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More About This Textbook
Overview
The sixth edition of Clinical Examination continues to serve all medical trainees with a clear explanation of history taking and clinical examination. Set out systematically, this best selling textbook has comprehensive coverage of the skills necessary for clinically evaluating patients. Thoroughly evidence based and referenced, in full colour with superior artwork and design, the book comes with free and complete access to Student Consult.
• Student Consult - full online access
• full colour with superior artwork and design
• evidence-based
• Coverage of ENT and Ophthalmology
• Expanded history taking sections with new differential diagnosis tables
• More anatomy content and illustrations
• Expanded evidence based medicine references - the only physical examination trainees book with detailed references; new section on inter-observer variability and kappa values
• New material on DVD includes OSCEs, ECGs and an imaging library.
The book is written for the clinical skills subject of the medical curriculum. Medical schools teach this at varying stages, some introducing the subject in the beginning years (graduate medical schools years 1 & 2) and others at year 3 (traditional/hybrid curricula, usually 5 or 6 years). Specialty Colleges and RACP teach a clinical skills subject in the early part of basic training which takes place after PGY1 & 2.
Product Details
Related Subjects
Table of Contents
Foreword v
Preface xi
Acknowledgments xii
Clinical methods: an historical perspective xiv
The Hippocratic oath xvi
Credits xvii
Chapter 1 The general principles of history taking 1
Bedside manner and establishing rapport 1
Obtaining the history 2
Introductory questions 2
The presenting (principal) symptom 3
History of the presenting illness 3
Current symptoms
associated symptoms
current treatment and drug allergies
menstrual history
the effect of the illness
The past history 5
The social and personal history 6
Smoking
alcohol
occupation and education
overseas travel and immunization
marital status, social support and living conditions
The family history 8
Systems review 8
Skills in history taking 11
References 11
Chapter 2 Advanced history taking 13
Taking a good history 13
The differential diagnosis 13
Fundamental considerations when taking the history 14
Personal history taking 14
The sexual history
Cross-cultural history taking 16
The 'uncooperative' or 'difficult' patient and the history 16
History taking for the maintenance of good health 17
The elderly patient 18
Activities of daily living (ADL)
mental state
specific problems in the elderly
Evidence-based history taking and differential diagnosis 19
The clinical assessment 19
Concluding the interview 20
References 20
Suggested reading 21
Chapter 3 The general principles of physical examination 23
First impressions 24
Vital signs 24
Facies 25
Jaundice
cyanosis
pallor
hair
Weight, body habitus and posture 26
Hydration 27
The hands and nails 28
Temperature 28
Smell 29
Preparing the patient for examination 30
Evidence-based clinical examination 30
Inter-observer agreement (reliability) and the κ-statistic
References 32
Suggested reading 34
Chapter 4 The cardiovascular system 35
The cardiovascular history 35
Presenting symptoms
risk factors for coronary artery disease
treatment
past history
social history
Examination anatomy 45
The cardiovascular examination 47
Positioning the patient
general appearance
hands
arterial pulse
blood pressure
face
neck
praecordium
the back
abdomen
lower limbs
peripheral vascular disease
acute arterial occlusion
deep venous thrombosis
varicose veins
Correlation of physical signs and cardiovascular disease 76
Cardiac failure
chest pain
pericardial disease
systemic hypertension
pulmonary hypertension
innocent murmurs
valve diseases of the left heart
valve diseases of the right heart
cardiomyopathy
acyanotic and cyanotic congenital heart disease
'grown-up' congenital heart disease
The chest X-ray: a systematic approach 96
Frontal film
lateral film
examples of chest X-rays in cardiac diseas
Summary 102
The cardiovascular examination: a suggested method
References 104
Suggested reading 105
Chapter 5 The respiratory system 107
The respiratory history 107
Presenting symptoms
treatment
past history
occupational history
social history
family history
The respiratory examination 115
Examination anatomy
positioning the patient
general appearance
hands
face
trachea
chest
heart
abdomen
other
bedside assessment of lung function
Correlation of physical signs and respiratory disease 128
Consolidation (lobar pneumonia)
atelectasis (collapse)
pleural effusion
pneumothorax
tension pneumothorax
bronchiectasis
bronchial asthma
chronic obstructive pulmonary disease
chronic bronchitis
interstitial lung disease
tuberculosis
mediastinal
compression
carcinoma of the lung
sarcoidosis
pulmonary embolism
The chest X-ray 137
Chest X-ray checklist
Summary 141
The respiratory examination: a suggested method
References 142
Suggested reading 143
Chapter 6 The gastrointestinal system 145
The gastrointestinal history 145
Presenting symptoms
treatment
past history
social history
family history
The gastrointestinal examination 153
Examination anatomy
positioning the patient
general appearance
hands
arms
face
neck and chest
abdomen
hernias
rectal examination
proctosigmoidoscopy
other
Examination of the gastrointestinal contents 183
Faces
vomitus
Urinalysis 184
Examination of the acute abdomen 185
Correlation of physical signs and gastrointestinal disease 187
Liver disease
portal hypertension
hepatic encephalopathy
dysphagia
assessment of gastrointestinal bleeding
malabsorption
inflammatory bowel disease
