Head-to-Toe Checkup: Why Does My Doctor Do That?

Ever ponder the purpose of all that poking, peeking and prodding that goes on during a physical exam? UR Medicine Primary Care’s Dr. Carla Schwartz explains what doctors are checking for as they look you over, from head to toe.

• I see it in your eyes. It may sound cliché but your eyes really can be a window to what’s going on inside you. We check your eyes for color; redness can be a sign of eye infection, while yellowing may signal liver problems. We shine a light into your eye to test the eye’s reflexes. The light should make the pupil get smaller. If it doesn’t, it may alert us to a problem along the signal pathway from your eye to your brain and back again, which we’d want to investigate further.
• Can you hear me now? We use a device called an otoscope to look into your ears, checking for signs of infection of the outer ear canal or of the inner portion of the ear. It’s also a convenient time to remind you not to put Q-tips into your ears—it just pushes the wax in further!
• Say ahhhh! Your mouth tells a story, too. Like the back of your throat—it looks one way when you’re healthy, another way if you have a bacterial infection such as strep throat, and yet another when there’s a viral infection like hand, foot and mouth disease. Your tongue gives clues as to how well hydrated you are. And because oral cancer can develop anywhere in the mouth, we also check your mouth and tongue for any abnormal growths.
• Your nose knows. A peek up your nose gives us a chance to sniff out problems like nasal polyps (swellings in the lining of the nose) or inflammation.

• It’s neck and neck. There are a couple reasons we feel your neck: we check your lymph nodes and your thyroid. Feeling your neck and under your ears is a way to see if your lymph nodes (often referred to as glands) are enlarged. It’s normal for them to increase in size when your body is fighting an infection. By feeling the front of your neck and asking you to swallow, we can check your thyroid gland for any enlargement or abnormal bumps.
• Listen to the beat. With a stethoscope, we listen to your heart on the front of your chest, often in different places, because the heart sounds different from different angles. We check the pattern of your heart beat and the sound of blood flowing through your heart, noting any extra sounds such as murmurs.
• Take a deep breath. We use our stethoscope to listen to your lungs in different places on your chest and back, checking for things like infection or fluid in the lungs, or wheezing, which is caused by an abnormal tightness the tubes that bring air into the lungs (called bronchi). Your lungs are divided into different sections, called lobes, and it is important to listen to each lobe to get the full picture.
• Ready to rumble? That stethoscope comes in handy again, as we listen to your stomach to learn how fast or slow your intestines are moving. This can provide useful clues if you are having stomach pain.
• Press on. Pressing on your stomach is the next best thing to x-ray vision when it comes to checking internal organs like your liver and spleen to make sure they are of normal size. And since certain gastrointestinal problems can cause pain in characteristic locations, we press down on specific parts of your abdomen, checking for pain.
• It’s hammer time. We check your reflexes by tapping on your knee with a reflex hammer. When we tap your knee, we are causing a stretch of your  tendon and the muscle attached to it, which causes a reflexive contraction of your quadriceps muscle that makes your leg kick out. This automatic response requires your nerves, spinal cord, and muscles to be working normally. 
• Get a leg up. We check your legs and feet to look for swelling. People with heart or liver disease may have fluid back-up in their legs, but it can also be a sign of infection or blood clots. We also check the pulses in your feet and look for any skin problems.  If you have diabetes, it’s especially important to make sure your feet are in good shape—no cuts, ulcers or rashes. We may also check for nerve damage by testing how well you can feel your feet being touched.

This gives you an overview of some check-up basics, but your personal exam should be tailored to your individual circumstances and needs.

And while a physical exam is important to your health, open and honest conversation with your provider is always an important part to your care.

Carla R. Schwartz, M.D., specializes in internal medicine and pediatrics, caring for people of all ages at UR Medicine Primary Care's Calkins Creek Family Medicine.