounds, no audible cough and no history of rhinorrhoea. She had a respiratory rate of 16/min with oxygen saturations of 98% on ambient air.
Ear examination and otoscopy did not reveal any deformities, suggestive of an acute otitis media (Muhrer, 1991 and Gottlieb et al., 2018). Little et al., (2013) in a prospective clinical cohort study for predictions of suppurative complications, suggest the presence of ear ache and tonsillar inflammation as important predictors for the development of complications.
Findings from nose examination were normal: healthy looking nasal mucosa, no swelling, no hypertrophy, no rhinorrhoea or discharge, ulceration or sinus tenderness. There was no indication of either rhinitis or sinusitis