The abdominal X-ray: a systematic approach 192
Radiography
bowel gas pattern
bowel dilatation
calcification
ascites
Summary 194
The gastrointestinal examination: a suggested method
References 196
Suggested reading 197
Chapter 7 The genitourinary system 199
The genitourinary history 199
Presenting symptoms
menstrual and sexual history
treatment
past history
social history
family history
The genitourinary examination 207
General appearance
hands
arms
face
neck
chest
abdominal examination
back
legs
blood pressure
fundi
The urine 212
Colour
transparency
smell
specific gravity
chemical analysis
pH
protein
glucose and ketones
blood
nitrite
the urine sediment
Male genitalia 215
Differential diagnosis of a scrotal mass
Pelvic examination 217
Summary 219
Examination of a patient with chronic kidney disease: a suggested method
References 219
Suggested reading 221
Chapter 8 The haematological system 223
The haematological history 223
Presenting symptoms
treatment
past history
social history
family history
The haematological examination 224
Examination anatomy
general appearance
hands
forearms
epitrochlear nodes
axillary nodes
face
cervical and supraclavicular nodes
bone tenderness
the abdominal examination
inguinal nodes
legs
fundi
Examination of the peripheral blood film 231
Correlation of physical signs and haematological disease 231
Anaemia
pancytopenia
acute leukaemia
chronic leukaemia
myeloproliferative disease
lymphoma
multiple myeloma
Summary 238
The haematological examination: a suggested method
References 240
Suggested reading 240
Chapter 9 The rheumatological system 241
The rheumatological history 241
Presenting symptoms
treatment history
past history
social history
family history
Examination anatomy 246
Joint structures
The rheumatological examination 247
General inspection
principles of joint examination
assessment of individual joints
Correlation of physical signs and rheumatological disease 276
Rheumatoid arthritis
seronegotive spondyloarthropathies
gouty arthritis
calcium pyrophosphate arthropathy (pseudogout)
calcium hydroxyapatite arthropathy
systemic lupus erythematosus
scleroderma (progressive systemic sclerosis)
rheumatic fever
the vasculitides
softtissue rheumatism
nerve entrapment syndromes
References 292
Suggested reading 293
Chapter 10 The endocrine system 295
The endocrine history 295
Presenting symptoms
past history
social history
family history
The endocrine examination 297
Thyroid
pituitary
adrenals
calcium metabolism
syndromes associated with short stature
hirsutism
gynaecomastia
diabetes mellitus
Paget's disease (osteitis deformans)
Summary 322
The endocrine system: a suggested method of examination
References 322
Suggested reading 322
Chapter 11 The nervous system 323
The neurological history 323
Headache and facial pain
faints and fits
dizziness
visual disturbances and deafness
disturbances of gait
disturbed sensation or weakness in the limbs
tremor and involuntary movements
speech and mental status
past health
medication history
social history
family history
The neurological examination 329
Examination anatomy
general signs
cranial nerves
head and neck
limbs and trunk
upper limbs
lower limbs
gait
speech and higher centres
cerebral hemispheres
Correlation of physical signs and neurological disease 383
Upper and lower motor neurone lesions
motor neurone disease
peripheral neuropathy
Guillain-Barré syndrome (acute inflammatory polyradiculoneuropathy)
multiple sclerosis
thickened peripheral nerves
spinal cord compression
important spinal cord syndromes
myopathy
dystrophia myotonica
myasthenia gravis
the cerebellum
Parkinson's disease
other extrapyramidal movement disorders (dyskinesia)
The unconscious patient 400
General inspection
level of consciousness
neck
head and face
upper and lower limbs
body
coma scale
Summary 403
Examining the nervous system: a suggested method
References 406
Suggested reading 407
Chapter 12 The psychiatric history and mental state examination 409
Obtaining the history 409
Introductory questions
history of the presenting illness
past history and treatment history
family history
social and personal history
The mental state examination 416
The diagnosis 416
References 422
Suggested reading 422
Chapter 13 The ears, eyes, nose and throat 423
The eyes 423
Examination anatomy
examination method
diplopia
Horner's syndrome
iritis
glaucoma
shingles
eyelid
The ears 430
Examination anatomy
examination method
The nose 433
Examination method
sinusitis
The throat 433
Examination anatomy
examination method
pharyngitis
epiglottitis
Reference 434
Chapter 14 The breasts 435
History 435
Examination 435
Inspection
palpation
evaluation of a breast lump
References 437
Chapter 15 The skin, nails, and lumps 439
The dermatological history 439
Examination anatomy 440
General principles of physical examination of the skin 441
How to approach the clinical diagnosis of a lump 442
Correlation of physical signs and skin disease 443
Pruritus
erythrosquamous eruptions
blistering eruptions
erythroderma
pustular and crusted lesions
dermal plaques
erythema nodosum
erythema multiforme
hyperpigmentation
flushing and sweating
skin tumours
The nails 451
Summary 452
The dermatological examination in internal medicine: a suggested method
References 454
Suggested reading 454
Chapter 16 A system for the infectious diseases examination 455
Pyrexia of unknown origin 455
History
examination
HIV infection and the acquired immunodeficiency syndrome (AIDS) 457
Examination
References 459
Suggested reading 460
Appendix I Writing and presenting the history and physical examination 461
Appendix II A suggested method for a rapid screening physical examination 464
Appendix III The pre-anaesthetic medical examination (PAME) 466
Index 468